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coMMONWEALTH OF PENNSVl,vANIA. DEPARTMENT OF HBAI.TH . VITAl. RECORDS
CERTIFICATE OF DEATH
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IU;NIJNctATION
In RC a~tate of ____~!}',(~~~!':I:~~U(1-~":Ii,'~~.J \^ .!,.~-~~ \' P R It
cumborl ulId
To the Regl~ler of Will' of ~l/!!l\l1 CO\II\ty,l'enn~Ylvanla,
1I1',\',f,111.1CI
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decea~ed '
___.....of
The undersigned __..,_..Illll<'.r",,::"-,l.,- iU~Tl~L.i'!'!J;!! t:..<.'!',----------.~----~----
the above neeedent, hereby renouncc(s) the right to administer the e~tate and respectfnlly ask(sHhat Letters .- 'l'oHtl\mentAfY--
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nOlores A. Rl\lD (SI~nalllre)
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Newv] 11e PA (Addr,") 17241
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IltPARIMENI Of REVENUE
DEPT 2110601
A PA 111 I
OfCEDEtffS NMlE (lASt, fiRSt, MOl,IlDDlE l!illlAL) 11M . bin bIlXk Q MIl.... WOl~'
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REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
0/17/101r)
L1H~ RETURN MUST BE FLED IN llUPllCATE WITH THE
REGISTER OF WILLS
---
[ZIl, Original R.lum 0 2. Supplomenlal R.lum 0 3 Rom,'nd.r R.lumld.."....""'.Il.IHlI
o Ulmlled E.lat. 0 4a Fulur. Inlllr..tGompromls. """""", 11 IlO1l 0 5 Fed.ral E.tal. Ta> R.tum Required
o 6, Oeco<I.ntOIOd T.,tal.l,,",h"ll""'OI 0 7. Oocod.nl M,lntalnod a living TrusIIM~h"ll"I1,",11 _.8 Tolal Number of Sal. Deposit Bo,..
o 9.lltlgallon Proceeds RO<>llved 010, Spousal povarty Gredlli...".........." 11.""1,,,. ,,1,"1 011. EloctIon 10 tax undarSoo 9113(A) l_h5<hOI
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAK INFORMATION SHOULD BE DIRECTED TO:
NN.4E COMllLETE 1MJ1INO ADDRESS -
12. Ne' Velueol Eltate (lIn. 8 mlnu. lIn.ll)
13, Gharilabkland Gov.mmonlal Bequ.slSlSoc 9\13 Trusts for whlch.n .Iectlon to ta, has nol be.n
med.(Sellodule JI
14, NetV.lue Subject to Tl. (lIn.12 minus lln.131
15, Amountoflln.141a,.ble
.t tho spousal tax ral. , I
See Il\Slructions on r.v.fS4l s~.'or applicable percenlago
18, Amounl of IIn.14 taxab.
,t6%ral. "
17 Amount of Iln.14 taxable
'115'. ralll
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(If ,awUCA8lEl 8URIJIIJ\NOSIWSE'S NMtE (lASI. FIRST, ANOMIOatE INITIAL)
FUNUII8I1R
2 <) 7
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Gall\' IT. ~'1i.n(10r I f~fKl.
fiRM NAME (lf~ebIe)
TELEF1lQNlNUMBER
'111 S32 - ')47G
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1. R.al Eslat. (Sell.dule AI
2. SIDCIts and Bonds (Selledu. B)
3, Closo~ H.~ Co"",rallon,P.rin."hlp or Sole.Proprloto"hlp
4, Morigogos & Notos RO<>llvable (Sch.dule 01
5, Gash, Bank Deposits & M~llanoous Porsonal P'u;-rty
(SelleduIeE)
8, JolnUy <N/nad Property (Schedulo ,)
7. lnlorNlvos Transf." & M~II.noou. Non.Probalo Property
(Selledule G or II
8. Total Oro.. A..elt (Iolal Uno. 1.71
9, Fun.ral E'pel\S05 & AdmlnlstraUv. Costs (Sell.dule HI
10, Debb of Dece<lont, Morigago L1ablliti.., & liens (Sch.dule I)
11, Total Doductlonl (Illtal llnos 9 & 101
"
OAn:OflilfWt
1 / 1 n /1 'I 'I
SOCIAl. StCUUI1V N~ill:fl
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18. To Out
19,
7n1 f:,l>1t l\'i no ,:tmr,t
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(10) 4 0 ') . 5 0
(111
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13,107.91
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(12)
(131
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(14)
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x ,0
(IS)
x ,08
(16)
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(181
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X ,15
(,,411-01
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Uodef penaltieS of pl(jury, t oeclw!tllt I hlWl pamjned !tIi. relulfl, Including ~yiog IGheduleS and .UMmentt,.xi \0 lhe bMt 01 my ~e and OOlf8f, ills true, oonfClllf1d cornpI/I\I), Declaration of prepMet' Othel
bnJlt oorsonal r.0tM8ntaliwa is Nsed on an Infolmalioo of Ylhich MIMe! has IIW knovrledOl
SIGN~ll,JRE OF PERSON RESPONSlB~,FOR F,ll!NG RETURN ADORESS 200 r.'t. roc~oi1(l,
(~(V( l.~\ X \.-,(,tLl1(( t1cwvl11o 11\ 172/1]
SIGNAT E If, REPARERpT~ERTHANRE2' ENTATlVE ADDRESS 701 r'~ Eino Strod
f tf \, .J l,l) (..y~ .-..~_ :~h:ippf'nHbur(l Pl\ 172~17
D:T}/3r)~-
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Decedent'. Com lete Addre..:
STREEHDOAASS 24 Mt: Hock POilc1
CITV-'
liP 17241
Newvi ] Ie
llx Plyments Ind Credit.:
1. Tax Due (Page 1 Line 181
2, Credits/Payments
A, Spousal Poveny Credit
8, Prior Payments
C, Discount
(1) . 6.413.01
Total Credits (A' 8' C) (2)
305. 38
3, InteresVPenalty If applicable
0, Interest
e, Penalty
5,
TotallnteresVPenalty (D' e) (3)
If line 21s grealer than line 1 . line 3, enter the difference, This Is the OVeRPAYMeNT.
ChICk box on pagt1 Llnt1G to requttta rtfund (4)
If line 1 . line 31s greater than tine 2, enterthe difference. This Is tha TAX DUe, (5)
A, Enter the Interest on the tax due, (5A)
8, Enter the total 01 Line 5 . 5A, This Is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLeAse ANsweR THE FOLLOWING QUeSTIONS
BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1, Old decedent make a transfer and: Ye~
a, retain the uae or Income of the property transferrad; """""""""""""""""""",,,,,,,,,,,,,,,,,,,,,0
b, rataln the right to dealgnate who shall use the proparty transfarred 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 yeer of death without
receiving adequste consideration? . ,,,'''' "" "" """" "",," """""."" "" ,"',"" ,,,,,,,,.,,,, ''''','','' ,," "",,0
3. Old decedent own en "In trust for" or payable upon death bank eccount or security
at his or her deeth? """"""",,,,,,,,,,,,,,,,,,,,..,,.,,,....,''''''''''''',,. """",,,,,,,,,,,,,,,.,,,,,,,,,,,,,,,',"''',,.,,'''' 0
4, Old decedent own en Indivlduel retirement accoun\, annuity. or other non.probate property?"" 0
h,107.G3
(,,107.(,3
4,
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72 P ,So g9118 (a) (1,1) (I) provldad for the reduction of the tax rate Imposed on the net value of transfers to or for the use of the
turvlvlng Ipouse from 6% to 3% for datel of death on or after July 1, 1994 and before January 1, 1995,
72 P,S, g9118 (a) (1,1) (II) provided for the reduction of the rate Imposed on the net vetue of transfers to or for the use of the lurvlvlng
apoule from 3% to 0% for dltel of death on or after January 1, 1995, The Itatule ~s not exemot a transfer to a lurvlvlng spouse
from tax, and the statutory requirements for disclosure of a888ts and filing a tax return are stili applicable even If the surviving spoule
lathe only beneficiary,
FOR DATES OF DeATH ON OR AFTeR JANUARY 1, 1995. Please answer the following <;uestlon by placing an 'x' In the
appropriate IpSce,
Old the decedent creete I trult ~Imllar arrangement which la solely for the aUNlvlng apoule's benefit for his or her entire
lifetime? Yee 0 No J!..l.
If you anlwered yes to the above question, the tax on the trust or similar arrangement Is postponed until the death of the second
lpoule, at which time It will be fully taxable at the rata(s) applicable to the remainder beneficlery(les), Enter the value of the trust on
Schedule J, Part II, In order to remove It from the calculation of tha tax due In this estate. You mey wish to file Schedule 0 In order to
make the election available under Section 9113, If tha election Is made, the trust or similar arrangement II taxed In the eatate of the
first decedent spouse, the portion of the trust or slmller arrangement which benefits the surviving spouse Is ta~ed et tt.e zero tex rate,
end the remainder Is te~ed at the rete(s) applicable to the remainder beneficlary(les), If you choose to meke the election, you must
attach Schedule 0 to a timely-flied ta~ return, along with Schedule(s) K end/or M In order to show the epportlonment of the trust or
Ilmllar arrangement between the surviving spou~e end the remainder beneficlery(les),
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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!0.fI1:J'!l!~~_~~!.l.!!1, S l' A!'1 EN!
T, MARY C. 1 1111I 111\ L](I, of tho 1Iorollgh of NewvUle, Cllmherlund County,
Pennsylvania, declare thin to he my l.UHt Will und 'I'estament and revoke any
wilt or codidl previoll"ly mndc hy mo,
TTF,M T: T direct thnt all IllY .IIIHt "ehts IInd funeral expenses, including
my gravenwrker and all eXpeO"eH "f my laHt il1nean, ahall he paid from my
restc1unry eotate aR Anon lIA prnr.tj(,llhlo [Ifter illY c1er.ellRO aA [\ pnrt of the
administration of my estate.
TTEM Tl: T devlHe and heqlleath the residllo of my estate of every nature
and wherever sitllateln eqlllll aharcs to 811eh of my chlldren, DOl.ORES A. REID,
EDt:AI\ s. II I': 11 EI\1. HI and .lACK (:, IlEIIERLI(I. "" flhnll Bllrvive 1110 hy thirt.y (30)
dllYs.
ITEM TIT: Shollld any of nlY chlldr",., DOLORES A. REID, EDGAR S. I\EBERLIG
IInrl .lACK C. HEllERI. 10, pred"ceaAe 1110 or die on or hd or" the th h'tieth day
following my dellth hilt: leavlnr, IA""" who so Hllrvive me, AIICh isslle shall
receive, per stirpes, tho Ahnre thnt ""ch pre"e"oaAed ohi1d wOllld have
received had he or Aho AO slIrvlved me.
TTEM IV: T uppolnt: hlH or reApective parent or gllardian, r,\Iardian of
any property whioh pUAsen olltrlght olther lindeI' thIs will or otherwise to a
lIIi nor ancl wi th rcspec t to wh I rh 1 IIlII lI\lthori?od to appoint a guard Jan ancl
have not otherwise spcdflcally done so, provldecl that Ihi9 appointment of a
Allnl'dtnn Ahal1 not Htlper~.wcl(' the rlHhl" of nny riduc"lnry -In "It.s d1Acretion to
d1Htrihutc H Hhllfe where pOiit-ilhle to tl1f' ndnor or to 1l1lot:her for the mlnor'a
henefH. Such guarcl I an shall hllvP the 1'0"01' to use prindpal as well as
Inco1ll0 fr01ll t:imo to lime for lh,' mlnM'n SlIpp\lrl and edu('atJon (inclucling
secondary. co] 1 ('gc l~dllCill: 1011, both gl'ild\l/lt l~ Ilnd t1IHlorArnrlIlAte., professional.
DECEDENT CONFIRMATION
NAME OF DECEDENT:
MARY C. IIEBERLlG
SOCIAL SECURITY NUMBER: 204.01.1863
DATE OF DEATH (DOD):
November 18, 1997
ACCOUllt No. IIP737 9000044 7100869
Type: _checkinll _--1RA Vacation olub
Date Opeoed
or I1sued: 1/20/64 7/6/82 5/9/97
Date Closed
or Matured:
Date or Deatb
Balance: 5,998.45 2,122.55 80.00
-
PLUS
Date or Deatb
Accrued loterest: -0- 2.83 1.09
Joint Ownen
(Iflny)
Date or Jolot
Owoenblp
Special Comments:
All accounts are in Mrs. Heberlig's name alone.
--
Date Prepared: 12/1')'97
Prepared By: Carolyn H. Kough.
Institution Name: The Farmers National Bank of Newville
Address:
P. O. Box 156, Newvill.e, PA 17241
Pbone Number: 717-776-5312
The following are all certificatea of depoait -
-#30010707 dated 5/24/99 $ 7,000.00 with 172.64 accrued intares t
-05009438 7/12/95 5,000.00 107.09 "
...#30010579 3/26/97 4,000.00 131.63 "
-030011020 10/22/97 5,000.00 18.48 "
-#5009914 2/15/96 2,000.00 85.37 "
-'30010937 9/6/97 5,000.00 50.20 "
_#30011053 1l/7/97 5,000.00 7.49 "
-030011055 11/7/97 10,000.00 14.99 "
-040010155 7/13/96 5,000.00 89.28 "
- 0 3001 0920 10/20/97 10,000.00 39.71 "
- 0 3001 0609 2/10/97 5,000.00 195.29 "
_030010524 3/4/97 4,000.00 17.61 "
-1130010453 1/17/97 4,000.00 169.64 "
- 1/30010921 10/20/97 6,000.00 23.83 "
-030010640 4/11/97 5 ,000 . 00 153.37 "
-030011061 11/14/97 3,000.OU 1.63 "
-U40010113 6/16/96 5,000.00 108.88 "
-030010811 7/11/97 5,000.00 89.79 "
_ *30010468 1/31/97 2,000.00 80.91 . "
040010091 6/4/96 7,000.00 161. 99 "
"'4'..'11'" ,,-...
\ SCHEDULE J _.1
BENEFICIARIES
--_.ml_,w.~~'-~=='~~ -.. ,
----.. ,- - ~_. PILI NUMBlR
~-
~J~~~
"/..:-tfll.
CfI.UIO".IIAll"tJlttIIIUtlltlollll
.Ulll'II.,lfCllU'lIu.~
'UIOIUlllHI~,1i1
r-
ISlAU Of
Mary c. IlFm:ru,m 21 ,. 97 - 0960
.--......... ,-...----.---. --,.~ ,...,
111M lOAM! AND ADllRiU OF D!NIPICIARY RELATIONSHIP AMOgNf OR
NUM.'R SHARI f ISTAU
---- ---_..--
A, T..obl. aequo",'
I Edgar S. Heberlig
200 MI. Rock Road, Newville I'A 17241 Son One- Third ( 1/3)
2. Delores A Reid
24 MI. Rock Road, Newville I'A 1724\ Daughter One-Thit'd ( \ /3)
3, Jack C Heberlig
\804 Pollard Terrace, Vienna VA 22079 Son One- Third (1/3)
~
InM
NUMBER
NAM! AND ADDRESS 0' BlNIPlCIARY
AMOUNT OR
SHAR! O' ISfAlIi
.. Cho,ltoblt ond Oo..,nmlnlol hqlltll1l
1.
'I
.1
d
TOTAL CH"~IfAeLI AND GOVERNMENTAL HQUrs'S IA"o '.'" on Ii.. 13, R.,opllUloUonl S
-
-tir;;;;;;;;;',';- ~;.~d.~..J:-i;;:;j;idiii;;;;r~i;;;i, .f, .an,,-.ht}
COMMONWIALTH OF PINNSYLVANIA
DIPARTMINT OF RIVINUI
,
(~
/s.,)11 J
BUREAU Of INOIVIDUAL TAXES
IHtlfRIUHCJ: UK 1I1IJISlUH
Of.pt, ~MbOI
liARRISBUMO, flA 11llll-0601
NOTICE or INHERITANCE TAM
APP~AISEHENT, ALLOWANCE O~ DISALLOWANCE
. or DEDUCTIONS AND ASSESSHENl Of 'tAX
DATI
ISTATI OF
DATI OF DIATH
FILl NUMBIR
COUNTY
ACN
04-27-98
HEBERLlO
11-18-97
21 97-0960
CUMBERLAND
101
SALLY J WINDER ESQ
701 EKING ST
SHIPPENSBURG PA 17257
'*
H~'IU' II." tlt.tll
MARY
C
1....."._."'" .. .........~...._. '---J
AMount R..l~t.d
"=~="..===~,,:--~---,:==
_.~_.~"-_._......---.--_..._._--,._.-_.~-
I CHANOED
U I --JllL
121 ' 00
131 ,00
141 ,00
151_119,991, 36
161 ' 00
171 .00
ISI
APPROVID DIDUCTIONS AND IXIMPTIONSI
~. Funaral EKpan.../Aa.. COltl/Hl.c. Expen... (Sch.dule H)
10, Debt./Hortgege Llebllltle./Llen. ISchedule I)
II, Totel Deduction.
12. Nat Umlue of T.~ Return
15. Charitable/Govern",."tel eequ..tIJ Non~.l.ct.d !JUS r,'ulh (Schedule J)
14, Net Value of E.tete Subject to h.
12,698.41
409,50
III )
U21
USI
(4)
191
UOI
Ufil
1161._
(7)
.00 X ,00,
106.883,45 X ,06.
,00 X ,15.
USI
MAKI CHICK PAYABLE AND RIMIT PAY MINT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LIN!! .. RITAIN LOWIR PORTION FOR YOUR A!COnDS ....
il"'lV: iS47 - EX'" AFii - iiIF;;"I - MOTi liE" "OF. i"NHEil"ii' ANCi - TAX - 'A"PPRAi iE'Hiiir; -At l"owAiici" cili" - -"""" n". - - - - -"
DISALLOWANCI OF DEDUCTIONS AND ASSISSMINT OF TAX
IITATI OF HEBERLlG MARY C FILl NO. 21 97-0960 ACN 101 DATI 04-27-9B
If .n ......M.nt w.. ia.u.d pr.viou.ly, lin.. 14, 15 .nd/or 16, 17 .nd 18 will
rafl.ct figur.. th.t includ. the tot.l of abk r.turn. .......d to d.t..
ASSESSMINT OF TAXI
IS. AMount of line 14 at Spou..l r.t.
16. A~ount of Lina 14 t.~.bl. .t lin..l/Cla.. A rat.
17. AMount of Lina 14 t.~.bl. at Collat.ral/CI... I r.t.
la. PrincipII TaM Due
TAX CREDITS I
PAYHENT
DATE
02-06-98
TAX ~ETURN WAS I (X I ACCEPTED AS FILED
RISIRVATION CONCIRNING FUTURE INTER 1ST . SIE RIVERSI
APPRAISED VALUE OF RETURN BASID ONI ORIGINAL RETURN
I. Reel E.tete (Schedule AI
2. Stockl and Bondi eSchedul1 8)
5. Clos.ly Uald stock/Partnership lnt.r..t (Schedule CJ
4. Hartllgal/Hot.. Rlcllyabla eSchedul1 OJ
S. C..h/8Ink a.politl/Hlle, Parlonal Property (Schedull EJ
6. Jointly Owned Property (Schedull Fl
7. Tr.n.f~r. eSchedull OJ
e. Total A,..t,
NOTlI
~ECEIPT
NUHBER
AA269728
DISCOUNT 1'1
INTEREST/PEN PAID 1-)
320,65
AHOUNT PAID
6,107,63
TOTAL TAX CREDIT
-~--~-_.
BALANCI OF TAX DUI
INTIRIST AND PIN.
TOTAL DUI
NOTE I To insure proper
oradit to your agoount,
sub. it the UPP." portion
of this for. with your
t.~ pIY"'lnt.
119.991,36
ll.1D7 Ql
106.883,45
,00
106,883,45
,00
6,413,01
.00
6.413,01
6,428,28
15,27CR
,00
15,27CR
. Ir PAID ArTER DATE INDICATED, SEE REVERSE
FOR CALCULATION or ADDITIONAL INTE~EST,
IF TDTAL DUE IS LESS THAN .1. NO PAYHENT IS REQUIRED,
If TOTAL DUE IS REfLECTED AS A "CREDIT" (CRI. YOU HAY BE DUE
A RErUND. SEE ~EVERSE SIDE Of THIS rO~H fOR INST~UCTIONS,)
~~ ~ iiP~
cr,
~i , ~ to ~?
I'"j
IIV ,.\
,
I, ~
C'J :9
" /1"
:u /, N jjj
I:l 0
:P .-:':~ -..
l>.
RESEAV,.UONI E.ht~.of decedentl dying on Of blfor. OICI." iZ, 198t -- if an" fuhlr. lllt.r..t In thl ..tit. I, t"m,f'tt.d
In pOII,ulon or enjoy..,nt t~ chIS I (oolllttr.ll b..,.flcl.rt., of the dt41edlnt aft.r th, IMPlr.Uon of IInV ..tat. for
Uf. or ~or y..r., thl COllllonw..lth het,by ll<pr...1V r...ry.. th_ right to IPpralu Ind II..... trlnsf.r l"h,rUI"ClI 'IMI'
.t the llwful Cl,.. . (ooll"t.t.ll tata on any .ueh future Int.r..t.
PUIlI'O'E Of
NOlleE I
PAYMEHTl
REFUND (eA) I
OBJECTIONSl
ADMI"
ISTRAflYE
CORRECT IONS I
DISCOUNT I
peNAL lY I
I"IUEIl I
To fulfiU the r.qulrllllnt. of S.otlon Z14n of the InherHancI lI:nd E.tat. falC Aot, Act 21 of 1995, (n P,S.
S.ot Ion 9140).
D.tach thll top portion of ttlll NfltiU and tubait wUh your Ply..nt to thl Rlllhhlr of Willi prlntldon thl rl"lr.. .Id_.
'.Heke chick or MonlV ordlr pftVflble tOI REGISTER OF HILLS, AGENT
A r.fund of 5 tSK credit. ~hJch we. not requ.,t.d on thl YaK Rlturn, ..v b. rlqul.t.d by co.pletlng fin "Appllc.tlon
far Rlfund of Pann.vl"anlft Inherltancl and E.tflte fflw" (AEY~ll1.U. APplication. flrl av.Uabll at thlOfflol
of the RIghter of Willi, any of thl 23 A'VlnUI Dhtrtct Officu, or bv celllng thl flPlelal 24-hour
fln.w.rln, .lrvlcl nu.olr. for for., ordlrlngl In Plnn.vl"anla l-100-}6Z-Z050, out. Ide Plnn,vlv.~la find
within 10011 Harrhburg Itll 1117) 117~a09tl, rDDII 1111l 111-Z252 Ollarlng IMPllred OnlY),
Any p.rty In Intlrut not ..thflld with thl apprlttl.lnt, litle-wane. or dlnUowtnol of d'ductlon., or .........,t
of bw (lnllludlng al.count or Int.rlllt) .. .hown on thl. Notle. MU.t objlct within .Iwty (60) dlV' of rlollpt of
thlt HolloI bYl
uwrltt.n protut to thl PA D.pllIrt..nt of A.".nu., Board of Appul., Dlllpt. 281OZI, Herrl.burg, PA
--.l.ctlon to hlv, thl ..tter d.terMlnld at lIudlt of th. Iccount of thl ".r.onll rlpr...ntatl",.,
.-app.al to the Orphan,' Court.
111Z1"1021,
OR
DR
f.ctuII Irror. dl.oo".r.d on thl. ........nt .hould b. .ddr....d In wrltln. tOI PA n'Plrt..nt of A.".nu.,
Bur..u of lndlvldu.1 TaM", ATTNI Po.t A.......nt R.~t.w Unit, D.pt. l8060l, H.rrltburg, PA 171ll-0601
Phon. (1111 111-6505. S.. p... 5 of the boola.t "In.truttlon. for Inhflrlhncl Tlw Return for, R..ld.nt
O"".ntl' (REY-150t) for IIn .wplan.Uon of edlllnlttrIlU",'tv corr.ctabl. .rror..
If InV t.w due It p,ld ~1thln three (5) c.l.ndar .onth. .fter the dlc.dlnt', d..th, . "",. plrc.nt (SiD dltcount of
the tllC p.td " aUowld.
Tilt 15% tllC .......ty non-plrUclp.Uon p.nlUy I. CDttPuttd on thl totll of thl t.1t end tnt.re.t .......d, and not
p.ld b.forl January I.. 1996, thfl; flr.t dllY Ifter tha and of the tlK &llnuh perloci. mh non-p.rUclp.Uon
p,n,ltv I. app..llbll In thft .... .enner and In the the .... tl.. p.rlod I' you would ,~p'81 th. taK and lnt.r..t
th.t hI' b..n .......d II Indlclt.~ on thlt nottc..
Inter..t It charg.d b.glnnln. with Hr.t d.y of d.lInqu.ncv, or nln. (91 .onth. Ind on. III dly frol the dati of
d..th, to th. data of ptva.nt. TIK" which blc..a d.llnquant b.for. Januarv I, 1'12 b.ar Int.rl.t tt the rat. of
.IM (6X) p.rcant plr 'nnuI c.lculat.d .t . dally rlt. of .000164. All t'ICI. which b.ce.. delinquent on Mnd If tar
JlnY.ry 1, 1912 w111 b..r Int.r..t at a ratl wMch will Vlry fro. cal.ndlr Yllr to c.l.ndlr yur ~Ith that rlta
IMOl,InCI.d by th. PA D.part,.nt of R.".nu., Thlappllcable Int.r..t ratu for 1982 through I". ar'l
'!!!r Int.r..t R.t. OaUy Int.rut Factor !!!r Int.rl" AI!.!! 0.11'11 Intlrut F.otor
1911 20X ,00054a 19.7 9% .OQOZ47
1m 16:< .00045a l'a'~1991 11% ,000101
191. 11;': .000101 1992 9% ,000247
19ti 1]1: .00OSS6 1'91-1994 7% .GOOI92
191' 101: ,OOOZ74 1"5~1998 ,% ,000241
~~Int.r..t I. oaloulltad .. follow'l
INTEREST . IALANCE OF TAX UNPAID X NUHIER OF DAYS OELINQUENT X DAILY INTEREST FACTOR
.'AnY "otic. I..uld aft.r the t.w b.oo... d.ilnqu.nt will r.fllct ~n Int.r..' calcul.tlon to flft..n <15) dav.
b.yond tha date of the ........nt. If Plvl.ntl. ..d. Ift.r the lnt.r..t COMPut.tlon d.t. shown on the
HattOl. .ddltlonal Intlr..t IUft b. ulcuht.d.
t,
81'M'US Hf,I'OWr .UNIJEHJ{ljI,.E: 6, 12
~_'__~__"'_._"_"_" ..._ __ _.< ... '____ "~_'~"." ___"_".__L"".n._..____
Date of
Oee.d,,' ,/fJJ,r"~
Del\t.hl~..~~JJ~'J~ .
CJ-k1xr(.Li& ~..~--_._"-----,---
1'1 -;
Adm 1 n, No, _.';fJ...::.57 -:QJ.(..,(j
'Name 0 f
Will No,
._..~~...._--~-~._-------- ""'
PUrllllant t.o Hul n (;, I? 0 f II\(! Suprnmo Court Orphans'
court Rules, I n'l[lrnt. tho 'ollnw.lnq wIt.h respect to completiondl:
t.he admlnist.r'atlulI of 1.11,. ahovn-cllpllonod ofltiltel
1, Stat.e whntllol' IHlminlOl.raliun of the est.at.e is complete 1
Yes .'/J. Nu
2, 1 f tll'> anfiWtlr is No, statn wllon t.he persona]
representative reaBollabl y I"d leves that ttlP admInistratIon will be
compiete 1______ ...-...-... ....
), If the answer to No, I is Yes, state the followingl
a, Did tho perBonal representative file a final
account. with t.he COllI'U Yr',; No.. X.
b, '\'h" 'Wl'ill,'}t" oll'hilf\!;' (""11'1. No, (I t (lny) for
tht-'t personal rf.~prPHc'ntat ivp!H aCT,ll\lllt is:
c, Did th,' p,,,sunal IP\"'(,s,'nl.ative st.ate all
alCcount. informally 10 t.lln 1',11'\ ins ]11 int,!!,.;;!? Yes"X.__ No
d, Copins of recnip!.R, releaRBS, joinders and
approvals of formal or tn(ormal accounts may be filed with the
Cark of the Orphans' Cou~t and may be attached t.o t.his report,
0".'-1+- s~, JW,b__~_
~~/(\;t ..J_W.j~JJ_L__....___
Name V'lpilsB type or" print.)
{oj E. f!{',~,) q.lmSA iJ>il.t.," ~b~M. '\ 114
AddrosR -aU 0
(7/7L_< 3) 'NLb \ 7d~ 7
Ilip \. N(), _..___________~_M
-, ...,'
f '\ < ~,
Carat: i t Y I PenlOUill Hep/:esentatl VB
....l'...counsel for personal
repUlBBntat i VB
(MAH I rmf/ AM3)