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COMMONWEALTII OF PIiNNSYLVANIA. DEPARTMENT OF ttEAlHI' VITAL ReCORDS
CERTIFICATE OF DEATH
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FilED IN DUPLICATE
WITH REGISTER OF WILLS)
'OR DAUSO' DIAlH Ann 12/31191 CHICK HIR
IF A SPOUSAL
POVIRn CRlDIlIS CLAIMID [ I
'Ill NUMan ;' 1 -"'(-1. '1'it)
C.OMMONWUI.TII or rl t4rlSYlYMlIA
DfPARTMH4t Of II{Yft~U(
Ofrr 180hu,
IIARAISftUlm, 'A " I Jll 060 I
==--==~ i~f{ii;f t'l.j 's'ft~t\f.li^ st -'-IR~,(kjj5'Mi()fii iifiiii^.t'j . ._h_._._'____.
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'.6. ClAls'tdIRIi'i tl(il,i~fll .. , .IDA.i.l: ;O'1.0..!fA/"':I.
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1'111 ,""IIC.I,IIII ~IIMVIVIW\ ~Pll'J\I\ !lAM' IIA\I.IIM\I AtI[l /'\'01'\1111111,1,11
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1. Reol e llote (Schedule A)
2. Slm.ks and Bond, ISchedule Bl
3. Closely Held Stock/Porlner,hip Interfl$t ISchedule q
4. Moll909et nod Nolin Receivable ISchodulo Dl
5. (cah, Bonk D(lpolill & MI$(ellaneOul PfH$onal Properly
15th.dul. EI
6, lointly Owned Property lSch(ldule FJ
7. Trnnllen ISchedule G) (Schedule t)
O. Tolol Oron Aueh (Iololline$ 1.7)
9. Funeral hpen$es, Adrnini'Irallve Cosh, Mhcollnneou,
hren"$ ISchedule HI
10. Debh, Morlgagl'l Uabillllel. lIenl (Schedule I)
11. Total Deduction$ ltolal line$ Q & 10)
12,
COUNTY CODE I ')'}'! YEAR' Ill) ") IjUMBF'
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IIIlGilnn:lonhul.'['" l'A 170~;~;
em] ",,,'uS; ~"'~~~~~i I;;; ~,m0(j'(~~:__~~~,=,__..,
! I 3, Remainder Return
lfor dalllll of death prior to 12.13.8,
['] 5, Federal etlale TOK Relurn Required
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'1IMH (Jf riiAlii
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Supplemental Return
TOlol Number of Soft Depotll 80KeI
111-
161,.
171..
1,2f&!..Q!J.,
13,
14,
15
16,
17.
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51
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S 20.
21.
Net Value of E$tote (line 0 ml'lulline II)
Cl1arllable and Governmenlal Bequ~ull (Schedule J)
I q I.,
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0,00
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181
PO) --
3,6Gb.OO
0.00
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O..QQ
0.00
(11)
(12) _
(13)
(14)
N!l Val~~u~j~,'.!.-I~~~.~lL~!__!3 minu~!i~_~.~____.___~..
(151 ._._.._"__.___!)~S)_",__=
O.OCl
1161
1'>.00
..__._______....... .__" ,06 =
0,00
0.00
If Une 19 h grnoter Ihan line 10, enle. the dllferflnce on LIne 20. Thll 1$ the OVERPA YMENT.
m[1
Spousal Transfers llor tllllel 01 death after &.30.Q41
See 'nurudlon$ for Applicable Percentage on Rever"
Side, llndude values from Schedule K or Schedule M,)
Amount of Uno \4 taxable at 6% rale
(Include value$ from Schedule K or Schodvle M.l
Amounl allln. 14 tOKablo al 15% rote
llndvde value$ from Schedule K or Schedule M.)
PrlnclpoltoK due (Add laK from lInel 15, 16 and 17,)
(redlll Spou,ol p.,verB' Credit Prior Paymol\h
_.u_ ..Q') +J).i)Q +
(17) .
n,oo
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118)
0.00
DlfCounl
"..0..00
Intore~t
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IIq)
120}
0.00
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_____________Q."O..Q
0,00
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._ __ .il,PO
.___._0.00
Chctk "Nfl if you rue If'quesllng (t 'fllund of youl oVNpoymcnl
If line 18 i$ greater than tine 19, enter the difference on line 21. Thi, II the TAX DUE,
A. Enler Ihe Inler8$1 on the bellonce <lu.. on line 21 A.
a. fnler the total 01 Una 2\ and 21A an line 219, Thll it ,he BALANCE DUE.
___..__~a~,~_~~~_c_~__~~y_~~.i~,t~_l__~~,I~!.!_~_~f ~!!l.!, _~_~~_~t ..n... ._ _ _.. ..._______ .._..___..
121)
121A}
1218)
___._.__..__._____.___.__~o..___.._
f_~_~ ~lJ!E_l_O.ANSWE~_~LL.QlJ_ES!~()N~_ ON~E~R~E_ SlP.E .~tll> T()~_~.fl~,K MATH <( <( __
Under penaltlet of pnri',ry, I dndllle thol I hClvo eKmnined !"i, relurn, bleil/ding accompanying \chtlduln, Clnd ~Iotomenh, and 10 the bell of my knowledge and bell'
III. hue, correct and ("'Il!,I"ln I dfldnre Ihat oil (eol futole hn~ bl)~n fflporled 01 true mark8t voluo_ Dodaro';"" 01 prnporer other Ihon Ihe perianal r.prelenlnllvl)
balld on all inlormalilll1 01 ....-hirh preparer h(n any knowledge
".:'" ~~ ~:"~:,:;:,:':::". ... :;:::i\I~'1~11\~;Otll. t~~;J~~~:l?li:]1';1;~l705~:-..-=-~:,:~ ::1.-= 17~:i~.i~
~~ ;"".' . i'11':n <>q\1f1l'O 0...1!'.1 " /,. /. j
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UVIJltf_. 11181
~ SCHEDULE H
~~ ADMF,UNN,sErRRAALrlVEXEPcEoNsSrEsS'AND
COMMONW!1\l11l Of PWlllYtVAN'A
'fH~~::I~~'~'Il\~~WJ:"" . ... _ ... MISCELLANEOUS. EXPENSES. . . PI.o.. PrInt at TVp.
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ITEM
NUMBER DESCRIPTION AMOUNT
- .. - _n___. __,.___ ~ ....~___<<~~______....' ~_~__. _.______.___~....____
A. funltol EKp.n.."
8.
4,
C. .
1.
2.
3.
4.
5,
6.
7,
8.
1.
Hono - Propaid.
1.
Admlnl,'rollv. Co.'"
P.tsonal Repre.entative Commission. _
Social Security Number of Personal Representallve, _'__'__~'_'__----'_
Year Commission. paid
2.
Allarney Fee. .r. Hobert Stf\uffe1', IGs']. atto!'neyt A fee,
fp
125,00
3.
family EKemptian ten h f\ ug h
Claimant .~!~od l'()\L_I:I._E!'l:J,:'~_. Relationship J[WJ b {\n~L_._____.
Address of Claimant at decedent's death
Street Address_~:} ?E()1'.t.QI1.bn~gl1..J,a.D~.___..____________.:..__
Clty_J1/3.cl1..Ht1!(lO!JI11'G._n..State ..]',-\.... Zip Code_170;);)__
3.500.00
Probate fees no[';istor of \'Iill.s of Cumberland County,
Pennsylvania, Lotto1's of Administration.
MI.c.llon.ou. bp.n.."
Jio{Stfltor of Willa, .ftlin~ InvontoI'Y and Ponnsylvania
Inheritanoe Tax Return.
41.00
20.00
~M________~_~___.____.,._ ..___.._._____,__....._.._ ~._..<O._____~_.,..w._
TOTAL (AI.o enter on line 9. Recapitulation)
(1/ mall spac. I. n..d.d, Inllrl additional .h.." of .011I0 "1..)
$
3,686.00
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
III
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. 119 u V . acco' "9 0 aw, OpO'.1 an "V' ,a \8.____... ._..__....___..__.___._..... __.....n__.
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wll ill' 1111 Invontury nHH UJY "I,' , '-,. - ....oj tho ,,,,ld. n____'~-_'.u__,,, ',. _,__~_1-_..
01 tho onll,,, ..1010 of 1.ld d.codo"l, C"fllilll"q of .11 tho 1'0,,0,,"1 p,o!"nly a"d roal ..101., ..c.pl ,.al ....t. ouhld.
tho COl1lmonwdallh (,I Pon".ylv."I., ""d th.t tho lIyuro. oppo.ll. oach lI.m 0' th. Involllo,y '.p,...nl 11'1 lal, vllu.
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INSTRUCTIONS
I. An Inv.nto,y mUlt b. III.d within Ih,o. mOI,th. .It., appointm.nt 01 p."onal r.p,os.nt.llv..
2. A luppl.m.nl Inv.nto,y mu.1 b. III.d wilh!II thirty d.V' 01 dilcovo,y 01 .ddillon.1 ....h,
3. Addlllonal .ho.ts m.y b. a"ach.d ft' 10 p."onally 0' ,.ally
4. See A,lIcl. IV, Flduclari.. Act 01 1949,
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04-20-98
FERTENBAUGH
07-01-97
21 97'1009
CUMBERLAND
101
t .!moun fR-o-.l It od --l
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS L,INE .. RETAIN LOWER PORTION FOR YOUR RECORDS ...
R 'EV: isr'-i - EiC" jiii - i 09-:97 T - NOTY cE""ci F" ytiHEiii;: ANcE - T-r. x - iip PRA- is EME NT"; -" L i:ciwA tic E - iiFi - - - -, - - - - - - - - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
MILDRED A FILE NO. 21 97-1009 ACN 101
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expens../Ad.. COltslMise. Expans.. (Schadl.lh H) (9)
10, Dobh/Hodgogo Llobllltlu/I.lono (Schodulo I) 110) ,00
11, Tohl Doduotlono III I
12. Nat Value of Tax R.turn (12)
13, Charitabla/Govarnllanbl Bequ.sts.l Non-elected 9113 Trulh ISchedule J) (13)
14, Not Voluo of Eltoto Subjoct to To. (14)
NOTE: If an assessment was issued previously, lines 14, 15 and/or 1&, 17 and 18
reflect f!gLlres that include the total of ALL. returns assessed to date.
ASSESSMENT OF TAX:
IS. Allount of Lina 14 at Spou..l
16. Allount of Lina 14 taxable at
17. AMount of Lina 14 taxable at
1a. Principal Tax Due
j', ,~,U" 'I
8UREAU aF INDIVIDUAL TAMES
INtif.AlYAHCE tAIt UIYUIlIN
Of.PT. 2"0601
tiARAIUIJRQ, PA 11 1 i.'1 " OM 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF nUIERITANCE rAM
APPRAISEHENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIDNS AND ASSESSHENT DF TAM
J ROBERT SIAUFFER ATTV
MARKET SQUARE BLDG
MECHANICS BURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
CDUNTY
ACN
ESTATE OF FERTENBAUGH
TAX RETURN WAS, (
) ACCEPTED AS FILED
( X I CHANGED
RESERVATION CONCERNING FUTURE INTEREST " SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
I. R..l est.t. (Schedule A)
2, Stocks and Bondi (Schedule B)
3. Clo..ly tlald stock/Partn.r-ship Intarast (Schedule C)
4. Hartl.ga./Not.. Raceivable (Sth.dul. OJ
5. C..h/Bank D.po.it./H1~c, Parsonal Property (Schedul. E)
6. Jointly Owned Property (Schedule F)
7. Tranlferl (Sohedule G)
8. Total A...t.
III
12)
13 )
(4)
15)
1/,)
17)
,00
,00
,00
,00
1.2B4,04
,00
,00
18)
1,470,04
rat.
Lin..l/CI... A r.t~
Collateral/CI... Brat.
,00 X' 00=
:00X,06=
,00 X ,15=
118)
1151
1161
(17)
TAX CREDITS:
PAVHENT
DATE
RECEIPT
NUH8ER
DISCOUNT 1+)
INTEREST/PEN PAID 1-)
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
c'
*
IlY.li.l U l" Cn.t1l
MIL DRED
A
SEE
DATE
ATTACHED
04-20-98
NOTICE
NOTE: To insure proper
cradit to your account,
subftit the upper portiun
of this forn with your
tax paynent,
1,284,04
] ,470 04
186,04-
,00
186,04-
will
,00
,00
,00
,00
.00 :]
,00 ~
---~~~j
o IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION DF ADDITIDNAL INTEREST.
IF TOTAL DUE IS LESS THAN .1. NO PAVHENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI. YOU HAV BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS, I
ItUllfllYAtlONI Elt,t.. of d,cldantl dvln, on nr blIfor. o.o..r Il, 1912 ~- if InY ~utur. Interi.t In tM utlt. I. tran.farred
in po.....lon or .njovI.nt to CII" I (c011.tlral) hen.flclarle. of thl dlced.nt .ftar thl .~plr.tlon of '"v ..t.te for
II'. or for ya.r..th. Co-.onw..lth har.bv ~~pr...ly r.l.rVI' the right to appr.I.. and ...... ttan.flr Ihhlrltane. l'~I'
It the lawful el... e (coUlt.rall rIte on IIf1';' ,uch future Jnt"ut,
PI_IIOf'
MOllef"
PAVMf.HT:
Rff'UHD C CR) I
a'JECTIONS I
ADlnM
ISTAATlYE
CCMtRfeTIONSI
DISCCUfTI
PENAL TV I
INTf.MITI
To fulfill the r.qulr...nh of Sl<ItJon 2140 of thl InharU.nu and E.tatl Tax Act, Act l!1 of 199!L en P,S,
SICUcm 9140),
OtItlcn thl top purtlon of t"" Motic. and .ub.it Mith your Ply..nt to tM RIghter of Will. prlnt.d on the rav.,.a .lde,
~.I'tlkll ch.ck or IOMY order peYllbl1 tell REGISTER OF MILLS, AGENT
, rlfund of I t.~ crldlt, which MIll not r.qu..tld on thl Tax R.turn, ..y bl r.qu..tad by coeplatlna en "Appllcltlon
for R.fund of Penn'YlIIanll Inh.rttenc. and f..tat. T.~" (REV-13UI, Application. art l",al1abl. at the OffiCI
of u.. Reilhter of Wllh, any of tha Z1 R'Vlnu. Ohtrlct Offlc.., or bv callinG the ,pl<llal llt-~lr
!In'Mllrlna IIrvle. nlU'" for for.. orderln'l In P.nn.ylvant. l-aOO-362-l0S0, ouhld. Peon.ylv",la Met
within 10cII Harrl.burg ar.. (111) 181-809lt, TOOl (111) 112'1.2S2 [H.arlng I~airad Onl~).
Any parb In Intarnt not ..thfted ~1th the apprall...nt, 11lo~ence or dlullow~. of cbduc:tJonll. or ......Mnt
of taJll (including dhcount or Interl.t) I' .hown on tnlt Notice IUlt obj.ct ~1tbln .bty (60) day. of rl<lll"t of
thlt Notice bYI
--written protl.t to the P' O,plrt..nt of RI~enu., Board of Appeal., Olpt. 281021, Hnrrl.burg, PA
--lllctlon to knva thl .att.r dlt.r.lned at ludlt of the .tcount of tha p.rsonal rlptl..ntlttvl,
-"eppaal to thl Orphan.' Court.
OR
1112a-1021,
OR
Feetun! .rror. dl.COVlrld on thl. ........nt .hould b. addr....d In Mrltlng tOI PA Dlp.rt..n~ of R'~I~,
lur~1U 0' Individual T'M", AlTMI po.t A.....-.nt R.vlew Unit, Dlpt. 280601, H.rri.burg, PA I11Z8~0601
Phone (711) 787-4S0S. S.. pl!llga 5 of thl bookl.t "In.tructlons for IMtrltanc. TI~ R.turn for I h,ldllnt
Oecldtnt" lREV-1501) for an 'MPlanatlon 0' adltinlttrfttJ",.1Y tortlctnbll errort,
If anv t.x due I. Plld within thr.. (3) c.lendar IOnth. .ft.r tnl decedent" death, I fl"'l Plrc~t (SX) dl.eount of
thl tex Plld It allowed,
The lSX tlM -.nI.ty non-p'rtlclp.tlon panelty l' coeputad on the total of thl t.x and Intar.st ......Id, and not
p.ld b.forl January la, 1996, tn. first day .ftar tnl end of thl taM .....lIty period, Thh non-parUc,lp.Uon
~Ity 11 app.alltlll In tt. .... laMlr and In the the .... ti.. period 81 you would apPIII thl tu and Inter..t
thet ha. bI.n ......ed al Indlc.tld on this notlc..
InterIPt It chatllld tMtOinnlne _lith first day of dlllnqulnCY, or nln. (9) IIOnth. and OM (1) day fro. the data of
da.th, to thl d.ta of pa~.-nt. T'M" which bee... dlllnquent blfor' January I, 1'82 blar Int.r..t at thl r.ta of
.IM ('Xl percllf'tt per ~ calculltad It a dally rat. of .000164. All taM" ""Ich bee... d.lInqu.nt on and after
JInUItY 1, 1'82 will b.er Internt .t . rat. loIhlch ~111 vilry frol c.l.ndar- yllr to callndar ~Iar Mlth that rata
~ed by t~ PA n.p.rt-.nt of Rov.nut. The applicabll int.r..t r.t.. for 1'82 tnrough 1998 arll
~ Int.r..t Rat. UallY Int.rllt factor ~ Intar..t Rlt. Olih Intarllt feetor
1982 20X .000S41 1'17 .~ ,0002"7
19I5 16:< ,000"58 1'88~1991 ax ,00nOI
19a~ 111( .oonOI 1992 .~ .000241
1915 m .oons' 1995-19lM 7X .OOO19Z
I'" lOX .OOOi!1~ 1995~1,"' .~ .000241
--Intar..t It cllculated .. follow'l
INTEREST . IALANCE OF TAX UNPAID X MUNIER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
--Any Notle. I..ued aft.r the tax bleGel' delinquent will rlflact an In1.r..t cllcul.tlon to flfttln (15) da~.
beyond the dlt. of the ........,..t. If PI)lHnt It ledlI .ft.r the Intarllt Coeputltlon datI thcM1 on tN
MatteI., MdltlOMlll Intar..t ...t be c.leul.tld,
~9, :0
\d ::0 (\)
en (t, n
.., ",., ':,/
::S ." (,
{'C ,
, i1Q
~J
LoJ
0
:g ~, -,
"-' 0' ()
0 .,.
"0 L,
J". ~1 ~