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No. 21-80 atiS.
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
D,<I1 ",
in the Estate of BERNT ~ LUNDBECK , deceased.
Mary C. Lewis
To nicl",8ra E. AAQemQr:l, Register of Wills for the County of Cumberland,
in the Commonwealth ot Pennsylvania.
IS
Petitioner(s) GJla,.N,e execut~__ named in the Last Will and
Testament of Bernt Oscar Lundbeck dated 23rd June, 1970 ~ (~~~,~
Decedent was a citizen of the United States and a resident of 5 Richland Lane (,"".....
~qr1 P<,^""kar. Township l ~ I
~ 8orlOllI!!Jhs Cumberland County, Commonwealth I ~7:1,
of Pennsylvania.
Decedent died on Hednesday the '~"'", day of May
A. D. 19~, in the County of
Cumberland
, State of
at the age of 85 years.
~ ~ me"
Decedent. has. not been married and tras not; had children born to him
since the execution of the above described Will.
Decedent was possessed of personal property to the value of
$25,000.00 and of real estate to the value of
-0-
as near as can be ascertained; said real
estate situated as follows
QW~
Therefore, your petitioner(s) respectfully applies for the probate
of the said Last Will and Testament and for Letters Testamentary thereon.
Dated June 3 1980
Name and address
of Petitioner(s)
CCNB Bank, N. A.
331 Bridge Street
New Cumberland, Pa.
~"--~AA.J>-'2
COMMONWEALTH OF PENNSYLVANIA}
ss
COUNTY OF CUMBERLAND
p." C, kva"".....
of CCNB Bank, N. A., Executor
named in above application, being duly sworn according to law
say(s) that the statements set forth in this petition are true to the
best of
his
knowledge and belief.
Sworn to and subscribed before ~)(. - s~..(1
mo.", ,,,,,' f; 19 80
,-/ '}' ruJ
.~;~ [~^Ad . n, R~gister
, MD
v-I'
Filed;
.;:U-h-38-/
June 5, 1980
//- t.''1-~
Attorn(2{( vi) fJJ &JJ2ifJ
. .
,
before this Will, for administration and distribution as part
of said trust.
IV.
I appoint CUMBERLAND COUNTY NATIONAL BANK AND
TRUST COMPANY Guardian of any property which passes, either
under this Will or otherwise, to a minor and with respect to
which I am authorized to appoint a guardian and have not
otherwise specifically done so, provided that this appointment
of a guardian shall not apply to property distributable under
this Will to a minor for whom special provision has otherwise
been made herein and provided further that this appointment of
a guardian shall not supersede the right of any fiduciary in
its discretion to distribute such share to another for the
minor's benefit. Such guardian shall have the power to use
principal as well as income from time to time for the minor's
support and education (including college education, both gradu-
ate and undergraduate) without regard to his or her parent's
ability to provide for such support and education, or to make
payment for these purposes, without further responsibility, to
the minor or to the minor's parent or to any person taking care
of the minor.
V.
In addition to powers given by law, my personal
representatives and their successors shall have the following
powers, to be exercised in their sole discretion:
A. To retain any real and personal property which
may at any time form part of my estate as long as they may
deem advisable;
B. To sell at public or private sale, for cash or
Page 2 of 3 pages
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OATH OF SUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND \
This................: ........??:>:':"..~. ...........' .......... ........... day of.., ....., .....~~~~......,.................................... A.D., 19.~.?....,
Mary c. Lewis
before me ~i9luud Ii: ~ _~n_nn", Register for the Probate of Wills and granting letters of Administration
in and for said County of Cumberland, in the Commonwealth of Pennsylvania, personally came ..............
......................................... ~~ ?r:.":.7.~..~.:.. ~~ ~~ ~......~.~. ~.....::;..~. ~.~.t r}..... (-:I..:. .?:~. '" )oLI/.............................................
the subscribing witnesses to the foregoing instrument of writing purporting to be the last Will and
Testament o.~~/l61::-~~~':'~~I,..V.l),C!!?~.9~.... ........ .......... ........ ...... ............ .... Dated .}.~.ry.7..n.l. ..~.~.~~......... .....
lateof..............::....I.~~~..~?~.~.~.~R............................................................... Cumberland County Pa., deceased
who being duly ......~~.?r;.'!............................ according to law, depose and say, thaID!\y...\'(~~......................
Bernt Oscar Lundbeck
present, imd saw and heard the testa...toz;.......................,
.............................................................................
sign, seal, publish, pronounce and declare the said instrument of writing as and for hJ.~............ Testament
and Last Will, and at the time of so doing .................n\!.............................was of sound and disposing mind
memory and understanding, to the best of .......~~.~..................................knowledge, observation and belief.
...............~!'!f!m.J.9................. and subscribed before
.....~.~.41..J.J..~.............................
~:::.:t~~.........
...qJ;~...e.:.. ~:v.:Yl.......................
RieL.!!. v...e.., =r
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND \
................. .....t'(,..~.:..'.I{t.."'.~.~.r..(.......,.~. ...c..c,#..8...8..,., :~..'5.....~.~...... .............. ......................being duly
............swat:n......,'................... says that as nearly as can be ascertained the said decedent ..........................
. .... .......... ...... ..B.er.o.t..D.sS:ilx..Lllnd\>.e\;~................. ........ ...... ........ ........ ...... ............................ .....................died on
~~ 8
...........l<ledJ:l.eJi.dilY.................... the .......J!ff.t;lJ'.................day of ........~.~:l....................................... A.D., 19...Q..,
at or about .......................................... o'clock, ....M.
............SwaJ:n..t.O.........................and subscribed this
3rd
................................................ day of ....June............
..~.........................................
19, ..80.., before
m~~e. :d~m
Riel.a. . !!Aon. R~~;
''J'~~
..II ,~...
. ,.
COMMONWEALTH OF PENNS~L"VANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLlCA TION FOR AND CONSENT
, TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
*
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby mode for CCI1sent to the tronsfer of the lallawing securities 01 0 Pennsylvania
Corporation or 0 Notional Bonking Association located in Pennsylvania:
(0) 50 (b) westinghouse Electric Corp. (c) Common
(NOTE: In describing securities enter in (0), ob Ole, either the number 01 shores 01 stock or the lace omount of
registered bonds, in (b), the nome of the issuing company and in (c) the closs 01 stock or the stoted interest rote
and maturity dote 01 registered bonds.)
DATE :1"...... !':II I'frD
ISSUED ON Jan. 2, 1980 ,and having 0 TOTAL MARKET VAtUE OF $ 1,200.00
(Date) Bernt O. Lundbeck May 2f, 1980
os 01 the dote 01 death 01 the decedent, ' on
(Hame of Decedent) {Data of death}
h I f 5-B Rdlchland Lane
w 0 was ate 0
(Street and Humber)
Camp Hill
Cumberland Penna.
(Po.t Olllee)
(County) (State)
The securities ore registered os follows:
Bernt O. Lundbeck
(Nome or nomes In which certificates are registered)
~CNB Bank, N.A., 2101 Market St., Camp Hill, Pa. 17011
EXECUTOR) (Name) _(,Add,u.l i i
NAME OF APPLICANT R. C. Kramer, Asst. V ce Pres dent
ClUJ 'I........tlL 6!J:.L\o06r
COUNTY FILE NUMBER~-:> I-/t - JJ'/ ADDRESS OF APPLICANT 2101 Market St., Camp Hill, Pa.
J./ull
BUREAU FILE NUMBER SIGNA TURE OF APPLlCANT...a.tJi.. ~~
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NbT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
DATE
I hereby consent to the transler 01 the above securities noW registered in the nome 01 t
Decedent ond waive the liIing of 0 certilicate certilying to the poyment 01 the transler inheritance tox to which
the property 01 said Decedent is mode subject pursuant to the provisions of the Act 01 June 20, 1919, P.L. 521,
os omended ond the Act 01 June 15,1961, P.L. 373, os omended. This is also in accordonce with the provisions
01 the Act 01 April 9, 1929, P.L. 343.
This Consent to Transler the herein described property operotes only in reference to the estate 01 the
abave.named Decedent.
.~
Signed lor the Secretory 01 Revenue
cA' ~~ 'I
By ~ ~.~ .~~~
Q ,(SI~ tu,e) ~
~<,f.-J ';a1~.J!.<A~"C
1.J'le) (County)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I.
J
55:
R. C. Kramer. Asst. Vice President & Trust Officer
- ,---_. --.--.---...-- -.,-....-.. - .-.- _.~--_.,_._-_.._-----_._----_.__._-
sworn d' I d d h h is executor
being duly _ ...._..._ accor '"g to aw, eposes an says t at a ....-.--.---.-.-.-
..__..__._. ___. ....._. ......._ of the Estate of Bernt Oscar Lundbeck
late of Camp Hill ..__, Cumberl.nd County, P.., dece.sed .nd that tho
within is an inventory m.de by .CCNB..Bank..-N..A...---... ..- ..-....-., the ..id-'=Xecu.tor
of the entire est.te of s.id d.cedent, consisting of all the persan.1 prop.rty .nd re.1 est.te, .xc.pt re.1 est.te ouhid.
the Commonwe.lth of Pennsylvania, and that the figures oppasit. each item of the Inv.ntory r.pres.nt it's f.ir v.lue
os of tho date of d.cedent's death. CCNB Bank. N.A.. Executor of the
1. Bernt Oscar Lundbeck Estate
SI1JoRI\L-_and subscribed before me, _..BY:-M:- _~
_ElfJIcutor.~
Asst. v~ce Pres. & Trust Officer
21st & Market streets
S.J~h '"
~~.!J,. 0,00/\ If 19 1(0
CP~L~~~"l ~:
e""", H, . r\ '.1< ~:'.i&-.,'"
.....,.. f' ", I. ll" .JfGrJSi'"'
Camp Hill. Pa.
17011
Address
O.te of O.ath _._.--1fj.tlL.
Day
~"r{"h
Month
,qRO
Vear
INSTRUCTIONS
I. An inventory must b. filed within three months after appointment of person.1 repres.ntative.
2. A supplement inventory must be filed within thirty days of discovery of addition.1 ....h.
3. Additional sheeh may b. attached as to personalty or realty
4. S.e Article IV, Fiduciaries Act of 1949.
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4 ,""0.,... .
... t;:~,;\~;:,:R,:;.,,570FFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTA'rE TAX
,"''''''':'I'''"''''''I.r...", '.'.. .
, =
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II
a ~Mn
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~ TAX AT 15%
[', ,RECEIVED CCIIB Bank, III. A.
'FROM TAXAT_%
331 Bd4,. stZ'S.t
ADDRESS ESTATE TAX
lev C\lllberlllJl4, ,.. 17070
TOTAL TAX CREOIT
276.55
'--ESTATEINFORMATiON:M~y--i9--igio-----------
DA TE OF OEATH '
DATE OF PAYMENT
21-80-381
Dea.aber l2, 1980
BBCJt
FILE NUMBER
C\llBbedancl
m
m
LESS DISCOUNT
PLUS % INTEREST
IFROM TO_I
NAME OF OECEDENT
COUNTY
276.55
TOTAL AMOUNT PAID
POSTMARK DATE
REMARKS: ,AJD 111 FULL
SEAL
RECEIVEO BY
'i
/~/~ ~ ,-///74/
. . M& / ~I
b9 ater of ills
t
REGISTER OF WILLS
----.---
INFORMATION
To Insure proper credit to your account. the namo of tho estato and fila number should be clearly print-
ed on the check or money order,
This assessment Is made in accordance with Section 708 of tho Inheritance and Estate Tax Act of
1961 172 P.S. ~ 2485.7081.
To the extent that inheritance tax is paid within three (31 months after the death of the decedent, a
discount of five (5) percent is aiiowed (72 P.S. S 2485.716).
Inheritance Tax. other than tax on a future interest. is due at the date of the decedent's death and becomes
delinquent at the expiration of nine (9) months after the decedent's death (72 P.S. 9 2485-711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. 9 2485.712). Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using tho fOllowing interest tnble;
------------ --------- ---------- --- ---- - ----- -- - - - --- - --- -- ------ -- - - -- - -- --
1 manth .005 4 months .020 7 months .035 10 months .050
2 months .010 5 months .025 8 months .040 11 months .055
3 months .015 6 months ,030 9 months ,045 12 months .060
1 days .00017 11 d.ys ,00186 21 days .00352
2 days .00034 12 days .00203 22 days ,00369
3 days .00051 13 days .00220 23 d.ys .00386
4 days .00068 14 days .00237 24 days ,00403
5 days .oooB5 15 days .00250 25 days .00420
6 days .00101 16 days ,00267 26 days .00437
7 days .0011 S 17 days .00284 27 days .00454
8 days .00135 18 d.ys .00301 28 days .00471
9 days .00152 19 days .0031B 29 days .00488
10 days .00169 20 days .00335 30 days .00500
-- --------- ---------- ------- - ---- -- -- ---- - - - --- ----- - - ---------- ------
Any party in interest, including tho Commonwealth and the personal representative, not satisfied with
the assessment may object thereto within sixty (60) days after receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961 (72 P.S. ~ 2485.1001 I.
Make check or money order payable to:
"Register of Wills. Agent"
Mail to the address listed below:
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"\
COMMONWEALTH OF PENNSYLVANIA:
SS.
COUNTY OF CUMBERLAND
R. C. Kramer, being duly sworn, deposes and says that
he is Assistant Vice President and Trust Officer of CCNB Bank,
N.A. and as such as knowledge of the subject matter of the
foregoing Proposed Schedule of Distribution is duly authorized
to make this proof; and that the facts set forth in the foregoing
are true and correct to the best of his knowledge, information
and belief.
~..c.4Y""'"
R. C. Kramer
SWORN TO AND SUBSCRIBED
before me this ~~ day
1981.
~-----,
,
,
Lif\i'. :.AJ 1'1\Ll
." .
~}I
.'
PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of 1961 provides that the following persons shall prepare and file
a return:
a. The personal representative of the estate of the decedent as to property of the decedent administered by him
and such additional property which is or may be subject to Inheritance Tax of which he/she shall have or
acqui re knowl edge;
b. The transferee of property upon the transfer of which Inheritance Tax is or lIIay be imposed by the 1961 Statute,
including a trustee of property transferred in trust, provided tliat no separate relurn need be made by the transferee
of property included in the relurn of a personal representative.
2. PLACE FOR FILING
The return is to be filed in duplicate w:th the Register of Wills of the county wherein the decedent resided.
3. TIME FOR FILING
The return is due nine months after the decedent's death, unless an extension for filing has been applied for and
granted by the Secretary of Revenue within the nine-month period.
4. FAILURE TO FILE RETURN
Section 791 of the 1961 Statute provides that" . . .any person who willfully fails to file a return or other report
required of hi III. . .shall be personally liable. . .to a penalty of 25% of the tax ultimately found to be due or $1,000
whichever is the lesser to be recovered by the Department of Revenue as debts of like amount are recoverable by
law."
5. TAX RATES
Inheritance Tax is payable at the rate of 6% on transfers to lineal descendants, such as father, mother, husband, wife,
son, daughter, grandchildren, grandparent, son-in-law and daughter-in-law and at the rate of 15% as to all others.
6. PAYMENTOFTAX
The tax assessed on the transfer of property reported in the return is due 9 months after the decedent's death. Interest
at the rate of 6% per annum accrues thereafter until payment is made. All payments received are first applied to any
interest which may be due with any remainder applied to the tax. IF TAX IS PAID WITHIN 3 MONTHS AFTER THE
DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED.
All checks should be made payable to the Register of Wills of the county wherein the decedent resided and are
received subject to the final determination of the Department of Revenue.
7. FAILURE TO PAY
The taxes imposed, together with any interest thereon, are a lien upon real property, which lien remains in effect until
the taxes and interest have been paid in full. The taxes may be sued for against any real property in the decedent's
estate or against any property belonging to a transferee liable for the tax.
a. FILING OF FALSE RETURN
Any person who willfully makes a false return or report required of him shall, in accordance with Section 793 of the
1961 Statute, be guilty of a misdemeanor and, on conviction thereof, shall be sentenced to pay a fine not exceeding
$1,000 or undergo imprisonment not exceeding one year or boUl.
" REV-4~2 EX+ (3-801
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DEce'1f~tnt Oscar Lundbeck
ESTATE OF
SCHEDULE "e"
TRANSFERS
*'
INSTRUCTIONS:
1. Answer the questions on reverse side.
2. If the answer to any of the questions on the reverse side is "Yes," provide a description of the property transferred per
Schedules "A," "B," or "E," its estimated market value at date of death, dates of transfer, to whom transferred and
relationship of tmnsferees 10 decedent. Attach a copy of any trust deed or instrument relating to the transferred property.
ITEM
NO.
DESCRI PTION
ESTIMATED DEPT. VALUATION
MARKET VALUE (OFFICIAL USE ONLY)
NONE
TOTAL THIS PAGE
-0-
-()-
491f
QUESTIONS CONCERNING PROPERTY TRANSFERS
.'
1. Did decedent, within two yems of death, make any transler of any material part of his eslate without receiving
valuable and adequate consideration? (Answer "Yes" or "No".) lA....
2. Did decedent, within two years of death, transfer property from himself! herself to himself/herself and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No",) ~
3. If the answer to one or two above is "Yes" and the transfers are cl:1imed to be nontaxable, provide the following
information:
a. Age of decedent at time of tmnsfer.
b. Copy of death certificate.
c. Affidavit by the attanding physician indicating Ihe state of decedent's heallh at time of transfer.
d. All other information supporting nontaxability of (Iilnsfer.
4. Did decedent, in his/her lifetime, make any trilnsfer of property without receiving a valuable or adequate consideration
tberefor which was to take effect in possession or enjoYllle!11 at or after his/her death? (Answer "Yes" or "No".) IMr'
a. Was there any possibility that the property translerred might return to Iransferor or his/IICr estate or be subject
to bis/ber power of disposition? (Answer "Yes" or "No".)
b. What was the transferee's age a\ time of decedent's death?
5. Did decedent in his/her lifetime make any tmnsfer without receiving a valllable and adequate consideration therefor
under which transferor expressly or impliedly reserves for his/her life or any puriod which does in fact end before his/her
death:
a. The possession or enjoyment of or the right to income from the properly transferred? (Answer "Yes" or "No".) lA"*
b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".) ""-
6. If the answer to five b. above is "Yes," state whether the right was reserved in decedent alone or others.
7. Did decedent in his/her lifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No".) ~
8. Did decedent, at any time, transfer property, the beleficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could reve.rt to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".) \M),
9. If the answer to eight above is "Yes." was the powel to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others'! (Answer "Yes" or "No".) '^--
'.
REV-453 EX+ (J.80)
COMMONWEALTH OF PENNSVLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
!
Estate of
(Instructions on Rovorse Side;
*
SURVIVED
DECEDENT
yes
Specific
INTEREST OF BENEFICIARY
Jean W. Lundbeck
21426 Rumford Drive
Cu ertino Calif. 95014
Wife
es
Bernt Oscar Lundbeck
BENEFICIARIES AND ADDRESSES
RELATIONSHIP
DATE OF
BIRTH
Legal
Joyce Weaver
21426 Rumford Drive
Cu ertino Calif. 95014
Daughter
Le al
S eeific
CCNB Bank, N.A. Residue
17011
The above beneficiaries are living at this time except for the following:
NAME
DATE OF DEATH
-
REV04'4 EX' (3.801
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
REEIOENT DECEDENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
(Instructions on Reverse Side)
*
Estate of Bern t Oscar Lundbeck
DESCRIPTION
TOTAL
MARKET
VALUE
p\
VALUE OF
DECEDENT'S
INTEREST
DEPARTMENT
VALUATION
(OfficIal Use Only)
CCNB Bank, N.A.. Checking Acct. #545-85 -7 1,296. 2
CCNB Bank. N.A.. Savings Acct.
#006-015089-3 3.306. 8
Above registered Bernt O. or Jean W.
Lundbeck, wife of decedent
TOTAL THIS PAGE
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule HE" must include all property. real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship, Both tangible and intangible property are to be
included. List real estate first.
1. Describe all real property as indicated in the instructions for Schedule" A", Describe all personal property
as indicated in the instructions for Schedule "B". Include the name, address and relationship to the
decedent of the co.owner (s) and the date the joint ownership was established.
2. Indicate th'e totell1'larket value of the jointly owned property,
3. . Indicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest.
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REV-484 EX+ 13.80)
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
File Number .,2 / - '10.- () jJ '8 /
Estate Name ~/tw'Llg~.eJtf:..___L (j AJd 6 ee. K.
;) '-,2.9 'ff'o
Date of Deoth
Saciol Security Number
REPORT OF iNHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County af ~l~,r f. /JII} )
Pennsylvonio, do rospectfully report thot I hove appraised the reol and personol property as reparte in t e oregoing
return at the values set forth opposite each item in the lost column to the right in Schedules "A", liB", "C", and "Elf
Doted:
11- C, - J' (J
~~;"..,l.., J '/?f~lirJJIII)
INHERITANCE TAX APPRAISER
INVENTORY
VALUE AS APPRAISED
ADJUSTMENTS
CODE (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE
Real Property (Schedule A)
Personal Property (Schedule B)
$
00+
10+
92+
Jolnt.Held Property (Schedule E) o;Z 20+
Trond.rs (Schedule C) IJ 30+
TOTAL GROSS ASSETS _._.,ff~2$ ~_"! I
Leu D.bts ond Daductlons
(SCHEOULE F)
CLEAR VALUE OF ESTATE
40-
93-
Valuation of life estates or
annuities. . . . . . . . . . . . . .
RATE
FACTOR
PRINCIPLE
VALUE
CODE
FOR USE OF REGISTER ONLY
Tax on $
CODE
COMPUTATION OF TAX
$
$
$
$
$
6%
Tax on $
15%
Tax on $
Tax on $
Tax on S
E,.;omptlons
Totol Estate
TOTAL TAX
INTEREST FROM
BALANCE
TO
$
$
$
Less Credits
DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST
S + S $ =
+ =
BALANCE $
INTEREST FROM TO __ 5
BALANCE DUE S
TAX CREDIT
$
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