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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
COMMONWEAlTH Of PrHNflVlVANIA
utMklMENT of RrVENUf
DEP\ 'J80(oOl
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21. If line 18 is greater lhan Liro 1Q, onler tilt! dlllorfH1cO on \.ino 21 Thi\ i\ Iho TAX DUE, (211
A. Enler Iho inlerest on Ihfl bnlol\(f1 due on linll 21 A (II A)
B. Enler ,he tOlClI of line 21 unci 2\A on line liB, Yhil 1\ Ihe BALANCE DUE, (218\
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(AHClCh copy of WillI (All(lch wpy 01 Trust)
ALLcoiiRiSPONDINCiAND'CON.iDENTIALfAXTN'OiiMATION-SH'OULiiiED-IR'ECfEDTOi-'--"- ,.----------
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20. If Una lq i\ grealer Innn Une 18, enler thu ~ilforen(u on line 20, This i~ tho OVERPAYMENT,
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1, Rflol E st!lle lSchedule A\ 1 \ 1
2, Stocks ond Bonds ISchedolfl Bl ( 2 \
3. Closely Hold SIc)ck/Porlnershlp Interesl (S(hoclulo q ( 3 l
Ii, Morlgagns Clnd NolllS RfI(oivoble (Schedule Dl ( 4 \
J, Cosh, Bank Deposits & Mis~'ellan()ous Porsonol Proporly t 5 J
(S,h.dvl. E)
6, Jointly Owned Property (Schedule f) (61
7. T,o",for, ISeh.dvlo GI15eh.dvl" LI 17 )
8, Total Gross Anel$ {towl Une\ 1.7l
q, funerol hpenHu, AdmlnishClllvo Cmh, Mi~(flllt1naou\ 19\
hpQfHeS (Schedule HI
10. Debh, Mortgage U\lbllllies, lie!1\ (Schedule I) (10)
11. T 0101 DoductlolH (Iotollines ? & 10)
12. Nol Vallie 01 E\IClla (lintl 8 mirllJ$ line 11)
13, Charitable and Govornmental Bnquesh (Schedule jl
14. t:.J_tt..!...Y'!l~! Su~iect 10 T~~(Unll 12 minus Une ~~l
15. Spousal Tronsler\ (for doles 01 denlh alter 6,30.cM)
See Instrucllora for Applicable Percentage on Reverse (l5)
Side. (Indudfl value, !rom Sthedule K or Schodule M.)
16, Amounl 01 Une 14 100(Oble elt 6% rate (16)
(Include values Irom Schedulo K or Schedule M,)
17. Amount of line 14 toxoble (II 15%) role i 17)
(Include values !rom S(hedule K or S(hodule M.\
18. Principal loll. due (Add 1(1)( from lines \5, 16 (Ind 17,\
19. Crtldlts Spousal Poverty Crodit Prior POYn\ol1ls
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fodar<ll EUClte Tu)( Return Requlrod
T olnl Number 01 5Clffl Dopo\II Bo)(os
None
:;142,111.13
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$21,212,63
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Operations Cenler
635 North 12th Street
Lemoyne, Pennsylvania 17043
7171731.1440
october 10, 1997
Brian R. Buchholz
51 Sunfire Avenue
Camp Hill, PA 17011-1019
The inrorw:\tion which :,ou requot,ton on the I'.ccount(o) oC Audrey J.
Buchholz Deceased (!iodnl Sncurity Number 546-22-1216) is o.s Collo~l/l.
Account
O'flnerohi '!'
23-00002438 23-60-001026
Checking Savings
8-30-96 8-30-96
$1, 549. 86 $3,569.82
.09 4.63
1,549.95 3,574.45
,
Revocable 'l'rust Revocable 'frust
Account llumher(lI)
Clas5 oC ^ccount
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Ac:::r'Jed !ntcr'cot
Dalo.nce n t
Date of Death
HSlTle of Joint
Owner. if nny
Dnte Ownnrshi)'l
'<IllS tstnblinhcd
8-30-96
8-30-96
Additionnl !nfor-
mation n('f1\lnr.tc~
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:e chen L. Ca1e
Sr. Deposit Documentation Services Rep.
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MU51 BE COM PI ':TED BY REPRESENTA'IVE OF fllIMiUAl INSIIIIJllflt, WIlERE SAil DEf'05IT BO! I:, LOCATED AND REIVRNED TO ABOVE ADDRESS
COUNTYCClliE------'--r-'ill NUMBER - , -- ~ 'Oi;IACSE~rf~I.~ D?T.z C~7lJ'tUMBU
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NAME AND ADDRESS 0' PERSONISI HAVING ACCISI TO BOX
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tSl~EE1. ADDRESS,---
ICITYI
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SECOND AMENDMENT TO THE
RICHARD T. BUCHHOLZ AND AUDREY J. BUCHHOLZ
1989 REVOCABLE TRUST
pursuant to the powers of amendment reserved to them under Article 2,02 of the
Richard T. Buchholz. and Audrey J, Buchholz 1989 Revocable Trust, as previously
amended by amendment dated September 21,1989, Richard T. Buchholz and Audrey J.
Buchholz, the Trustors therein, hereby amend said trust as follows:
1. Article 4.01 of said trust, as previously amended, is hereby revoked in Its
entirety. In its place, the following provision is made:
4.01 Distribution of Trust Estate on the Death of the Surviving Spouse
Upon the death of the surviving spouse, the Trustee shall
distribute the entire remaining trust estate, both principal and income,
unto Trustors' children, Barbara J. Cooper and Brian R. Buchholz, in
equal shares, share and share alike; provided, if Trustors' former
residential dwe\1lng and real property located at 2609 Charleston Drive,
Bakersfield, Kern County, California, shall then be a part of the tr\lst
estate it is Trustors' desire and intent that said dwelllng and real
property shall be made and distributed as a part of the one-half share of
the trust estate passing hereunder to their said daughter, Barbara}.
Cooper, insofar as such distribution may be made.
. 2. In addition to the general and specific Trustee's powers set forth i1\ Article
6.01 of said trust, the Trustee is empowered to do aU things necessary or appropriate for
the orderly administration of the trust estate and to do all acts that might legaUy be done
by an individual in absolute ownership and control of property, including those powers
provided under the Oregon Uniform Trustees powers Act, as amended from time to
time.
3. The following provision is added to and made a part of Article 9.00:
9.08 The laws of the State of Oregon shall govern with respect to the validity
and interpretation of this trust and with respect to all questions relating to the
management, administration and investments of the trust, except insofar as the laws
of the State of California may apply to any specific property located within or subject
to the laws of said state.
Second Amendment to the Richard T. Buchholz
and Audrey J. Buchholz 1989 Revocable Trust - 1
~IRST AMENDMENT TO THE
RIOHARD T. BUCHHOLZ AND AUDREY J. BUCHHOLZ
1989 REVOCJ\BLE TRUST
RICHARD T. BUCHHOLZ and AUDREY J. BUCHHOLZ, Trustors and
Trustees of the RICHARD T. BUCHHOLZ AND AUDREY J. BUClU!OLZ 1989
REVOCABLE TRUST, dated May 31, 1989 (hereinafter "Trust"), hereby
amend Section 4.01 of the Trust pursuant to the power given them
in section 2.02 of the Trust, to read in its entirety as follows:
"4.01. Division of Trust Estate on t.he Death oLW
~urvivina Soouse
On the death of the su~~iving Spouse, the Trustee shall
distribute to BARBARA J. COOPER, if she survives the
surviving Spouse for a period of thirty (30) days, the
Trustor's residence located at 2609 Charleston Drive,
Bakersfield, California, along with the household furniture
and furnishings contained therein. The Trustee shall then
divide the remaining Trust Estate, including any additions
thereto by reason of the death of the surviving Spouse, into
as many equal shares as there are children of Trustors then
living, and, as a group, issue of a deceased child of
Trust.ors. The Trustee shall allocate one such equal share
to each living child and one such equal share to each group
composed of the living issue of a deceased child of the
Trustors. Each such share shall be distributed as hereafter
provided. "
In all othElr respects I the RICHARD T. BUCHHOLZ AND AUDREY J.
BUCHHOLZ 1989 REVOCABLE TRUST, dated May 31, 1989, remains
unchanged.
if. .,.,"1
THE RICHARD T. BUCHHOLZ AND AUDREY J. BUCHHOLZ
1989 REVOCABLE TRUST
RICHARD T. BUCHHOLZ and AUDREY J. BUCHHOLZ, (hereafter
T~ustors or Trustee, depending on the context, and sometimes
referred to as Husband and wife) declare that they have set aside
and hold in trust the property described in Exhibit "A" ,attached
to this instrument.
1.00 :r~UST ESTATE
1.01. Trust Estat~
All property subject to this instrument from time to time,
including the property described in Exhibit "A", is referred to
as the trust estate and shall be held, administered and
distributed according to this instrument.
1.02. ~romunitv prooertv
All property described in Exhibit "A" is the community
property of Trustors, and it, and any other community property
transferred to the trust, shall retain its character as such
notwithstanding the transfer to, this trust.
2.00 REVOCATION AND AMENDMENT
2.01. Revocation Durina Trustors' Join~ Lifetimes
During Trustors I joint lifetimes I this trust may be revoked
in whole or in part by a written instrument signed by either
Trustor and delivered to the Trustee and the other Trustor. On
revocation, the Trustee shall promptly deliver to Trustors all or
the designated portion of the trust assetS. All property
delivered to Trustors on re.vocation shall continue to be
oommunity property of Trustors and shall be held and administered
as community property.
2.02. ~dment Durina Trustors' Joint Lifetim~
Trustors may, at any time during their joint lifetimes,
amend the terms of this trust by written instrument signed by
both Trustors and delivered to the Trustee.
2.03. Revocation and Amendment J2Y. survivina SDouse
on and after the death of the first spouse to die, the
surviving spouse may amend, revoke in whole or in part, or
terminate the survivor' II Trust hereinafter created by written
instrument delivered to the Trustee. On any revocation or
termination of the Survivor's Trust, the designated portion or
all of the trust assets, as the case may be, shall promptly be
delivered to the surviving spouse.
2.04. Revocation and Amendment on the Death of the
survivina Soouse
On the death of the surviving spouse, none of the trusts
created hereby may be amended, revoked or terminated except as
otherwise specificallY provided hereafter, but shall be held,
administered and distributed as set forth beloW.
3.00 INCOME ~ND PRINCIPAL
3.01. pavrnents to Trustors
During Trustors' joint lifetimes, the Trustee shall p~y to
2
or applY for the benefit of Trustors, first from l.ncome and then
from principal, as much of the net income and prl.ncl.pal of the
trust as the Trustee considers necessary for their proper health,
support, maintenance, welfare, comfort and happiness. Any income
or principal paid to Trustors or applied for their benefit shall
continue to retain its char~cter as community property and be
administered a9 such. Any income not distributed shall be
accumulated and added to principal.
3.02. ravmen~s to others
The Trustors, acting jointlY, by written instr\lme,nt may, at
any time, direct the Trustee to pay single sums or periodic
payments out of the trust estate to any other person or
organization. Each Trustor's power to so direct the Trustee
shall be personal to the Trustor except that this power may be
exercised by either Trustor's conservator or Attorney-In-Fact
under a Durable General power of Attorney.
3.03. pavment-s to survivina SPQ~
on the death of the deceased spouse, the Trustee shall
continue to administer the trust ~state, including any additions
made to the trust by reason of the deceased spouse's death, such
as from the decedent's Will or life insurance policies on the
decedent's life, according to the terms of the trust set out
under paragraphs 3.01 and 3.02, above, with respect to the
surviving spouse and without distinction as to whether any
property was derived from community property, separate property
or quasi-community property.
3
"
4.00 DISPOSITION OF TRUST ESTATE .QILTIiE DEATH OF THE
SURVIVING SPOUSE
4.01. Division of Trust Estate on ~_ Death ~f tQjl
Survivinq Spouse
On the death of the surviving spouse, the Trustee shall
divide the trust estate, including any additions thereto by
reason of the death of the surviving spouse, into as many equal
shares as there are children of Trustors then living, and, as a
group, issue of a deceased child of Trustors. The Trustee shall
allocate one such equal share to each living child and one such
equal share to each group composed of the living issue of a
deceased child of the Trustors. Each such share shall be
distributed as hereafter provided.
4.02. Distribution to Children
Each share allocated to a living child of Trustors shall be
distributed to such child free of trust.
4.03. ~istribution to Issue of Deceased Children of
~1;;QrJi
Each share allocated to a group composed of the living issue
of a deceased child of Trustors, shall be distributed free of
trust to such issue by representation; provided, however, if any
person who would otherwise be entitled to a distribution free of
trust is then under the age of eighteen (18) years, such person's
share may be distributed to them or to their guardian in the sole
discretion of the Trustee.
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00 ,./," .. '0 . O. '0
.<" . 0 <),.~'.""
", ,.... ",' v v
.., ""0 "" . " 0< <:, .0 - <. "<
'0 0 ., " ... .. " o. ·
'. ", .. '" .'0 .""" · '0 ·
.(i!'.< ~ $0' ~ '"
.~ 0/", ot. ct
<t ct-6 i!'o o~ Ot
~ <f) ~ .(~
~ $ 's>
~~ 0.... Of) ct
-t(-. ~ '.(t. ~
f)$ <-06 $
n. :/$
"
~
Co
.:<~
?<# ~
t.f) <--t
, <"'. to
't- <-.; ...~
f) .;
~.:< ... 0
.....0 ~
.o~~ ~$~ $.(t1
r:- _ t:. ...
n ~~
the property constituting the trust estate from time to time, and
the Trustees shall have all powers conferred on Trustees by law
including, but not limited to, all powers contained in California
Probate Code Sections 16220 through 16249 and any successor
statute. Enumeration of powers in this instrument shall not
limit the Trustee's general powers, and the Trustee shall have
all the rights, powers and privileges that an absolute o_~er of
the same property would have, subject to the fiduciary
obligations and to any limitations stated elsewhere in this
instrument.
6.02. Powers of Trustees Other Than Trustors
Subject to any limitation stated elsewhere in this
instrument, a person other than Trustors acting as Trustee shall
be limited to the exercise of the fOllowing powers in
administering any trust hereunder:
The Trustee shall have, without the necessity of any court
order, all the powers which a court is authorized to confer under
the terms of California Probate Code Section 16220 through 16249,
as amended from time to time, and shall also have the following
express powers in addition to those powers now or hereafter
conferred by law:
A. The Trustee may acquire every kind of property,
real, personal or mixed, and every kind of investment, including
but not limited to, corporate and government obligations of every
kind, and stocks (both preferred and common), mortgage
participations, shares of investment trusts and regulated
6
..
investment companies (including any under the control of any
investment counsel employed by the Trustee) and mutual funds;
provided, however, considering individual investments as part of
any overall investment strategy, when investing, reinvesting,
purchasing, acquiring, exchanging, selling, and managing the
trust property, the Trustee shall aot with the care, skill,
prudence and diligence under the circumstances then prevailing,
specifically inClUding, but not by way of limitation, the general
economic conditions and the anticipated needs of the trust and
its beneficiaries, that a prUdent person acting in a like
capacity and reasonably familiar with such matters would use in
the conduct of an enterprise of a like character and with like
aims.
B. The Trustee may employ any custodian, attorney,
certified pUblic accountant or other agent, as an expense of the
trust, to assist the Trustee in the administration of the trust,
and to rely on the advice received in good faith from those
agents.
C. Except as otherwise specifically provided in this
instrument, the determination of all matters with respect to what
is principal and income of the trust estate, in the apportionment
and allocation of receipts and expenses between these accounts
shall be governed by the provisions of the California Revised
Uniform Principal and Income Act, from time to time existing.
The Trustee, in the Trustee's discretion, shall determine any
matter not provided for either in this instrument or in the
7
california Revised Uniform Principal and Income Act.
o. If more than one trust is held under thi.s
instrument, there need be no physical segregation or division of
the various trusts except as segregation or division may be
required on the termination of any of the trusts, but the Trustee
shall keep separate accounts for the separate undivided
interests.
E. In any case in which the Trustee is required,
pursuant to the provisions of this instrument, to divide any
trust property into parts or shares for the purpose of
distribution or otherwise, the Trustee may make the division and
distribution in identical interests, in kind, or partlY in kind
and partlY in money, pro rata or non-pro rata, and may make such
sales of the trust property and upon such terms and conditions as
the Trustee deems necessary. In making non-pro rata
distributions or allocations under the terms of this instrument,
the Trustee need not consider the income tax bases of the various
assets nor make any attempt to equalize the aggregate income tax
bases of assets distributed or allocated, and such decision by
the Trustee to consider or not to consider those various income
tax bases shall be binding on all parties in interest. The
valuation of all assets distributed shall be determined in the
Trustee's discretion.
F. Income accrued or held undistributed by the
Trustee at the time of termination of any trust created under
this instrument shall be distributed to the next succeeding
8
benefioiaries of such trust in proportion to their interests in
it.
G. The Trustee may make distributions to a minor or
other beneficlary under disability by making distributions to the
Guardian or conservator of his or her person, or to any suitable
person with whom he or she resides, or the Trustee may apply
distributions directly for the beneficiary's benefit. The
Trllstee may make distributions directly to a minor if, in the
Trustee's judgment, he or she is of sufficient age and maturity
to make proper use of any income or assets so distributed.
H. All of the powers of the Trustee provided in this
instrument shall be exercisable by the Trustee in the Trustee's
fiduciary capacity and only in such capacity; and,
notwithstanding any of the provisions of this instrument which
might otherwise be construed to the contrary, the Trustee shall
have no power under any such provisions to enlarge or shift any
of the beneficial interest under such trust except as an
incidental consequence of the discharge of the Trustee's
fiduciary duties.
I. If at any time the administrative expense of any
of the trusts administered hereunder is such that it would be
impractical or unfeasible to continue the trust or would
substantially defeat the purpose of the trust, then the Trustee,
in the Trustee's discretion, may terminate that trust and
distribute the remaining balance of that trust to the then income
beneficiary or beneficiaries.
9
.
7.00 DEBTS. EXPENSES
7.01. peceased Soouse's Debts. Exoenses
On the death of the f1rst spouse to die, the Trustee, in the
Trustee's discretion, may, to the extent not otherwise provided
for, payout of the deceased spouse's interest in the trust
estate that spouse's debts outstanding at the t.ime of his or her
death, not barred by the statute of limitations, the statute of
frauds, or any other provision of law; the last illness and
funeral expenses of the deceased spouse; and attorney's fees and
other costs incurred in administering the deceased spouse's
probat.e estate.
7.02. Survivinu-Soouse's Debts. Exoenses
On the death of the surviving spouse, the Trustee, in the
Trustee's discretion, may, to the extent not otherwise provided
for, payout of the Survivor's Trust t.he surviving spouse's debts
outstanding at the time of his or her death, not barred by the
statute of limitations, the statute of frauds, or any other
provision of law; the last illness and funeral expenses of the
surviving spouse; and attorney's fees and other costs incurred in
administer ing the surviving spouse's probate estate. Any such
payments shall be charged, without apportionment or charge
against any beneficiary of the trust est,ate, to the Survivor's
Trust. Payment of any of the surviving spouse's debts shall be
made proportionately from the property of the trust estate as
such property shall be liable for the debts.
10
8.00 DEFINITIONS
8.01. ~
As used in this instrument/ the following definitions shall
be applicable:
1. The term "community property" shall include
"quasi-community property" as that term is defined by California
law.
2. The words "deceased spouse" shall refer to the
first Trustor to die.
3. 'l'he words "survlving spouse" shall refer to the
Trustor living after the death of the deceased spouse, unless the
context indicates otherwise.
4. "Survivorls Trust" refers to that portion of the
trust estate administered under paragraph 3.03.
5. The words "child" or "children" shall refer to
BARBARA J. COOPER and BRIAN R. BUCHHOLZ.
6. The word "issue" shall refer to lineal descendants
of all degrees and shall include afterborn and adopted persons.
7. The use of the word "shall" indicates a mandatory
direction, while the use of the word "may" indicates a permissive
but not mandatory grant of authority.
9.00 GENERAL PROVISIONS
9.01. 1,&aal Title to Trust Prooertv
The legal tltle to all property held in any trust hereunder
11
t
"
I
I
I
I
I
i
I
I
,
.
shall be and remain vested in the Trustee from time to time
acting hereunder without active conv~yance or transfer to, by or
from any succeeding or retiring Trustee, and the Trustee from
time to time acting hereunder shall have all of the rights,
powers and authorities, discretionary or otherwise, herein
granted to the original Trustee.
9.02. SDendthrift Clause
No interest in the principal or income of any trust created
under this instrument shall be liable for or subject to the debts
of any beneficiary designated therein, nor shall the same be
anticipated, assigned, mortgaged, pledged, hypothecated or
encumbered, or subject to any Creditor's claim or to legal
process prior to its actual receipt by such beneficiary.
9.03. PerDetuities Savinqs Clause
Unless sooner terminated in accordance with the provisions
of this instrument, each trust created under this instrument
shall terminate twenty-one (21) years after the death of the
issue of Trustors who are living at the time of the death of the
surviving spouse.
9.04. Contest Clause
In the event any beneficiary under this instrument shall
singly or in conjunction with any other person or persons contest
in any court the validity of this trust or the wills of either
Trustor or shall seek to obtain an adjudication in any proceeding
in any court that this trust or any of its provisions or that
such wills or any of their provisions are void or seek otherwise
12
to void, nullify or set aside thb t.rust or any of its
provi.sions, then the right of that person to take any interest
given to him by thl.s Trust shall be determined as it would have
been determined had the person predeceased the execution of this
agreemen't without surviving issue. The Trustee is hereby
authorized to defend, at the expense of the trust estate, any
contest or other attack of any nature of this Trust or any of its
provisions.
9 . 05 . Gender: Number
The masculine, feminine or neuter gender, and the singular
or plural number shall be deemed to include the others when the
context so requires.
9.06. HeadiMs
The titles or headings to the sections of this instrument
are not a part thereof, and shall have no effect upon the
construction or interpretation of any part of this instrument.
9.07. Trust Name
The trusts created under this instrument shall be referred
to collectively as THE RICHARD T. BUCHHOLZ AND AUDREY J. BUCHHOLZ
1989 REVOCABLE TRUST and each separate trust created in this
agreement may be referred to by adding the name of the
beneficiary.
13
,.
.
.'
.
I r' II \,1 ("
....) ..-....".. t" \..)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
Bll~EAU Of INDIVIDUAL TA~ES
1t4I1ERI1AHCt 'AI( DIVISION
Of,Pl. 1,AOf,Ol
tIARRISlUMO, 11", 17128--0MI
NOTICE OF INHERITANCE TAX
APP~AISEMENT. ALLOW~NCE OR DISALLOWANCE
OF OEDUCTIDNS AND ASSESSMENT OF TAX
03-02-98
BUCHHOLZ
09-12-9'1
21 97 - 0977
CUMBERLAND
101
t_::=~A~i~=~~~Jt~=~:~~l
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLlSI.E. PA 17013
CUT ALONG TH18 LINE ~ RI!TAIN LOWER PORTION FOR YOUR RECORDS ..
. REV: i54,-ix-AFP -io'iFi'iY-NOTicf-OF-YNHiiiii'ANci "TAx-APPRAi SEHENr;"ALi:owANci "oli-.--.----- - -""" --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
AUDREY .1 FILE NO. 21 97-097'/ ACN 101
DAT!
ESTATE OF
DATI! OF DI!ATH
FILE NUMBER
COUNTY
ACN
If .n ......m.nt W.B i..u.d pr.viou.ly, lin.. 14. 15 .nd/or 16. 17 and 18 will
r.fl.ct figur.. th.t includ. the tot.l of ~ r.turn. .......d to d.t..
ASSESSMENT OF TAXI
15, A~ount of Line 14 at Spou..l rat.
1&. A_aunt of line 14 t.~.bl. .t Lin..l/Clasl A rat.
11. Allount of tine 14 ta)(abla at Colletaral/Ch.. 8 rat.
18, Principal Ta)( Dua
LISA MARIE .cOYNE ESQ
3901 MARKE" ST
CAMP HILL
PA 17011
ESTATE OF
BUCHHOLZ
I ACCEPTED AS FILED
TAX ~ETU~N WASI I
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERS~
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1, R..l Elt.t. (Soheduh A)
2. stockl and Bondi ISchedule 8)
3. Clo..ly Held stook/partnership Int.....t (Sch.dul. C 1
4. "o..t.a..s/Hot.. R.c.ivable (Sch.dul. Dl
5. C.lh/I.nk D.posit./Hi.c. p....on.l Prop...ty (Schedule EJ
6, Jointly Owned Property (Schedul. fJ
7, T..anlf.... (Schedul. OJ
I. Tot.l A..et.
APPROVED DEDUCTIONS AND EXEMPTIONS I
.. fun.ral Ey,pen.e./AdM, Co.tl/MiIC. Exp.nl.' (Sch.dul. H)
10, D.bt./"ortg.g. Ll.bllltl../L1.n. (Soh.dul. II
11. Total Deduction.
12, N.t ValUe of Tlx Raturn
13. Ch.ritable/Goye..n.ental lequ..1M; Non,'ellcted '9113 Tru.t.
14, N.t Vdu. of E.t.t. Subj.ot to r..
NOTE I
TA_~DI!l1
PAYMENT
DATE
-l.2-T0" 9'7-
.~.--_.~.--_.~-_.-~.-.~
_.------------_.-~--
DISCDUNT 1+)
INTEREST/PEN PAID 1-)
--"1';-378 ;42"
RECEIPT
NUMBER
--AA242537
1I1_
(21
(3)
(41
(!i)
Ib)
171
Iq)
1I01
liS)
lIbl
Cl71_
X) CHANGED
,00
142,111,13
.00
,00
151.88Lil.
,00
IBB.358.10
lal
16.212,63
1,679,00,
1I11
1I21
IUI
1I4)
lSoh.clull J)
.00
464.461.21
.00
SEE
x ,00,
X,06.
K ,15,
1181
,,-~.---_.~...~....~~_...,_..~-
AMDUNT PAID
------------26;"f9il~O
'*'
U~.\Ii., U ,,, U..t/l
AUDREY
J
DATE
ATT ACHED
03-02-9B
NOTICE
NOTE I To in.ur' prope..
Q..edlt to you.. lecount,
lubMtt the uppe.. portion
of thtl forM with your
t.)( ply"ant.
482.352,84
17.R01 1.:\
464.4hl,21
-:00
464.461.21
,00
27,867.68
,00
27.867.68
----- ' TOTALTAX' CREDIT 27.560.42
BALANCE OFTAXDUi -------m-:2'6-
--....----------------- -.------
INTEREST AND PEN. ,00
-- -----~
TOTAL DUE 299,26
PAYMENT MUST BE MADE BY 06-13-98*,
. IF PAID AFTER OATE INDICATED. SEE ~EVERSE
FDR CALCULATION OF ADDITIONAL INTEREST,
I IF TDTAL DUE IS LESS THAN U. ND PAYM~NT IS REQUIRED.
IF TD1 AL DUE IS REFLECTF.O AS A "CREDIT" ICR). YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE Of THIS FORM FOR IHS-'~UCTIDNS.)
"
""t
'.',
RESERYAflONI f.t,tl' 0' d'c'd.~t. dYln. on or blfor. Deo"ber 12; 1911 -. if 'nv future Int.r..t In the ..tat, I. tran'f'rred
In PO.....lon or .njoy~.nt to CI... . (0011Itlrel) bAneflOlarll. 0' the dlcldent .ft., the Ikplratlon of .nv ..tete for
I1f, or for ye.r., the €;oMonw..lth hereby '!Cpr.ub r...r..... the right to appr.h, and a..... Irans',,' lnh.r hanol TalUII
.t tht llwful CI.'M B (collet.ral) rat. on any .ueh future Jnt.r..t.
PURPOSE OF
NOTICEI
To fulfil! Ih. requlr...ntl of Slotion 2)40 ofth. lnharlhnat end Estll, Tel( Aot. Act Zl of 1995. (n P.S.
Slotlon 9IitO),
PAIf'HENT I
O.hoh the top porUon of this Hotlo. end tub,1t with your PIY'.nt to the RIght,r of Wl1h prlntld on the re...lrlill licit,
.~".k. Clhlok or .on.y ord.r plnbl, tOI REGISTER 0." NILLS_ AGENT
REFUND (CM) I
A rlfund of a tail or.dlt, which wal not requ..t.a on the TalC A.turn, Ilay b. r.qu.tt.d by oOllpl.tlng an ".pp1!caUon
for Refund of PonnlY1v.nlo Inhlrltanc. and E.tat. T.lC" (R~~-l!ll). Application. are Ilv.II'b.. It tnl Of'lc.
of the AIgl,t.r of Will., any of the 21 Rlvlnu. Olltriot OfficI., or by tailIng the Ip,clal l4-hour
.nlNlrlng nrvtce nU.b.r. for fcr.. ordlrlngl In Plnntylvanln 1'800"162-20S0, ouhld. PlnnsYlvanta and
Nlthln Iot.l Harrhburg .r.. (117) 187-11094, TOOl UI'IJ 171-2252 (H.artng l,pRtr.d Only),
O~JECTIO"SI Any party In Jnt.r..t not .atJ.ft.d Nlth the .ppr.I...."t, .llow.nc. or dl..lloNlnc. of dlductlon., or ........nt
of talC (Including discount or Inter..t) I' .hown on tnll Notlc. IIU.t Object within lilCty (60) d.y, of recllpt of
this Notlo;:l bYI
ADHIN
lSTRATIVE
CORRECTIONS I
~-wrltten protllt to the PA n.part..nt of R.vlnul, Board of App.ah, O.pt. 2B1021, Harrisburg, PA 1112a~1021, OR
--II'ction to have the .attar dlterllln.d at audit of the nccount of thll p'r.onll rlpr...ntatlv., OR
-~app.al to the Orphan.' Court.
DISCOUNT I
Fletull ."ror. discov.red on thlt a.....".nt Ihould b. addr'..ed In writing tOI PA Olpart"lnt of R.venuI,
Il.Ir.al.l of Indlvldulll r.il.., ATTNl Po.t AU.....nt R.vl.w Unit, n.pt. 280601, tlarrltburu. Pol 17128'0601
Phona (111) 181"6S05. S.. pIg. 5 0' tha boOkl.t "trlltructJon. for Inharltanc. TalC R.ttJrn for I Ratld.nt
Dacedlnt.. (REV-UOi) for an .ilpI.natJun of ed.lnistreUv.lY cOI'rletabl, error..
If 'ny ta)C dua It paid within three (3) ul.ndar Mcnth. aft.r the d.c.d.nt'. death, a Un p.rc.nt (SJO discount uf
the talC paid J. allaw.d.
PENAL TV I
Th. 15% tllC a.na.ty non"partlclp.tJon p,n.lty I. aQaput.d on the total of the tail and Int.r..t .......d, Ind not
Plhi b.for. January 18, 1996" the flr.t day alt.r the .nd of the lIIlC Il'nlllty p.rlod. Thl. "on~parUclpatJon
p,nalty I. 'pp.,labla In tha 1.1lt. .'nn.r .nd In tha the .... tla. p.rlod II YOU would appaal the tlil and Int.ra.t
that h.. b..n .......d as Indlcat.d on thlt notlo..
INTEREST I
Int.r..t I. charg'd b.glnnlng with fJr.t dllY of d.llnqu.ncy, or nln. (9) Iltonth. .nd ona (1) day frollt the d~tl of
d..th, to the dati-of paY'lnt. TalCe. Which b.ca.. d'llnquent b.for. January 1, 198Z b',r Jnt.r..t at the r.t. of
.llC (6%) rarc.nt P'r annUll calculat.d at a datly rata of .000164. All talee. whIch b.oa.. d.llnquent on and after
January 1. 1982101111 bur tnterllt at a r.ta whlllh will var-y fro. caland.r y.ar to calandar y..r with thlllt r.t.
IMounctd by the PA Dapartll.nt of R,vanu.. Th. .pplJoabl. Jnter..t rat.. for 1'82 'hrOUgh 1998 ar'l
Vllr Int.ra.t Rat. naUy tntarut Fattor ~ lnter..t Reta Dally lnt.r..t Faotor
-
19112 20% .00054' 198" 'X .000247
19.3 16% .000438 1988-1'.91 11% .000301
1914 11)( ,000101 1992 9% ,000241
1985 13)( .000156 1991-1994 1% .000192
1.16 lOX .000274 1995"1998 9% .D00241
~~Intef...t It <<I'lel/htad at followll
INTEREST = BALANCE OF TAX UNPAID X NU"BER DF DAYS DELINQUENT X DAILY INTEREST FA~TOR
--Any Notice luu.d .fter tha tllle b.eOMII d'llnquant will raftact an Intarllt calcul.tlon to flft..n (15) dllYI
b,yond tha d.t. of tha .....III.nt. If paVM.nt It !Ilad. .Itar the Intar..t COMputation data .hown on thl
Notlo., addltlon'l In~.ralt .u.t b. calculated.
P~VMI\N!1
O,,"h 'hO tot' porUo. of thll NoUo' ood ,....1' with .o..r p......t ..d. p..obl. to tho oa.. .nd .ddro"
prll'ttd on thl ,.Iver" std.,
If RES10EN! OECEOEN! .... ,h'" " """" .rdor p....1o tOl REGISTER OF WILLS, AGENT,
If NON.RES1DEN' OECEDENT .... .h'" .r ,">0' ord.r p....,. tOI CO"HONWE~L TH OF PENNSVLVANIA.
REFUMO (CRlI A rof""d .f . t.x .r.dll, whl.h W.' no' r".","d .0 th. '" R..urn. ... .. roo....t.d .. ."P,.tln. .n
.A..lI..U.n lor R.fund ., p.nn..".nl. Inh.rlt.n.. ond E...II T.'. \R"-ISl'" A..lI.."'''.ro ...11.'" .t
. thO OUI.. .f tho R..I.llr .t Will', ... o. th. " R".nu, OI..rI.t DW," .r frno .h' D.p.....nt.. ,.-hour
.n...dno .."I.. nu...re fOr 'or.. OIdorlno' In ponn..I''''. l-aOO-361-!OSO' ou..ld' P.onIY"..I.
.nd within '0'" Hord"U" .r.. (7I/1I81-a094. "D' Ol1l m-"" ,,,...1". 1...lr.d onl,l,
REPL V TOl
Qu..,I.n. r...rdln. .,r'" ..n..I".. .n thl. "..,.. .hOu" .. .ddr....d t" .. O...,...n. of R.,.nu', au,"u
of 10dlvldU.' T.''', AnNI POI' ........n' ..V,.W Unl'. Dop', ,",601. "."I..u,..'A ,,"0-0601. .M..
(111) 167-6~DS.
Dl$COUHTI
If ... ,.x duo I. p.ld within 'h'" '" ..Iond.r ..n'h' .ftor .h' d...d.n'" d..'h. . "" por..nt "" ....oun'
of the t8)( paid 'S aUowed.
PEHAllVI
Th' "X '" .on.... n.n-portl.lp.t1.n p...It. I. ...pulld .n ,h' ..... .f .h. ,., .nd I"...... .......d. end not
p.ld ..,... J.n"'" 18, 1996. 'h' fire' d.. .ftor .h. ond .f 'h' t.x ....... porl.d,
INTEREST I
In'or'" I' .hor..d ...,onln. with fire' ... ., ..1Inouon... or nino 19l oon.h. .nd ... (\l d.. fro' thO"" of
...'h. t. th' d." 0' p....n._ T.'" whl'" 00.... d.lInquont b"'ro J.n..." I, 19"' .... In..r..' ., thO "" .f
.Ix (6Xl p....., por .onu. ..I.u,...d " . ..11. "t. .f ,000164, 01' IIx" whl.h ...... d.lIn....nt .n .nd .ftor
J_or. I. 19a' will ...r Inll"" .t . r." whl.h .111 ,,,. fr.' ..,ond.' ...r '0 .,'on..r ...r with th.' r.t.
"nnounc"" 'h' .. O,p.",,,, .f ."..u., Th. .ppll."" In.or..t ,.... f.r 198' throu.h 199a or..
V..r tn,.r..t Reta O.11Y Interut FaCltor
Vear
tntere.t Rat-
DaUy Intflr..t factor
lnil! ZOZ ,00013'18 lCJa7 l)y' .0001.41
'91S 16;( ,00045& 198&..1991 llY. ,00030\
..a4 \1;( ,000'501 1992 'X .DOOl41
19151 U;( ,OOOlS6 1995~ l q?4 7'1. .OR01IJZ
.... 101: ,OOOZ74 1995-191)1 'X ,OOOl47
~ ~ tnterut \I c.lculated .. fol1DWIl
INTf.RElT . BALANCE OF TAX UNP^ID X NUKBER OF O^~S DELINQUENT X DAIL~ INTEREST FACTDR
__A" Hotl.. I....... .ftor .hO 'ox b...... ..lIn",oon' wUl rollOO' .n In",..t .,'.u,o".n ,. "".on liS) d...
bovood .... d.,. ., tho ........... II p.,-, 10..... .ftor ,... In'or'" ._t.tlon d.t. .tIn"" .n .h'
NotlC., additional Intere.t .u.t ba calculated.