HomeMy WebLinkAbout80-00714
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No. 1'.80
PETITION FOR PROBATE OF WILL AND
in the Estate of 14onroe W. Farerice
'71,1
LETTERS TESTAMENTARY
, deceased.
Mary C. Lewis
To nisRsrel C. P.JiI88 rEi 9 JiI, Register of Wills for the County of Cumberland,
in the Commonwealth ot Pennsylvania.
JIll
Petitioner(s) are the executo.l:!S-__ named in the Last Will and
dated November 30, ~977
resident of
Testament of ---1'1onl"oe W. Fal"enee
Decedent was a citizen of the United States and a
xl'~wn:shl~
Borough, Cumberland
County, Commonwealth
Meehaniesburg;
of Pennsylvania.
Decedent died on
the
26th
Sunday
A. D. 19 An , in the County of
Cumberland
Pennsylvania at the age of 76 years.
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Decedent has not been married and has not had children born to him
since the execution of the above described Will.
Decedent was possessed of personal property to the value of
$100,000.00 and of real estate to the value of
None
as near as can be ascertained; said real
estate situated as follows
None
apply
Therefore, your petitioner(s) respectfully:opplias for the probate
of the said Lost Will and Testament and for Letters Testamentary thereon.
Dated November 5 , 1980
Name and address
of Petitioner(s)
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Monroe Wilbur Farenee, J . 1705'
701 Central St., Mechaniesburg, Pa./
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Harie Farenee Rupp
8 Hemlock Drive, Mechaniesburg,
17055
Pa./
COMMONWEALTH OF PENNSYLVANIA}
ss
COUNTY OF CUMBERLAND
Monroe Hilbur Farenee, Jr. and Marie Farenee Rupp
named in above application, being duly
say(s) that the statements set forth in
51-lOrn according to law
this petition are true to the
best of their
knowledge and belief.
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Sworn
and subscribed before
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me, November ~ 1980
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~~ ~. ,^, ~; Register
Filed: November 7, 1980
Attorney: J. Robert Stauffer l~..;):ii-J
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LAST WILl, AIm TESTM.mNT UF !.lONROE "1. FARENCE
I, 110NHOE "1. PAREtICE. of tho Florough of Hechanicsburg,
County of Cumberlpnd and State of Pennsylvania, boing of sound
ano disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and
making void any and all prior Wills by me at any time heretofore
made.
1.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can be conveniently
done.
2.
I give and bequeath all the rest, residue and remainder
of my estate, of whatsoever nature and wheresoever the same may
be situated, to The First Bank and Trust Company of Mechanicsburg.
Pa., in trust, nevertheless, for the followi.ng purposes, to wit:
(a)
To hold, invest and reinvest the same and to pay the net
income derived therefrom, to my wife, Ruth B. Farence, in convenient
installments at least as often as quarter-annually, for and during
the term of her natural li.fe.
(b)
Hy said Tr'ustee may, at its sole discretion, pay to my said
wife, or use for her benefit, so much or all of the principal of
said trust fund, as it may from time to time determine to be
required or desired for her comfortable support, welfare and
best interests. -1-
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( c)
Upon the death of my wife, Ruth p. l"arence, I direct that
said Trust cease and determine and that my Trustee payout the
principal of said Trus t l"und, together with any interes t which
may have accrued thereon, to my three childl'en, to ..lit, Marie
Farence Bupp, Viola Parence Burke and Monroe '1lilbur Farcnce, Jr.,
share and share alike, per stirpes.
3.
In the event that my wife, Ruth B. Farence, should predecease
me, or should she die within thirty (30) days from the date of my
death, then in such event, I direct that the foregoing trust
provisi.ons be null and void and that my personal representatives
hereinafter named, payout and distribute my entire estate, of
whatsoever nature and wheresoever the same may be situated to my
three children, the aforementioned, Marie Parence Rupp, Viola
Farence Burke and Monroe Wilbur Parence, Jr., share and share
alike, per stirpes.
In this respect also, should my said wife predecease me, or
should she die within thirty (30) days from the date of my death,
then for the purpose of facilitating the settlement and distribution
of my estate, I authorize, empower and direct my Executors herein-
after named, to sell any and all real estate which I may own at the
time of my decease, at either public or private sale or sales.
LASTLY, I nominate, constitute and appoint my wife, Ruth
B. Parence, Executrix of this my Last vl:l.ll and Testament, and
in the event that my said wife should predecease me, or should
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she be unable or unwi.lline; to serve in such capacity f'or any
reason, then in such event, I nominate, constitute and appoint
my son, Monroe \Hlbur Farence, Jr., and my daughter, Marie F'arence
Rupp, Co-Executors of this my Last Will and Testament, in her
place and stead.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this 307'# day of' November, A. D., 1977.
~w~a~
Monroe W. Parence
( SEAL)
Signed, sealed, published and declared by the above named,
Monroe W. Farence, as and for his Last Will and Testament, in the
presence of us, who have subscribed our names hereto as witnesses,
at the request of said testator, in his presence and in the
~resence of' each other.
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OATH OF SUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLVANIA I HH:
COUNTY OF CUMBERLAND \
This. ...............................~.~~............... ...... ............. day of. ........~.R.Y.~.~)?~.r......................, ............... A. D.. 19.~.?...
Mary c. Lewis
before me R:JI.II illi: ^ _-'....M~. 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 ..............
.........J... ..Rp,bar.t.. S.tlluf.1:~:r...Il-.nR-..,Ql.f!..P.Y.~...?. ,... p..~.~!:..... .... ..... ....... ..... ............... .... ......".... .,......................
the subscribing witnesses to the foregoing instrument of writing purporting to be the last Will and
Testament of ...i:!9.lJ.r.Rf.l...W., ...f.i!-.J;'.!:!:l.<':.~. .......... ,... ......."........... ........ ,............. Dated .!j~.y.~~~.7.~...??!..Y?~I
late of ...............}le.c:r..e.nl.c,a );>U1:&.....,.. .............. .............. ,....,....... ............ Cumberland County Pa.. deceased
who being duly .....:mRr..n........................... according to law. depose and say. that ...l?)::l.~;[...~~.~7..................
present. and saw and heard the testat.ar:........................... ....H.9.nr.!?!?...y!.,...p.~f..~.ns.~....,.............................
sign, seal, publish. pronounce and declare the said instrument of writing as and for hl~........... Testament
and Last Will. and at the time of so doing ........b.~....................................was of sound and disposing mind
memory and understanding. to the best of ......j:;h.~Jr.............................knowledge, observation and belief.
...,;\.W9;r.n................................ and subscribed before ~O&u-~~.~~.... .. ..~....
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AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND \
.~.2!:.~2~...~:.~.~?~.~..~.~~~.?~~. !...~.:.:....~~~...:.:.~.:.~.~...~.~.:.~::.~~. ..~~~.~~................... ........................being duly
......J>.wpr.n.............................. says that as nearly as can be ascertained the said decedent ..........................
. .......... ......~.?!: ?:.?7. ..~~.:...~ ~ ?:.:: ~ .~.::.....................................,.......................................... .....,.................... .died on
.....!?v.ng.~x............................. the .............?~.~.l::..........day of ......R.I<Ji.9.p.!lr............................... A.D.. 19..?9..
at or about ....9.;,g9...,.......................... o.clock~.~..M.
...........!?~Rr.n.............................and subscribed this
.....................~.~~..................... day of .JI.RY.€?~J:?.'?.r...,
19. .8Q..., before
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RIURIIF "-^. ReglS~r
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA}
COUNTY OF CUMBERLAND SS:
Before me. the Register for the Probate of Wills and granting of Letters of Administmtion in and for
Paranee
the County of Cumberland. personally came .!~.9.nr..9.~.}~J.;J,!?~r....f.~r.<;,!:.l?~..(...~!:.:...~.~~..,~~;,.~.?!.~~p..?....
who. being duly .....~.~~.'::!!........."" do .......... depose and say that as....l!;~.l?9.~.~.?r..L.....................................
of the last Will and Testament of ...!1.9.p.;t;'S!!l...\:!.,...f.!l-r.~m<;:.~..,..,........................................................deceased
....t.O!lY............. will well and truly administer the goods and chattels, rights and credits of said deceased
according to law. And also will diligently comply with the provisions of the law relating to Transfer
Inheritances. ...~.~!?~.n.............. and subscribed
before me.
..N.9.y~:I,Titm.r......!?............................ A. D., 19..!;\.9......
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Be it remembered that on the ..",...?~::.......... day of .........y9.y.<:!!\~.<:,~.................... A. D.. 19~.Q...... there
was probated and recorded the last Will and Testament of .~.?~F..?~...~!.~...~!:.~.~!:.?~...................................,
late of ....J:l.'il.!;h.~ni.<;:.~)?~g............................................. Cumberland County. Pennsylvania, Deceased. Letters
Faranee Rupp,
........'F.~.~.~~!!\~.t:I.~~t..~................... were granted to !1onr.o(l..l1. i, :l..'9.'U'.,.f.,Il-.:r.!lD.c;,!l~,..:J.r.,.. ..~.I]~...~~r.t.~..L.
Witness my hand and official seal the day and year aforesaid,
. Register.
21-80 '71,1
No.................................
Renunciation and Request
In the Matter of the Estate of ..........!~\9.r..r.g.~...~~!.~....f.!!-E.~n.C?~..........................,........................................................
To ....!1!!-.r.ll'....9..,....~!!"!J.~.......................................................................................... Esq., Register for the Probate of
Wills and granting Letters of Administration for the Counly of Cumberland, in the Commonwealth of P.nnsylvania.
..1........ the undersign.d. being the ..\1.t.9.9.'!!....?:.D~...~.!:.~.c.~}?~~.~....!:.~~.~9....~.!.l....~~.~...~.':~.~..y~.~~..........
and Testament of Monroe W. Farence, deceased,
..................................................................................................................................................................................................
....n............................................................................................................................................................................................
.................................................................................................................................................................................................
.................................................................................................................................................................................................
do hereby renounce .....~y.................................................... right to have Letters .........::r..~!?};.~!!!!':.r..~.~!y...................
.......................................................................... on said Estate issued to ......!!!!':.................................................................
................................................................................................. ................................... and do h.reby request you to grant
the same to ..~!.9.!n;:9.~...\.'!.1J)?),;,;:...F..!!-.r.~.!l.c.!?.!..J!.'.~....~.~9....~1.~:!.'.~.~...K.~!:~.!.l.~.~...~~p.p..............................
Witn.ss....~:Y:........hand................and seal.............. ..this...... ...................................................................................
day of ........p.QY.~.!'.1.'R.~:r................................A. D. 19....?.9
ad ~ delivered in presence of
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,~~Fl:~~~(;'Y;';"':;'P . .... . COMMONWEALTH OF PENNSYLVANIA
. "...".v000354...... ..' DEPARTMENT OF REVENUE
i 4 ~g~.".: .'OFFICIAL RECEIPT' PENNSYLVANIA INHERITANCE AND ESTATE TAX
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~I ,RECEIVED Mari. F. Rupp
Jj FROM
ADDRESS MaJ:Jtet SCZuan B14V.
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TAX AT 6%
TAX AT 15%
TAXAT_%
,
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ESTATE TAX
5,263.15
Mechanicsbw:q, Pa. 17055
.--eSTATEINFCifiMAi'iCir.r::,:---i6---i980-----------
DATE OF DEATH \Ai". ,
TOTAL TAX CREDIT
FILE NUMBER
21-80-714
DeceDbeJ: 12, 1980
MOlOOE W. rARBHCE
lip cabedand
5,000.00
263.15
LESS DISCOUNT
PLUS % INTEREST
(FROM TO_I
DATE OF PAYMENT
m
m
TOTAL AMOUNT PAID
NAME OF DECEDENT
COUNTY
---------------- --- ------ --------------
POSTMARK DATE
REMARKS: -PAID OW ACCOUft-
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SEAL
RECEIVED BY
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bcJilter of Willa
t
REGISTER OF WILLS
HEY-4113 HI-lIU
COt.'MONWEAL TH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASSESSMENT OF PENNSYLVANIA
ESTATE TAX
TO,
DATE:
ESTATE OF,
FILE NO,
COUNTY OF,
DATE OF DEATH,
------------------------------------------------------------------------------------------
I.. DETERMINATION,
1. Toxoble estate based upon:
The United States Estoto Tax Return (Form 706)
The communication from the Federal Government
confinning the acceptance of or changes to the
Federol Estate Tax Return
2. Amount of credit lor State deoth taxes (os verified)
3_ Pennsylvania Inheritance tax assessed
(excluding ony discount and/or interest)
4. Nonnal inheritance tax paid to other States or
Territories 01 the United Stat os (excluding
any discount and/or interest}
5_ Total inheritance tax credits (line item 3 plus line item 4)
5. Totol liability lor Pennsylvonio estate tax (line Item 2
minus line item 5)
$
$
$
$
$
$
NOTE, Complete line items 7 and 8 ONL Y when detormination
is based on Fedorol Closing Letter
7.
Amount of Pennsylvania estate tax assessed on determination
doted
Addition (reduction) to Pennsylvonio estote tox (line item 6
minus line item 7)
$
8.
$
Determination prepared by:
Dote:
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B. ASSESSMENT:
1. Pennsylvania Estate Tax reflected on:
line item A (6)
line item A (8)
2. Less credits:
DATE OF PAYMENT
$
AMOUNT PAID INTEREST
($ )
- (5 l
- ($ )
CREDIT
=
3. Balance of Pennsylvania estate tax due
$
Interest is due at the rate of six (6) percent per annum from
to the dote of payment.
Assessment prepared by:
AGENT FOR THE COMMONWEAL TH
Dote,
SEE REVERSE SIDE FOR INSTRUCTIONS
INSTRUCTIONS
To insure proper credit to your account, the nome 01 the estate ond lile number should be
c1eorly printed on the check or money order.
This determinotion ond Dssessment is made in accordance with Section 421 and Section 732
01 the Inheritonce and Estate Tax Act 011961,72 P.S. 2485-421,732.
The estate tax imposed by Section 421 is due at the date 01 the decedent's death but shall
not become delinquent until the expiration 01 eighteen (18) monlhs alter decedent's death prDvided
that ony estate tox occasioned by 0 linal chonge in the Federal return or 01 the tax due tbcreon
shall not become delinquent until the expiration 01 one (1) month alter the person liable tD pay
fhe tox receives final notice 01 the increase. Colculate interest from the delinquent date shown
on the lace 01 this lorm to the dote of payment using the following interest tab'e:
---------------------------------------------------------------------------------
1 month .005 4 month s .020 7 months .035 10 months .050
2 months .0lD 5 months .025 8 months .040 11 months .055
3 man ths .(l1S 6 mon ths .030 9 months .045 12 months .060
1 doy .00017 11 day s .00186 21 days .00352
2 days .00034 12 days .00203 22 doys .00369
3 days .00051 13 day s .00220 23 day s .00386
4 days .00068 14 days .00237 24 days .00403
5 doys .00085 15 days .00250 25 days .00420
6 days .00101 16 days .00267 26 days .00437
7 days .00llB 17 day s .00284 27 days .00454
8 days .00135 18 days .00301 28 doys .00471
9 days .00152 19 days .00318 79 doys .00488
10 doys .00169 20 days .00335 30 days .00500
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Any party in interest, including the Commonwealth and the personal representotive, not
satislied with the assessment may object thereto within sixty (60) dDYs olter receipt 01 this
notice os provided by Section 1001 01 the Inheritance and Estate Tax Act 011961 (72 P,S.
~ 2485-1001)
Make check or money order payoble to:
"Register 01 Wills, Agent"
Moil to the oddress listed below:
REY..UI3 (e.78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASSESSMENT OF PENNSYLVANIA
ESTATE TAX
TO,
DATE,
ESTATE OF:
FILE HO,
COUHTY OF,
DATE OF DEATH:
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A.
1.
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I 3.
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! 4.
5.
6.
DETERMINATION'
Taxable estate based upon'
The United Stotos Estoto Tax Return (Form 706)
The communication from 1he Federal Government
confinning 1he acceptance of or changes to the
Federal Estate Tax Return
Amount 01 credit far Stoto death taxes (os verilledl
Pennsylvania Inheritance tax assossed
(excluding any discount ond/or interest)
Hormal inheritance tax paid 10 o1her Stoics or
Territories 01 the United States (excluding
any discount and/or interes1)
Total inheritance tax credi1s (line item 3 plus line item 4)
Total liability lor Pennsylvonlo estate tax (lIne Item 2
minus line item 5)
$
$
$
$
$
$
NOTE: Complete line Items 7 and 8 ONLY when determination
is based an Federol Closing Letter
7.
Amount of Pennsylvania es1ate tax assessed on determination
dated
Addition (reductionlto Pennsylvania estate tax (lIne item 6
minus line item 7)
$
$
8.
Determination prepared by:
Date,
'..--- -------- ---------------------------------------------------- -------- ----------------
B. ASSESSMENT,
1. Pennsylvania Estate Tax reflected an:
line Item A (6)
line Item A (8)
2. Less credi1s:
DATE OF PAYMENT
$
CREDIT
AMOUNT PAID
INTEREST
(5 )
(5 )
(5 I
$
=
=
3. Balance of Pennsylvania estate .ax due
Interes' is due at the rate of six (6) percent per annum from
to the dote 01 poymont.
Assessment prepared by:
AGENT FOR THE COMMONWEAL TH
Dote:
SEE REVERSE SIDE FOR INSTRUCTIONS
INSTRUCTIONS
Ta insure proper credit to your account, the name al the estate ond file number should be
c1eGrly printed on the check or money order.
,
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This determination and ossessment is made in occordancc wilh Section 421 and Section 732
of the Inheritance ond Estote Tox Act of J96J, 72 P.S. 2485-421,732.
The estate tax imposed by Section 42J is due at the date of the decedent's deoth but sholl
not become delinquent until the expirotiDn 01 eighteen (18) manths alter decedent's death provided
thot any estote tox occasioned by 0 linol change in the federal return or of the tox due thereon
sholl not become delinquent until the expiration of one (1) month after the persan liable to pay
the tox receives final notice 01 ,he increase. Calculate interest (,om the delinquent do'e shown
an the lace 01 this larm to the date 01 payment using the following interest tab'e:
----------------------------------------------------------------------------------
J month .005 4 month s .020 7 month s .035 10 months .050
2 manths .OJO 5 month .025 8 months .040 1I months .OS5
3 manths .m 6 manths .030 9 manths .045 12 months .060
1 day .00017 11 doys .00186 21 days .U0352
2 doys .00034 12 dDYs .00203 22 days .00369
3 days .00051 13 days .00220 23 doys .00386
4 days .00068 14 days .00237 24 days .00403
5 doys .00085 15 days .00250 25 days .00420
6 days .00101 16 doys .00267 26 day s .00437
7 days .00118 17 day s .00284 27 doys .00454
8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 days .00318 19 days .00488
10 days .00169 20 days .00335 30 days .00500
Any party in interest, including the CDmmanwcalth and the pcrsonol representative, not
satisfied with the assessment may object thereta within sixty (60) days alter receipt 01 this
natice os pravided by Section 1001 al the Inheritance and Estate Tax Act 011961 (72 P.S.
~ 2485-100 J)
Make check or mDney order payable to:
"Register of Wills, Agent"
Mail to the address listed belaw:
PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of 1961 provides th,tlthe follow;ng IH,rsons 51wll prepare and file
a return: " .
a, The personal representative of the estate of lhe decedenl as to properly.ollhe decedenl "dministered by him
and such additional property which is or may be subjer.l to Inherilance T"x of which he/she shall have or
acquire knowledge;
b. The transferee of prop~rty upon the transfer of which Inheritance Tax is or may be imposed by Ihe 1961 Statute,
including a trustee of property transferred in trust, provided 111<11 no separate return need be made by the transferee
of property included in the return 01 a personal represenl"live.
2. PLACE FOR FILING
The return is to be filed in duplicate with 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"n extension for filing has been applied for and
granted by tile Secretary of Revenue within tile nine.month period.
., .
4. FAILURE TO FILE RETURN
Section 79101 the 1961 Statute provides that". . .any person who willfully fails to file a return or other report
required of him. . .shall be personally liable. . .to a penalty of 25% of the t"x 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 011 the rate of 15% as to all others.
6. PAYMENT OF TAX
The tax assessed on the transfer of property reported in the relurn 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 lax. 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 tile 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 lier. upon real properly, which lien remains in effect until
the taxes and interest have been paid in full. The taxes may be sued for agarnst any real property in the decedent's
estate or against any property belonging to a transferee liable for the tax.
8. 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, shal! be sentenced to pay a fine not exceeding
$1,000 or undergo imprisonment not exceeding one year or both.
REV-451 EX+ (3.80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
Estate of
ITEM
NO.
(1)
(3)
(4)
(5)
(6)
(7)
(8)
SCHEDULE "B"
PERSONALPROPERTV
(It1strucrions on Reverse Side)
Monroe W. Farence
DESCRIPTION
19 shares of common stock of The First
Bank and Trust Company of Mechanicsburg,
Pa., as follows:
Certificate No. 860 issued May 27, 1966
for 3 shares.
Certificate No. 441 issued July 5, 1958
for 16 shares.
7~% Certificate of Deposit No. 3458
issued 7/3/75 by The First Bank and
Trust Company of Mechanicsburg, Pa., in
the principal amount of $18,000.00.
Interest accrued to 10/26/80
7~% Certificate of Deposit No. 3457
issued 8/17/77 by The First Bank and
Trust Company of Mechanicsburg, Pa.. in
the principal amount of $30,000.00.
Interest accrued to 10/26/80.
7~% Certificate No. 11-00-3054 issued
7/7/77 by Carlisle Building and Loan
Association in the principal amount of
$5,000.00.
Interest accrued to 10/26/80.
Passbook Savings Account No. 10832 with
Carlisle Building and Loan Association.
Principal balance.
Interest accrued to 10/26/80.
Certificate of Deposit No. 14-2556
issued 11/8/77 by The Commonwealth
National Bank in the principal amount 0
$7,000.00.
Interest accrued to 10/26/80.
Savings Certificate No. 002-20-13715
issued 9/9/77 by State Capital Savings
and Loan Association in the principal
amount of $18,000.00.
Interest accrued to 10/26/80.
Savings Account No. 2-39-221304 with
First Federal Savings and Loan
Association.
Interest accrued to 10/26/80.
UNIT
VALUE
135.00
135.00
ESTIMATED
MARKET
VALUE
405.00
2160.00
18000.00
431. 25
30000.00
56.25
5000.00
27.08
3.05
.06
7.000. O~\
(543 . l~
18000.00
436.41
10011. 07
53.15
*'
DEPARTMENT
VALUATION
(OFFICIAL USE ONL Y!
.;J-J'f,I.3
TOTAL THIS PAGE ~2126.4~
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two ye,ns of death, make any transf~1 of any material part of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No".) No .
2. Did decedent, within two years of death, transfer propelty from himsel Ii herself 10 himsel f/hersel 1 and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".J ~~
3. If the answer to one or two above is "Yes" and tile transfers are claimed to be nontaxable, provide the following
information:
a. Age of decedent at time of transler. None
b. Copy of death certificate.
c. Affidavit by the attending physician indicating the state of decedent's 11~nllh "I lime of transfer.
d. All other information supporting nontaxabilily of Iransler.
4. Did decedent, in his/her lifetime, make any trc:nsfer 01 property without receivinp, a'v;llual1le or adequate consideration
therefor which was to take effect in possessiou or enioYllle~1 al or aftr.r his/her death? (I\nswer "Yes" or "No".) No
a. Was there any possibility that the property transferred might return tll transferor or his/her eslate or be subject
to his/her power of disposition? (Answer "Yes" or "No".) Nt'!
b. What was the transferee's age at time of decedent's deafh? N/A
5. Did decedent in his/her lifetime make any transfer without receiving a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves for his/:1CI life or nay peried which does in fact end before his/her
death:
a. The possession or enjoyment of or the right to income from the property tr~nsferred? (Answer "Yes" or "No".) ~
b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".) No
6. If the answer to five b. above is "Yes," state whether the right was reserved in dEcedent alone or others. N/A
7. Did decedent in his/her lifetime make a transfer, the consideration for which was li,lI1sferee's promise to pay income
to or for the benelit or care of transferor? (Answer "Yes" or "No".) No
8. Did decedent, at any time, transler property, the b61eficial enjoynlent of which was subject to change, because of
a reserved power to alter, amend, or revolle, or which could revert to decedent u~der lerms of transfer or by operation of
law? (Answer "Yes" or "No",) No
9. If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Yes" or "No".) No
REV0453 EX+ (3.801
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT OECEDENT
SCHEDULE "D"
BENEFICIARIES
....
.. ~
. ~
(/1I.'itructions on Reverse Side)
Estate of
Monroe W. Paranee
BENEFICIARIES AND ADDRESSES
RELATIONSHIP
SURVIVED
DECEDENT
DA TE 0 F
BIRTH
INTEREST OF BENEFICIARY
Ruth B. Parence
528 E. Simpson St.
"Iife
e
Lifo Estate in
entire estate
with ower to
consume principal.
One-third share
of residuary estat
csbur
Fa 1 0
Marie Farence Rup
8 Hemlock Drive
Mechanicsbur Fa. 1
Viola Farence Burke
15 Coventr Road
Stamford, Conn. 06903
Monr e Wilbur Farence Jr
701 Central St.
Mechanicsbur
Dau hter
Yes
Dau hter
Yes
One-third share
of residu
S
Yes
One-third share
of P-~It~g.uar-y est
J
The above beneficiaries are living at this time except for the following:
NAME
DATE OF DEATH
J'_ "
INSTRUCTIONS FOR SCHEDULE "D"
1. List full names and addresses of all who have an interest in the estate
either vested, contingent or other interest.
. 2, Indicate the beneficiary's relationship to the decedent. Specify if
stepchildren or illegitimate children are involved.
,
3. Indicate "Yes" or "No" if the beneficiary survived the decedent.
4. Indicate the date of birth of the beneficiary if the interest is a life
interest, term certain interest or a future interest.
5. Indicate the interest of the beneficiary in the decedent's estate.
For example: Specific bequests of a diamond ring, savings bonds
or cash of $5,000; bequest of 25% of residue; remainder interest; etc.
6, At the bottom of Schedule "0" state those beneficiaries who are not
living at the time the return is being filed and include date of death.
REV0454 EX. 13.80)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "E"
JOINTL V OWNED PROPERTY
..
(lnsrrucrlons on Reverse Side)
Estate of
Monroe W. Farence
P
TOTAL E VALUE OF DEPARTMENT
ITEM DESCRIPTION MARKET \ DECEDENT'S VALUATION
NO. VALUE INTEREST (Official Use Only)
T
None - (All other property of decedent
I not reported otherwise herein, was
owned by decedent and his wife, Ruth
B. Farence, as Joint Tenants and/or
\ Tenants by the Entireties. Ruth B.
Farence survives the decedent) None None
!
,
,
i
,
I
I
I
i
,
I
I
I
I
I
,
I
I ,
I
I
I
I
I
,
I
,
,
,
I
,
I TOTAL THIS PAGE None ^I~~" 1InA'
v
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of surviuorship. 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", Descrlbe all personal property
as indicated in the instructions for Schedule "S". Include the name, address and relationship to the
decedent of the co.owner (s) and the date the joint ownership was established.
2. Indicate the total market 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.
c ..., a n > '" ~ :5
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REV.414 EX+ (5-101
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
[] Original
o Supplemental
o Remainder
File Number
21-80-0714
Estate Noma
Farence, Monroe W,
Date 01 Deoth
Oc~_obe~.E.I?,_1.91l_0
Sociol Security Number ___._'11~:,O~:_E~~__
REPORT OF INHERITANCE TAX APPRAISER
I, the underslvned duly oppolnt.d Inhorltonce Tox Appraiser In and lor tho County of Cumberland
PennsylvanIa, do respectfully reporf fhot I hove appraised the rool and p~rsonol proporty os roportod In tho lorogolng
retum at the valul..lt forth oppollt. loch Item In thela.t column to the right in Schedules IIAIt, liB", "e", and "Elf
Dated, _ April 20, 1981
JjJh",},tj 'lr'f"PJ~j)
U~""HERITANCE TAX APPRAISER
--.--...-. . -",---"-" ~.---
INVENTORY
VALUE AS APPRAISED CODE
---...-.-.---
I None 00+
92 117 45 '0+
None 21H
None 30+
$92,Ul ~
40-
ADJUSTMENTS
(HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE
92+
Rool Prop.rty (Schodul. AI
P.,.onol P,op."y (Sch.d",l. B)
Jolnt.Hold Proporty (Sch.dul. E)
T,an.f.,. (Sch.dul. C)
TOTAL GROSS .\SSETS
L... D.bl. ond D.due'lon.
(SCH EDULE F)
CLEAR VALUE OF ESTATE
o Lifo Estate
o Annuity
93-
RATE
FACTOR
PRINCIPLE
VALUE
CODE
. _.. ._.......___..""'L'.....'-"4. ".__....--......-.....____
FOR IISE OF REGISTER ONL y
Tax on S
COOE
COMPUTATION OF TAX
S
$
S
$
6"
"
Tax on S
15%
Tax on S
Tax on S
Tax on' _
$
Euml)flon. ~~..-
Total E'fnl" --.---.---..-.-.
TOTAL TAX
INHREIT FROM
BALANCE
TO
S
$
S
TAX CREDIT
s
~
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u
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s..
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- 0 Q) Q) ::l
U Z ::;: ::;: 0.. U
- 0
1>0 -
1>0 ~
0 1>0 0
~ 1>0
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REY-Ua "-711
OFF ICE OF THE
REGISTER OF WILL~
STATEMENT OF DEBTS
AND DEOUCTlONS
OF Cumnerl Rnd COUNTY
AND AGENT OF THE COMMONWEALTH
ESTA TE OF 110nroe ',1. :?arence
LATE OF
l"ee:->unicsbur~
NO. OF I I
DATE VOUCHER NAME OF PAYEE REMARKS AMOUNT
Register of ilUls Letters Testamentary SS 00
Ree;ister of Hills One Short Certificate 1 00
Myers Funeral :Iome, Inc. Funeral Expenses 3707 71
Cumberland Law ,Tournal Estate Not ice 18 00
West Shore Times Estate Notice 18 00
Lester G. Connor Real istate Aooraisal 100 00
Honroe Hilbur Farence Jr. Executor's Commission 2':\00 00
Harie Farenee Ruoo Executor's Commission 2300 00
J. Robert Stauffer, Eso. Attornev's Fee 3600 00
Re!':ister of 'l1ills Filim: Debts and Deductions .. 00
Rel<ister of Wills Filinrz Account !.LO 00
Anna M. Bowker, Notary Taking Affidavits S 00
I I
DATE OF FILING APPRAISEMENT
DATE OF DEATH Oct. 26, 19BO
COMMONWEALTH OP PENNSYLVANIA 1
COUNTY OF Cumberland I SS:
RUPF
Wii MonroA 1rli 111,,,., F'al'"nCA r Jl'. A"rJ 1.:Q,.,i P l"Q""-Hl"" / HEREBY CERTIFY, THAT TO THE BEST OF
MY KNOWLEDGE AND BELIEF, THE FDREGOING IS A JUST AND TRUE STATEMENT OF DEBTS, FUNERAL EXPENSES AND
EXPENSES OF ADMINISTRATION SUBMITTED TO THE ESTATE OF ;"""'T''''' \.) H'Ql"P"'''''
DECEASED, AS DEDUCTIONS FOR INHERITANCE TAX PURPOSES.
SWORN AND SUBSCRIBED BEFORE ME THIS cil tJ-t/3 DAY OF
~ A~t ~~9~
~G,~.:, SL~r.r;J:.'-~' ,
MECIIANlc,HI'H" UUH~. d'MI<UlLANU ClIIJIIII
MY COMMISSIOII EXPIR,S APR. 30, 19R,\
Memlh!r. Pennsylvama AsSOOtdtton 01 NoldTle<;
(L.S.)
:-.
'7 ~ ;'"J ;. ~
., 7:r..:.;
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(.>
- _._ __ - _n_ ____ ___ __ -.- -- .--- -~- -
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
~.
~
COUNTY FILE NO: () I - X' n _ '1, l/
:'-YliGhAJt. -. '(NLI"" L T'<. J.) -, 'I- "rq':".:J_,i"J;.,,-.;.-.
C' ~-
TO: ( ,1,1' 1 '.. ......
\
"Yr\uo1", I j ~ "(I'" . h "'~ .1., .
----yy, J ,/ I.... P c
.. I~' ( ,0"" I .r AJlMj\^} i Q. / ? 0 5cc;
DATE
'if
it-I '4.r~..., [I~ L(L
. . "-.
or I - k"6 - 7 III
COUNTY ()..)/VV C ~J (..~~1
DATE OF DEATH (t).t ~b /'9J-V
~
t
\t
ESTATE
FILE NO.
Appraised Value of Estata:
Real Estate
-
$
Personal PropertY
+ '1 J. / / '7 l/ 5'
Jointly Held PropertylTransfers
+ --
$ 9&. 1/7 ti5
laJ JI.J-7 7/
$ t7~.. 9 c~ 7L/
Total Gross Estate
Total Approved Deductions
Clear Value of Estate
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
Amount Taxable @ 6% Rate
tax due
$ L/- 7 9 f.1 r
Amount Taxable @ '5% Rate
tax due
LJ-79J?)g
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
$
* * * * * '* A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
/ Pl _/~ KO
$ 5'()OO /)Q+ $;;}1,-315 - $
= $ 5<9(,.3./5'
+
=
+
=
Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
is
"
( $
, \
V 'J..:Jrv
Assessed by: . ,. .. , I /,
See Informal ion on Reverse Side Agenl~or,rheCommgnwel,"h,/
;.,>:,0 ,,;/'.r. i
: 1-'1'-( c.J/--":../
" . .
!/
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
" ,.
"1' ,;~J
: ',' ~ j':
INFORMATION
To insure proper credit to your account, the name of tho estate and file number should be clearly print.
ed on the check or money order.
This assessment is made in accordance with Section 708 of tho Inheritance nnd Estate Tax Act 01
1961 (72 P.S, ~ 2485.7081.
To the extent that inheritance talC. is paid within three (3) months after tho death of the decedent. a
discount of 'iv~ 15) percent is allowed (72 P.S. ~ 2485.7161.
Inheritance Tax. other than lax on- a future interest. ;s due at the date of the decedent's death and becomes
delinquent at the Bltpiration of nine (9) months after the decedent's death (72 P.S. ~ 2485.711). Inheritance
Tax on a future interest is payable within three (3) months aher the transfer takes effect in possession and
enjoyment and is delinquent thereafier 172 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 the following interest table:
---------------------- -------- - --- ---- --------- - - --- - --- -------- -- -- -- - -- --
1 month .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 days .00186 21 days .00352
2 days .00034 1 2 days .00203 n days .00369
3 days .00051 13 days .00220 23 days .00386
4 days .00068 14 days .00237 24 days ,00403
5 days .00085 15 days .00250 25 days .00420
6 days .00101 15 days .00267 26 days .00437
7 days .00118 1 7 days .00284 27 days .00454
8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 days .00318 29 days ,00488
10 days .00169 20 days .00335 30 days .00500
-- ---------------------- - - - - - - --- ---- ---- -- - ------- - - - - --------- ------
Any party in interest. including the Commonwealth and the personal representative, not satisfied with
the assessment may object thereto within sixty (60) days after receipt of this NOlice as provided by Section
1001 of thelnherilance and Estale Tax Act of 1961 (72 P.S. ~ 2485.10011.
Make check or money order payable to:
"Register of Wills, Agent'"
Mail to the address listed belDw:
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'.
IN THE COURT OF COMMON PLEAS OF CUrlBERLAND COUNTY, PENNSYLVANIA.
ORPHANS' COURT DIVISION NO. 21 - dO - 714.
FIRST AND FINAL ACCOUNT OF MONROE WILBUR FARENCE, JR. AND MARIE
FARENCE RUPP, EXECUTORS OF THE LAST WILL AND TESTAMENT OF MOm~OE
W. FARENCE, LATE OF THE BOROUGH OF MECHANICSBURG, COUNTY OF
CUMBERLAND AtID STATE OF PENNSYLVANIA, DECEASED.
Date of Death: October 26, 1980.
'.
'i
Dates of Adverttsement of Letters Testamentary:
In the Cumberland Law Journal: November 28 and December 5 and 12, 1980.
In The West Shore Times: November 19 and 27 and December 4, 1980.
PRINCIPAL ACCOUNT
Debits
Accountants charge themselves with the following principal
assets belonging to decedent's estate, which consist
entirely of personalty, to wit:
Nineteen (19) shares of the common capital stock of the
First Bank and Trust Company of Mechanicsburg, Pa.
Proceeds of 7~ Certificate of Deposit No. 3458, issued
7/3/75 by The First Ban]{ and Trust Company of Mechanics-
burg, Pa., in the principal amount of $18,000.00.
Proceeds of 7~ Certificate of Deposit No. 3457, issued
8/17/77 by The First Bank and Trust Company of Mechan-
icsburg, Pa., in the principal amount of $30,000.00.
Proceeds of 7~ Certificate of Deposit No. 11-00-3054,
issued 7/7/77 by Carlisle Buildin~ and Loan Associa-
tion in the principal amount of $5,000.00.
Proceeds of Certificate of Depostt No. 14-2556, issued
11/8/77 by The Commonwealth National Bank in the
principal amount of $7,000.00.
Proceeds of Savings Certificate No. 002-20-13715, issued
9/9/77 by State Capital Savings and Loan Association
in the principal amount of $15,000.00.
Proceeds of Savings Account No. 2-39-221304 with the
First Federal Savings and Loan Association.
GROSS PRINCIPAl, ESTATE......................................~
1I9ER 99 PAGE 651
-1-
$
2,565.00
18,000.00
30,000.00
5,000.00
7,000.00
18,000.00
10.011.07
90.576.07
....
PRINCIPAL ACCOUNT
Credtts
Accountants ask credit for the following al110unts paid
out, to wit:
Register of Wills, Letters Testamentary. $
Register of Wills, one (1) Short Certificate.
Myers Funeral Home, Funeral expenses.
Cumberland Law Journal, Estate Notice.
West Shore Times, Estate Notice.
Lester G. Connor, Appraising real estate.
Register of Wills, certified copy of Will and one (1)
Short Certificate.
Register of Wills, filing State Appraisal.
Monroe Wilbur Farence, Jr., Executor's commission.
Marie Farence Rupp, Executor's commission.
J. Robert Stauffer, Esq., attorney's fee.
Register of Wills, filing account.
Anna M. Bowker/Peggy A. Simpson, Notary Public,
taking affidavits and acknowledgments.
Register of Wills, filing Debts and Deductions.
Register of Wills, Pennsylvania Inheritance Tax.
TOTAL PRINCIPAL DISBURSEMENTS............................$
INCOME ACCOUNT
Debits
Accountants charge themselves with the following
income received:
1980
10/29
11/8
11/17
11/29
1l/23
12/15
12/22
1981
1/26
1/29
Carlisle Building and Loan Assn., Interest.
The Commonwealth National Bank, Interest.
The First Bank and Trust Company of Mechanics-
burg, Pa., Interest.
The First Bank and Trust Company of Mechanics.
burg, Pa., Dividend.
Carlisle Building and Loan Association, Interest.
The First Bank and Truat Company of Mechanics-
burg, Pa., Interest.
The First Bank and Trust Compan;,> of Mechanics-
burg, Pa.. Int.erest.
The First Bank and ~rust Company of Mechanics-
burg, Pa., Interest.
State Capital Savings end Loan Assn., Interest.
lIBER 99 rAGE 652
.2-
,
.
55.00
1.00
3,707.71
18.00
18.00
100.00
5.50
3.00
2,300.00
2,300.00
3,600.00
40.00
5.00
3.00
4,798.18
16.954. 39
$ 31.34
553.00
187.50
28.50
31.34
102.92
157.50
187.50
519.66
"
-.
1981
3/2
I 6/'5
I
I 7/29
I
I
..~ 8/26
GROSS
INGOl'IE ACCOUNT
Debits
The First Bank and Trust Company of Mechanics- $
burg, Pa.. Dividend.
The First Bank and Trust Company of Mechanics-
burg, Pa., Dividend.
The First Bank and Trus t COlflpany of Nechanics-
burg, Pa., Interest on Money Market Certificate
of Deposit.
The First Bank and Trust Company of Mechanics-
burg, Pa., Dividend.
INCO!~E. ..... .... .... ...... .. ........ .. ............ .... ...... ......................... . ...$
INCOME ACCOU NT
Credits
Reserved for payment to Ruth B. Farence, de-
cedent's wife and lifetime beneficiary of
Estate Income. $
TOTAL INCONE CR}])ITS..............................................................~
SUM!1~~r
'.
29.45
29.45
5,695.24
29.45
7,612.85
7.612.85
7,612.85
Prine ipa1 Account
Debits $ 90,.576.07
Credi ts 16,954.39 $ 73,621.68
Income Account
Debits S 7,612.85
"
Credits 7,612.85 :1; 0.00
BALANCE IN HANDS OF ACCOUNTANT FOR DISTRIBUTION 4> 73,621.68
UglR 99 PAGE 653
-3-
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p..Z ...: ill fil 11:: ~ :<1 r", 0 f,j <Il :.:: J
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o ..1-1 HH~5r'1"; ~r..iI"" p.. Z .' ~ 0
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N o::or~r.~ E-4W~crQ::~ -- <- ..
g:;o~ "
ot:r.l!::tLIZ 80~;;?' ~. ,. .rJ
p.. ZO<l;~~~ ~<'3-r..iI :'";::' ;~
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IN THE COUR'!' OF' COMMON pr,r:AS OF CU:.jj;l':RLANlJ COUNTY, PENNSYLVANIA.
ORPHANS' COURT DIVISION NO. 21 - 80 - 714
IN RE: ESTATE OF 110NROE VI. FAH;;:HCE, LATE OF 'l'HE ROHOUGH OF HEGHAN-
ICSBURG, COUNTY OF CUMBERf,AIW AND STATE OF PENNSYLVANIA, DECEASED.
SCHEDULE O~' PROPOS2:D DISTRIBUTION
. Suggestion is made, that the balance in hands of' Accountants
for Distribution, to wit, the sum of $73,621.68, be made partly in
Kind and partl" in Cash, and that the Saine be paid over and distributed
in its entiret" to The First Bank and Trust Company of Mechanicsburg,
Pa., to be held in trust for the benefit of decedent's wife, Ruth B.
Farence, in accordance with item "2.n of decedent's Last vlill and
Testament, and subparaeraphs (a), (b) and (c) thereunder, and there-
fore DistI'ibution is proposed as follows, to wit:
TO: rrlE FIRST BAW~ AND TRUST COMPANY OF MECHANICSBURG, PA.
Trustee under the Will:
( a)
(b)
In Kind, nineteen (19) shares of common
stock of The First Bank and 'I'rust Company of
Mechanicsburg, Pa, $
In Cash, $71,056.68, which is included
in a certain investment made by the
Executors of decedentts estate in the
total amount of $76,530.73 in a six (6)
month Honey t4arket Cert;ificate of Deposit,
issued on July 29, 1981 by The First Bank
and Trust Company of Nechanic;;burr;, Pa.,
due on January 29, 1982, the balance of
the face amount of said Certificate, to wit,
the sum of $5,474.05 being an investement
of the Estate Income on behalf of Ruth B.
Farence, the Income beneficiary under the
Will.
',"p,otru11, 'Ub~'
PfM K. a--. e.nu /
~~
LIBER 99 PAGl 655
+
-1-
Executors
2,565,00
$
71,056.68
73.621.68
REV-e07 EK (...eo)
INHERITANCE TAX REFUND CALCULATION SHEET
'-
.
EST ATE OF --L!J-CJjJ:4k--"c/~~a.c..(,.nc. t::.__ .n
COUNTY OF (!~ bt,,.L.....d
DATE OF APPRAISEMENT ~ /"0 lfL
STATE FILE I
DOCK ET I
~ 1- 20_-=..fL7./l1
li5~:<'
REAL PROPERTY S -tJ -
PERSONAL PROPERTY (j .2. ILZ .y f
,
TRANSFERS -tJ~
JOINTLY HELD PROPERTY -t:J -
GROSS ASSETS 9~/1, ~5
LESS DEBTS AND DEDUCTIONS /.2- J /1/7. 7/
CLEAR VALUE $ 79, 91g 1#
TAX@6% /15%
$
4, '7 99. IS<'
':1.8 9. 9/
LESS 5% DISCOUNT ON $
~ '79fJ. If?
PLUS 6% INTEREST FROM:
TO:
NET TAX DUE
L/, S5S'. .2- 7
REFUND DUE
~ 000. 0 0
$ .y..y /. 7.-g
LESS TAX PAID
CALCULATED BY' ~ 8f'..//
REFUND CLAIMED, $ lJ(".!:L 9 1
DATE, O,,+.b"'-- :l.J, Iqp/
REFUND DETERMINED: $ ~ij/, 7,g
..
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