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COMMONWEALTH OP PENNSVLVANIA' OEPA~TMENT OF HEALTH' VITAl. ~ECO~DS
CERTIFICATE OF DEATH
"""'DflCllClDlHJ(1~.Mlldt,l",
,. David A. Robertson
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1712 Elm Street, New ClllIDer1811d PA 17070
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LAST WILL UD TESTANlNT
0..
DAVID A. ROBERTSON
I, DAVID A. ROBERTSON, of the Borough of New CUmberland,
CUmberland County, PennSYlvania, declare this to be my last will and
r.evoke any will previously made by me.
lTEM II I give and devise my real property situate in WinSlow
Township, J.efferson County, Pennsylvania, consisting of 0.54 acres,
more 01' less, being identified 011 the Jefferson County Tax Map as
Parcel No. 43890112A, and having been left to me in Jefferson County
Will Book 19, Fage 897, to my nephew, GEORGE R. ROBERTSON, 1.f he
survives me, and if he does not survive me, to his issue, per stirpes.
ITEM ~I I do not find it necessary in this will to provide for
my wife, RUTH M. ROBERTSON, although she may become the surviving
joint tenant of real and personal property which we may hold as
tenants by the entireties. The reason for this decision is her
deClining physical and Inental condition at the time of the execution
of this will, I am confident that my daughter will provide for her
need and comfort should she be unable to do so for herself.
ITEM III: I devise and bequeath the rest, residue and remainder
of my estate, real and personal, to my daughter, JUDITH ANN DILLEN.
Should my daughter, JUDITH ANN DILLEN, predecease me, I devise and
bequeath the rest, residue and remainder of my estate to her issue,
Page 1 of 4
c..,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 200601
HARRISBURG, PA 17120-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Off-IUM lI~lI.mILY
I ,- 'J -, C
~). '...... ~_ ,I
Ilf
FILE NUMBER
COlJNf},:Ulll
1997
YfAFl
NJ9"\~
DECEDENT
DECEDENT'S NAME (lAST, FIRST, AND MiDDLE iNITIAL)
Robertson, David A.
SOCIAL SECURIlY NUMBER IDATE OF DEATH-----.rDArE'OfBIRTH- .
194-14-9307 __L 09/05/97 01/08/1917
(IF APPliCAa",SUflVIVINQ SPOU", '8 NMo1'-(LA',', J SociAL "ECU'RilY NUM-BE~THIS HETURHMUST BE FILEiiiNooPLlCATE'
mWT, AND MIDDLE INITJAI) .,
WITH THE REGISTER OF WILLS
----
Igi I i R 3 fl~tTlall1dfH Rltlurn
1. Or na Hoturn 2, Supplomenla olllln (d.ltllul dulhIHlllf10 '''-IJ-a2l
4a FlIturlt InllHII~t (;()lllIHOllll~1l FIE T R Rid
4. lImltod Eslata ' ((Iahl of UlldUI "litH 1;(. 12-8;.>) 5. -tJdm8 slalo ax lilt oqu ro
6. Dlc.d,nl Died Tntate 7. tlllredllnt M/llfltilllllHI it L.I~Hl~ Trust 0 6 TOlal No 01 Safo Doposll Bo)(os
(Alllchcopyol Will) ~A1I4Ch copyol TruSlj '_ '
e,_Lltl allon !roceeds Recoil/ad 10, ':!:~:\If;~~'~~~/~~ ~;!~1111(d!11tl (II dealtl tlo\we:I:__,-=rr.11, tAI~t~~;~n[;12htbl undlf SIC. 81 13(A)
1'1111 8ECTION MU8T lIli! COMPLITED. ALl. CORRESPONDENCE' CONFIDENTIAL TAllINFOII,,!-,TION l!!tOOUllll DIIIICT!D TO:
NAME COMPLETE MAILING ADDRESS
Charles II. Stone 414 Bridge Street
FIRM NAME (iI Appilcabla) New C.\urberland, PA 17070
Stone Waver & Stone
TELEPHONE NUMBER
717-774-7435
CHECK
APPRO-
PRIATE
BLOCKS
CORRES-
PONDENT
1. Roal ESlala (Schadulo A) (1)
2. Stocks alld Bollds (Schadule B) (2)
a. Closelv Held Corporalloll, Partllershlp
or Solo-Propriotorship (3)
4, Mortgage. & NOles Recelvabio (Schedule D) (4)
5. Cash, Bank Deposiln & Miscollaneous Porsonal
Proporty (Sohadulo E) (5)
6. Jolntlv Owned Propal1y (Schadulo F) (0)
7. Intor-VIYos Transfers & MIscellanoolls
RECAPIT - Non-Probate Proporty (Sched"la G or L) (7)
ULATIOM
56~~)
OFFICIAL. USE ONLY
4..'
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DIn
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h
None
None
t
~,
i'I_'J
None
~e
\;)
;.')
t-.....J
"
I"
None
6. Tolal Gro.. AI.eta (lOla' Lines 1-7)
9. FunoraJ E)(penses & Administrative Costs (Schedule H) (9)
10. Dabts 01 Docedom. Mortg. liabilities, & Liellslsoh. II (10)
(8)
3,500.00
None
566.40
11, Tolal DeduoUona (Iotal Lllles 9 & 10)
12. Net Valu. 01 E.late (LillO 8 millus Line 11)
13. CharUabla and Govornmemai Boques(s/Sec 9113 Trusts
lor which all eleciloll to lax has Ilot boen made (Sched"le J)
(11)
(t2)
-.------
3,500.00
(2,933. 6Ql
(13)
None
14. Net Value Sub ect to Tax Lille 12 mlll"s Line 13
15. mount 0 Ina 14
I""abie a( tho .pousal
lax rale
Soo illstrucliolls on pago 2 lor applicable porcomage
16. Amount 01 iln014
taxablo ot6% rate
17, AmoUllt 01 illla 14
'""ablo at 15% rota 0.00 . :15 (17)
16 TIM Due ..1!.'!L..--
19. Cli~K HERIIF YOU ARE ~STING A REFuND~ OVERPAYMENT '__ .
1>" BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND RECHECK MATH << ~
Onder penalllo. 01 porJury, I doclaralhall havo O.aminad tills 'otUln, includlllg accompanvlllg schod"lo" R,;iff.iiiiii'ii'ieIlIS, alld '0 Ihe be_t 01 mV knowlodgo
and bollef. III. true, conoclalld comploto. Oeclaratlon of preparer OlhOl tha"lho porsollallaplOoolltatlva is boood on aillnlOlmalloll of which praparor hae
any knowledge,
SIGNATURE OF PEAMN HESPONSlfll.E FOA F1tINO RETURN
1 ."") 1(1
H...L-l ~-..(i .'...'__/
St T.Y,A _ FPRE~EAOTHf:ATHA~~~PIU~HHA1W[
r 1 <<~(J.r jj {f~.~. . _
'7 PAtll101 NTF '"''
Copyrlghl Forml SOllW/lfl Ol1ly, liilr Nlllco, Inr.,
14
(2,933.60)
0.00
0.00 . L..
(15)
TAX
COMPUTA-
TION
0.00 .
.06
(16)
0.00
0.00
0.00
ADDfU':S8
See Schedule attached
AOOfl(5f>
414.Bridge Street
New Clurberland, PA
170'10
DArE .
(,,/..'i/ 'IS'
"
IlATV /:' /, '
(./ ,'"/,
Page 2
PA. REV-1600 EX (1-97)
Decedent'. Complete Add"..:
STREET ADDRESS
1712 Elm Street
CITY
New CUnilerland
Tax Plyment. Ind Credits:
1. Tax Duo (P.g01 Lillo 18)
2. Crodlts/Payrnolllo
A, Spousal Povorty Crodll _
B. Prior PaymolllS
C, Dlscoulll
lamE -~
PA l. 7070
(1)_ o.~
0.00
0.00
Totsl CrodllO (A + B + C) (2)
0.00
3, IlltorosVPollalty II appllcabl.
D,llltoroot
E, POllalty
Tolslllll..o.IIPonalty (0 + E)
4, IIl1no 210 groalor Ihsllllllo 1 + 1I1l0 3, olllor 1110 dlll..olloo. Thl.l. 1110 OVERPAVMENT.
Check boa on PI"" 1 Un. 19 to requeatl relund
8. II IIno 1 + 1I1l0 31s groator Ihallllllo 2, ollt.. 1110 dlll..onco. Tl1lolo 1110 TAX DUE.
A, Ent.r Iholnl.rool Oil Iho lax duo,
B. Elllor 111. total of Lillo 5 + 5A. This 10 111. BALANCE OUE.
Make Chock Payable to: REGISTER OF WillS, AGENT
(3) 0.00
(4) 0.00
(8)
(8A) 0.00
(8B) 0.00
ANSWER THE FOLLOWING QUESTIONS
BY PlACING AN "X" IN THE APPROPRIATE BLOCKS
Vo. No
~ I
1, Did decodont moko a Irallolor and:
a, rolalll tho use or Incomo 011110 propOlty trallolorrod;, . . . . . . . . , . . . . . . . , , . . . . . . , , , . , . .
b, rotalll 1110 rlghllo doslgllate who shall usolho proporty translorrod or lIs Illcome;. . . , . . . . , , . , , . . ,
o. rEltatn a, reversionary Inlerosl; or. , , , , , . . . . , , , ,. ,.,.""..'""....,' . , , , , , . . . , , , , , ,
d. recelvolhe promise for IIle of elthor paymelllo, bollolilo or caro? . , . . . . . . . . , . . . . . . . . . . . , . . , . . . .
2. II doalh occurred Oil or bolore December 12, 1982. did decode III wlthllllWO yoars
procedlng dealh Irelloler proporty wlthoul recoivlllg adoqualo consld..alioll? It doalh occurrod
oller Decembor 12. 1982. did decodolll Irallolor proporty wllhlll one yoar 01 doalh wlthoUI
receiving adequole conoldoratloll?, . . . . , . . , , . . . . . , , . . . . . . . , . , . . . . . . , , , . . . " , , , . . . . . , . . , . . ., 0
3. Old cler.odenl own Oil "In trusl lor' or payablo UpOIl doalh bank accounl or socurlty
.t his or her de.lh? . . . . . , . . . . . . . , . . . . . . . . , . . . . . . . . . . , , . . . . . . . . , . . . . . . . , , . . . . " . .
4, Old decedent own .Il illdlvldull retlromenl OCCOUIl\' allllulty, or olhor Iloll'probato property? . . . . , . , , , . .
~
B ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
COMPLETE SCHEDULE G AND FILE IT AS PART OF THE
72 P.S.19116 (a) (1.1) (I) provldod for Iho reduction 01 tho la' ralelmposod Oil Iho net valuo 01 tranoforo to 01 lor Iho use 01 tho surviving spouse 110m 6% to
3% lor dalee of de'lh on or .lIer July 1, 1994 and boloro Jalluary 1, 1995.
72 P.S, 19116 (I) (1.1) (II) plOvldod lor Iho roductloll 01 Iho ralelmpoood Oil thollol value 01 Irallolero 10 or ler Iho uso 01 Ihe Burvlvillg opousolrom 3% 10 0"10
tor doles of de.lh on or .1I0r J.nu./V 1, 1995. Tho olalulo does llol o,emol a Ironoler 10 a oUIvlving spouse Irom lOX, alld Iho sl.lutory requlremenl. lor
disclosure of .....10 .nd IIlIng a 10)( relurn .ro ollll.ppllcablo .vellll Iho oUlvlvlllg opuuoo 101110 ollly bonotlola/V.
FOR DATES OF OEATH ON OR AFTER JANUARV 1, 111115 -- Plo.oo allow.. lholollowlng quoolloll by placing all "," In tho approprl.le opoco,
DId the ...._nl oreatl I tru.t or .Imll.r ,,,".gement whloh I. .01.IV lor the .urvlvlng """u.... benellt lor hi. or her enUrelll.Ume?
Ve. 0 N"~
II you .now.red yes 10 Ihe .bove queotlon, Iho I.. Oil Ihelrusl or .'milar .rrallgemelltls pOSlpOllod unlll the doalh 01 the oooolld Bpouoe, .1 which limo II will
bo lully tax.ble al 'he rale(o) appllc.blelo Ihe remallldor bol1ellcl./V(loo). Enter tho v.lue ollho Irusl Oil Schedulo J, Part II, In ordor 10 removo " hom the
oalcul.llon 01 Ihe lax due In Ihlo eolalo. You may wloh 10 11I0 Schedulo 0 in Older 10 make Ihe oloollon avallBblo ulldm SOCtlOIl 9113. II tho olocllon iB m.de.
the trust or ~mllar arrangomant Islaxed In tho estate 01 tholiml decodont spouse, tho portion oltha tnlSt or simIlar arrangomont which benefits tho surviving
apouse Is taxed al the zero 10' r.lo. .Ild Iho remallldor is la.ed al 1110 ralo(o) appllc.bio 10 tho rem.'ndor bonohcia/V(los). II you choose 10 mako Iho elecllon,
you roost .u.oh Schedule 0 to . tlmely-lIIed la. relurn, alollg wlll1 Schodulo(s) K alld/or M in order to Bhow tho appor1iolllOOlll ollhe truol or 9111'0101
arrl11lJOment bo\W88lllhe ourvlvl1l9 opouse .Ild lho rom.lllder bollollolaly(loo).
7 PA15002 NTF "'10
Copyrlghl florml SoftWlr. Only, 11191 Nelco, Inc.
.p\W4~l"tDrt.on,ct.\l-9'
LAST WILL AND TESTAMENT
OF
DAVID A. ROBERTSON
I, DAVID A. ROBERTSON, of the Borough of New Cumberland,
Cumberland County, pennsylvania, declar.e this to be my last will and
revoke any will previously made by me.
ITEM I: I give and devise my real property situate ~n Winslow
Township, Jefferson County, pennsylvania, consisting of 0.54 acres,
more or less, being identified on the Jefferson County Tax Map as
Parcel No. 43890ll2A, and having been left to me in Jefferson County
Will Book 1.9, Page 897, to my nephew, GEORGE R. ROBERTSON, if he
survives me, and if he does not survive me, to his issu.e, per stirpes.
ITEM II: I do not find it necessary in this will to provide for
Iny wife, RUTH M. ROBERTSON, although she may become the surviving
joint tenant of real and personal property which we may hold as
tenants by the entireties. The reason for this decision is her
declini.ng physical and mental condition at the time of the execution
of this will. I am confident that my dauq-hter will provide fot' her
need and oomfort should she be unable to do so for herself.
ITEM III: I devise and bequeath the rest, residue and remainder
of my estate, real and personal, to my daughter, JUDITH ANN DILLEN.
Should my daughter, JUDITH ANN DILLEN, predecease me, I devise and
bequeath the rest, residue and remainder of my estate to her issue,
Page 1 of 4
r. \d.d \AOliIRTSH. EXIi
~
,
., .
TH:(S IHDI!lNTURE made the ;"'-, day of \ f,(.~" , in the year 1998,
between JUDITH ANN DILLEN, as Exeoutrix'of the Last Will and Testament
of DAVID A. ROBERTSON, late of the Borough of New Cumberland, County
of Cumberland, and Commonwealth of Pennsylvania, of the first part,
hereinafter oalled the Grantor,
- AND -
GEORGE R. ROBERTSON, of the second part, hereinafter called the
Grantee1
WHI!lREAS, the said DAVID A. ROBERTSON beoame in his lifetime
seised, as of fee, of and in to a oertain traot of land, together with
the improvements thereon ereoted, sit.uate in the Township of
Winslow, County of Jefferson, and COIlUDonwElalth of Pennsylvania, and
more particularly described hereinafter; and being so thereof seised,
died on September 5, 1997, having first made his Last Will and
Testament in writing dated March 3, 1995, duly probated and registered
in the Office of the Register of Wills of Cumberland County on
December 23, 1997, wherein and whereby he appointed as Executrix, the
said Judith Ann Dillen, to whom letters testament.ary were duly issued
by said Register of Wills on December 23, 1997, and wherein and
whereby said premises hereinafter described were specifically devised
to GEORGE R. ROBERTSON, in ITEM I of the Will, all as in and by said
Will and the records of said Register of Wills more fully appears;
- 1 -
..
NOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in
consideration of the sum of ONE AND NOII00 Dollar, which hils been paid
to her by the said Grantee at or before the sealing and delivery
hereof, receipt whereof is hereby acknowledged, has granted,
bargained, sold, aliened, released and confirmed, and by these
presents does grant, bargain, sell, alien, release and confirm unto
the said Grantee:
ALL THAT CERTAIN lot of land situated in Winslow Township,
Jefferson County, Pennsylvania, bounded and descri~ed as follows:
BEGINNING at a post; thence North 29 degrees West, 9.8 perches to
a stone; thence North 89 1/2 degrees East, 20 perches to a post;
thence South 60 1/2 degrees west, 17.7 perches to the place of
BEGINNING.
CONTAINING 86.7 square perches, or 0.54 acres, more or less. The
northeast line of said described piece of land is on line of land now
or formerly of Samuel Fye and the southwest and northwest lines
thereof are on line of land now or formerly of Samuel Steele.
BEING the same premises which the School District of Winslow
Township, Jefferson County, Pennsylvania, b~ its deed dated March 13,
1944 and recorded in the Jefferson County Recorder of Deeds Office on
May 31, 1946, in Deed Book 237, Page 247, granted and conveyed unto
Tom Robertson. See also proceedings in the estate of Thomas A.
Robertson, alkla Tom Robertson, in the Court of Common Pleas of
Clearfield County, pennsylvania, Orphans' Court Division, and
Jefferson County will Book 19, Page 897.
- 2 -
,.'
TOGETHER with all and singular the buildings, improvements, ways,
streets, alleys, passages, waters, water-courses, rights, liberties,
privileges, hereditaments and appurtenances whatsoever, thereunto
belonging or in any wise appertaining and the reversions and
remainders, rents, issues and profits thereof, and all the estate,
right, title, interest, property, claim and demand whatsoever of him,
the said DAVID A. ROBERTSON, at and immediately before the time of his
decease, in law, equity, or otherwise howsoever, of, in, to or out of
the same.
TO HAVE AND TO HOLD the said lot or piece of ground above
described, with the buildings and improvement~ thereon erected,
hereditaments and premises hereby granted or mentioned, and intended
so to be, with the appurtenances unto the said Grantee, to and for the
only proper use and behoof of the said Grantee, forever.
And the said Grantor, for herself and her respective heirs,
executors and administrators, does covenant, promise and agree to and
with the said Grantee, his heirs and assigns, that she, the said
Grantor, has not heretofore done or committed any act, matter or
thing whatsoever whereby the premises hereby granted, or any part
thereof, i~, are, shall or may be impeached, charged, or encumbered in
title, charge, estate or otherwise howsoever.
This is a conveyance to confirm title in a devisee and is exempt
from all realty transfer taxes.
- 3 -
Inventory of the real and personal estate of
1l0vId A. HolwrtHo.!l.-
deoeased
1----
I HEAl, I'H()I'IIHTY
l'arcel of lond In WInslow TownshIp. Jefferson Co., I'A b,dng .'\!fferHon County Tox
Pal'cel 1140-389..112-A. (101' tl.tl.e see .Jeffel'Aon County Ileed Ilook 237. Page 247,
proceedings In the t:statc of ThomaH A. RobertAon in .JefferHon County WIll !look 19,
l'age 897 I and t:xecutl'ix' A deed confIrming tho devhlC In ltom I of the wIll. Value
is based on aAAeAsment of $120.00 times comlnOIl level l'atlo of 4.72
PERSONAL PROPERTY
NONE
N 1:'<;(
'0 I?, :~1 0.-;
!'! 0\ ",
, ~ 1 .: ::: <:c
CO
I
.,... ,
, , ~
:i) .l~
tl ': ~\
U "~ ~ ~8
c!o.
$566 40
COMMONWEAlTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
HI
,Judith Aun 1l111"11
-~.~. "-~---_~_"'~T"".'
boing duly___..,..H_~''!'.\__, _ ..'_ according to law, dopoltl and lay. that Aha .1 A Ex""u t r ix _'_~_
.---.---...'---.-....--...- of tho Eltat. 0' Illlvid A. RobertA(ln ___,_
lato of _Nuw (;lImll\ll'] fllld Borough __~.__,.__, Cumbarland County, Pa., daculed and that the
within il .n Invontory m.dn by__"....J~lliH.!LA!.~~U!..!.l!!~'-___ ._ _'__., the lald~ocutix .
of tho ontlro oltato of laid decode nt, conllatlng of ./1 tho porlonal prup.rty and r..1 ..tate, .xc.pt r..l eltat. oultlde
tho Commonwealth of P"nnlylv.ni., .nd that the flgurol oppollle oach It.m 0' the IlIventory r.pr..ent It'. f.ir value
II 0' the d.te 0' decodont'. de.th.
19
~. 11
. till 4~ CZiil?.!=.________
Jll t h Ann S.".toF!X",",...mtlrftor
Dill en
257 S, Lewisberry Road
and lublcrlbed be'ore mo,
Mechnni(!HbllrR, PA 17055
Addr...
Date 0' Duth
05
D.y
09
Monlk
1997
v..,
INSTRUCTIONS
I. An Inventory mUlt be flied within three month. .ft.r appointment 0' por.on.1 "p"lenltl/n.
2. A luppl.ment inventory mUlt be flied within thirty day. 0' dl.covery 0' additional a...t,.
3, Addltlona' Iheelt may ba .ttached 01 to porlonalty or realty
4. See Artlola IV, Flduciori.. Act 0' 1949.
I i
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
)5'. )M) . 1 L/
BUREAU OF INDIVIOUAL TAXES
tMHERITAMC[ TAX nlVt~lOH
OCPl , .21060 I
HARRISBURO, PA 11116-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-17-1998
ROBERTSON
09-05-1997
21 97-1015
CUMBERLAND
101
EMountR,eIlIHod -=l
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ... REThIN LOWER PORTION FOR YOUR RECORDS ~
REF is;;7-EX-Aj:in oq-:9'f'--iiiificEuOF-YNHEiiiTANCE-TAX-jiPPRA iSEHENr;-,\L.i:owiiiicE-OR'-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
DAVID A FILE NO. 21 97-1015 ACN 101
If an asseBsmen~ waB issued previously, lines 14, IS and/or 1&, 17 and 18
reflec~ figures ~hat include the total of ALL returns assessed to date.
ASSESSMENT OF TAXI
1S. AMount of line 14 .t Spousal ~.t.
16. AMount of line 14 taxable at Lina.l/Class A rat.
17. A.ourlt of Line 14 taxable at CoUateral/Class 8 rat.
18. Principal Tax Due
TAX CREDITS I
PAYMENT
DATE
CHAllLES H STONE
414 BRIDGE ST
NEW CUMBERLAND
PA 17010
ESTATE OF ROBERTSON
TAX RETURN WAS, (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. Rool E.t.t" (Schodulo AI
2. stocks and Bonda (Schedule 8)
5. Closely Held stock/Partnership lnt.rest (Schedule Cl
4. Hortgag../Not.. Receivable (Schedule 01
S. Cash/Bank Deposits/Hisc. Personal Property (Schedule El
6. JointlY Owned Property (Schedule f)
7. Transfer, (Schedule Gl
8. Total A,..t,
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expen,../AdM. Costs/Hisc. Expenses (Schedule Hl
10. Dobts/Mortgogo Llobllltl.s/Llons (Schodulo II
11. "ot.l Deductions
12. Net Value ~f Tax R.turn
13. Ch.~it.bl./GoY.~nft.ntftl Bequests) Non-elected ~113 T~usts
14. Het Velue of E,t.te Subject to Tex
NOTE I
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (,)
) CHANGED
(1)
(2)
(31
(41
(51
(61
(7)
566.40
.00
.00
.00
.00
~
.00
(8)
6
*'
(91
(101
3.500.00
~
(11 )
<12l
(131
(14)
UV.IS~' U UP (...."
DAVID
A
(Schedule J)
(15)
(16)_
(17)
.00
.00
.00
DATE 08-17-1998
NOTE I To insure p~op.r
oredit to your eccount,
subMit the upper portion
of this form with your
tax paYM.nt.
566&
::L linn nn
2,933.60-
.00
2,933.60-
will
X .00=
X .06=
x .15=--
(18)
.00
.00
.00
.00
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
---
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL. INTEREST.
( IF TOTAL DUE IS LESS THAN fl, NO PAYMENT IS REqUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREon" (CRI, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
If'l
-~ t
lX'"
"'....
'e5
qi:"
"
~~
~
,1,1
'j': rJ
'9
00
M(llRVAflDHI e.t,t.. of dtctd~t. dying on or before Oece~'r 12, 1982 ~- if any future lnt,r..t In the e.t.t. I. tran.f'rrtd
'n po"'1I1on or enjoy..nt to Chili I (coll,t.raU beneflclari.. of the d.c.dent after the e)(plr.Uon of WIll ..tet. for
Uf. Dr for Y,lr., thl COtIlaOflWealth h.reby .xpreuly r....rve, thtl right to appr.h. Wld a..... tran.f.r IntMlrhenc. nile.
et the lawful Cl... IS (coU.t.r.ll rlh on ,my "uch future lnt.re.t.
1~,,"WIlt
HOlltr.
To fulfill the requlre'Gots of Section 2140 of the lnherHanoe end Estate hue Act, Aflt 21 (If IfJ9!i. (72 P.S.
lilotlon .140),
l'AV"fMI t
l~h'Clh the top portion of thlt tbtiC8 amI ;lub.it with your pay.ent to the R~ghhr of Willi printed 00 ttt. r.ver.. licit.
~n"Mt. ahlok or .oney order payable tOI REGISTER Of MILLS, AOENT
Ml'rtIHD leM'1
A refund of a t.x oredit, which wat not requlsted nn the Ta~ R.turn, .ay bl r.que.ted by c~pletine an "Appllcetlon
for R.fund of "enn,~'lv'nla Inh.rltllnce and Estate Tal<" IREVN1313). AppUcotJons are Iv.llabl. .t the Dfflc.
of the Aeglat.r of Will., 'ny of the 2~ R,v'nl~ Distriot Offlc.s, or by calling th. sPlclal 24Nhour
.".w.rlng ..r~lc. nu.b.rs for for.. orderine: In Penn5ylvanl~ 1~800-362-20S0, out.ld& P.nnsYlvanla end
within 10Qal Horrl.burg ftrea (717) 787-8094. TDO' 1717} 772~22S2 (H.aring l~.lr.d Only).
OIJF.r.lIONSI An~ p.rty In Int.r..t nDt satlsfl'd with the .pprals...nt. allowanc. or disallowance of d.ouctlonsl or ........nt
of taM I including discount or inter.~t) a. shown on this Notice .ust Object within sixty (601 day, of r.c.ipt of
this Notlc. b~1
ADMIN
IITOm!/[
COMtt[ClUlNSI
~-wrlttan prot.st to the PA Depart..nt of RO\l.rn.le, Board (}f App.als, D.pt. 281021, Harrhburg, PA
~n.l.ctlon to have the .ath,r deteralned at audit of the lu:count of the parsonal rIPI'..entaUva,
--app.al to the Orph.n.' Court.
17128-1021,
OR
OR
Factual .rror. dhcover'd on this OIlOssll.nt sht.JUld b. addressed In writing tOI PA Depart"nt of R.v.nue,
lur.au of IndJvldual TaxIS, Alith Po.t AlIloSta.nt Ravlew Unit, D.pt. 280601, H.rrlsburg, PA 171211-0601
Phone (711) 7a7~6S0S. S.e page 5 of the bookl.t "Instructions for Inh.ritanc. Ta~ Raturn for. R.sldent
Deu.dent" (REY-lSOI' for an explanation of ad.inistrat~velY correctable .rror..
blltlMllll<
If ~~ tax due I. paJd within thr.. (~) cal.ndar .onths after the d.c.dent's d.ath, . fJv. p.rcant 15~) dlsc~t of
the taM P.ld I, .llowed.
PfN.\llV.
The 15~ t.x elH1lsty non-participation penalty Is COllput.d on th. tot.1 ot' the ta~ and Inbrest ...."'.d, and not
paid before JlIOUary 18, 1996, the first dll~ .ft.r the end of the tax ..nash pel'lod. This non~partlcipetlon
penalty I. .ppe.l.ble In the .... ..nner .nd in the the 'D.. tl.1 p.rlod 85 ~ou would 8p~..1 the ta~ and Int.r..t
UWllt ha. be.n ....u.d .. Indicated on thlt notice.
'HTlIIE'l.
Int.re"t It charg.d beginning with first dlY of cktllnquonoy, 0" nine (9) .ooths ond one (1. d.y frotl the date of
death, to the date of pay..nt. T8~" whtch b.e..e delinquent before Janullry 1, 1932 b.ar intllre.t at the rate of
.I~ (6iO fllro.nt p.r aMUII calculat.d ftt a dally r.te of .000164. All tal(8S which beo'''D dllUnqu.nt on .nd aft.r
Jlnuary I, 1982101111 bur inter'lIt .t a r.t. which wIll vary fro. ottlender yaar to calendar y..r with thet rete
lNWtouno.d bV the PA o.Plr'i:.ent of RevenlHl. Th. applicabl. Jnbrest rates for 19112 through 199& .,..:
~ Int.r..t R.t. Oath Interest factor :!!!l' lnter.st Rab D.lly Inter.st fector
1982 20;( .OO05~8 1987 9% .000247
I'", 16% .000438 1988-1991 ll~ .000101
19.~ 11% .000101 1992 9~ .000247
198& U% . 000156 l'J9~-1l)94 71. .000192
1966 lOr. .000274 1995-19911 9% .000247
~~lntere.t it (Il1loulllt.d .. folloWlI1
INTEREST . BALANCE OF TAX UNPAID X NU~BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any HotlQ' luued Ift.r the tex beco... dellnqu.nt will reflect .n Int.r.st ultlcul.Uon to flft.In (5) day.
beYood thl date of the ........nt. If ~lIly..nt Is ""de aft.r the int.rest eallpuhtlon deb IIhown on the
Notlc8, additional Int.r..t .u.t b. o.lculated.