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HomeMy WebLinkAbout81-00443 " " I. t,:l I,'JI'; H' ("I:" '.:.1 , C'': Q ~/~ ?::: r; " \.\, ~~!in L! f'-, , "" .." ,.."it, I:" OD\ Cc:o-' I."J ~ (,:~~j I.:i ~:[! '''' ~tl 4l p:; .. n ~ ,.oR1 ("" ~"r'l ~,:~ '1/ 1.'1("") .....;0. 1.1(':,) !,1,1 t ;." ji,!(P It',T_, ,~ta 'II:"' (' ~~l, ;n! ,~ J , :1. J ., : " '.i , , i;J " hi , " ~~-j ~...4 H ~ ~'_. ~'!:' " [el ~~ iij ~5ll. W Q E-l Cl ' ~ '" rn a. ~ i '" ftl q 0'. {;-I '-I ;:l' rl A {H ti ,~ 3 0 Ol~ ~Tl . rd ~o; g~ '-I r:.j I" m~ i; 'I;. \. 1'-" 01 l~1 ffi (J') .'.11 ,.1 ~ . .. .c.. ,";':' r: .' \,., ('f', ~" 0' ~,'Jg ", I!_,]; :.<;(;1 I.,', 1"" ~:. ';,r, fJ1n .- .~ li..1 i ;s ~;I .,,, Ui :~ld- \1;\ liQ cl Y cllrnply with the provisions of the law relatlns to Transfer Inheritances, "t.. ,D" t9....~ ~r (];p~ Roa\stor ;;( ,:;!I ] j',j '" f._I (-;!' 0 1'1(\ ~";:::. ' .. (,.., LL; ,,': r~:J ,-~j l" '-'.2: , :I,',J-- [;1': ,..... 1,.11.,1 ~!; ~.i \D '01 - ~.)t5 Bt5 ~ I ~ :'::i!. U. '. l~t' fl' Ii: 50 ~B VI (.,) 0 ~"t:S ~ - J \"':> ... ....I ,c....:> W"'~ V 0'-': ....I ; - u @\ ~ .a " ..J 1 I :! .~ c} ! 1 ~\ en ~ C\l ~ , \D ~ * k \-f ! ae It r.omemberedthat on the 20th day of recorded the last Will and Testament or Dli:CltEli: July ,A.D,,19.ID.-, thoro wuprobat~and ~U~y E. Ohidsey IlIto of Came HH~ ,. Deceased. Letters Testamente.ry, were granted to_ "' ,_ .. .0.-..... . Wltneumy hand and ofnolal seal the day,and yoar afQtesald, 109 , , cumberland County, Pennsylvania, De.vid Q.,Chidsey -. ~ ,{~.~ ~ Re Ister 1'- , ~I , ~ r: ) /;~ i'l ... (\ . '. Q.. U'.";: II': . . t.,} lL1 ~(: ('~ (,'t:-,~ ",. dL':i: :1" . ~ Ull,.+ ... ~....( hJtl! fU-J I'll;; ~ ''''ill ~ID ~~ ~ 0 ;; OOMMONWIA~TN Qfl "NNIYLYANIA OOUNTY O~ OUMIIRLANP , "~I\ v"Q C. , c: k l e(~'l.t hi., duly ~~"..ki.L~ ....'dl., I. I."" d'~o"'.nd"YIlh., ho----. _:.. 01 Ih. .,.1. 0' Rllhl( Iii. Qh IIlIIY I.t. 01 ..JIlU'''.ll.IIll...Rl..cAJ1\ll._Ul~._ , CUII\~.,I'nd C.unty, h" d......d ..d Ih.t Ih. within h .n Imnl.,., ",.d. ~y _ _ _ , Ihl IIld ., tho Inllto III,t, OI,.ld d...d..t, tlMI.lln, 0' !lIlh. porIon.1 P,oR.1l .nd ,;,1 "ht.. ....p, to~1 . ,.t. o.hld. tho Comm,nwOOllh 0 '.Mlyly.nl., Ud th.1 tho , 'U,,, ,oppo.lt. 'lIh 11\ 0' I . Inv.nl~y """'011 , I.l! v.I.. ., 0' I d.t. 01 d...d.nl'. d..lh, , k "_~'" )~ ' ./ /, ,-0 ...~ \ // ;/ " 'LI C Y'.1i.L ' .nd lu~..,,~.d bol.,. m" '3-,:,~ -::~ _.u~_., !:l_ '~" ~.I~.~u..;", ^,r"~i~~~:., c.. A.u \> (.(,,, I, ~ " \~1 tl I , AlI,", } ~I Vtldf I, GblKtl,", Nollry 'u~ M, 'om,"ll~ ~pl", ... II, 1m ~t~", PA O'\lIlhln c..wu, D.I. oID..,h 2~th D., !7uno M'III~ 1981 V.., 'NITRUOTlONI I. "An I.v.nlory mUll b. fII.d within Ih,.. m.nth. "'01 .pp.,.tm.nt 01 p."o..1 ,.p,,,..tollY., I; I!o, !Up,l.m..t I.v.ntory m..' bo fII.d within thllty d.y. 0' dlll.vOlY 0' ,ddltl...1 "..h, I. Addltlo,n.lth..h "'.v b. .ttoohld " t. pOll...lly .in"t, 4, I.. MI.I. IV, PlduOl,,11I A., .1 i.... ~, I ,1 !I I 1 j ~ ~ ;I J' jl~ ~ ~ ' = ~ .:l '" M :!I :g~ ~I. j i ~ ~f .,. ;,~ t , J :o:t n l-J Ii; ,'._,.l.( .. - (~-lfl; t,: ~/, " J .. Q. I/') ~;-, :! ~ It ' . I.,) Al ~l(, r-. :P;t:." , ; ~~7i 1:':1';.' .- tr.~ I..lHu ~;...J ~tl'; ~ -p'!j 1iJ~ .liO ill' '4 R~V.l.OO E>< , 1"'.11 II -.,) J a U. I paNNSV~~:~I~UD~~;~t~~~~~~~EVfiNUE INH~RITANOE TAX RBTURN RESIDBNT D~OEDENT 04 u ':l HAR~~~~~, ~~i7106 FII. Numh.r ..AJ . ~ /., .., ~ --~ ~""""'"' 0.,",",', N,.. '"", 'h"~~' ,.,,,, ,..d.", ,~~" D~CEA8.P _..tbid~...._ .1 E. ~O\ A," \ d'O,~1"'\ ~ OQ.d. · Socl.1 8.curlty Nuiiiblr' Oal8oi1lUth ' ..J __ ."tl\.:..a&n~~u,,__ I.e~J . ~arn It/11M ,'011 CHECK " Orl~n.1 R.turn\]J '~, 8uIIIII.m.nt.1 Return 0 3. Retn.lnd.r R.turn 0 APPRO. PRIATE 4, ~1"E,tet.D 6, F.d.r.1 elt,t' T.x 0' , R.turn R.qulred. ' 8~DCK8 O. O.c.d.nt dl.d t.ltato m 7, O.c.d.nt m.lnteln.d ,living 0 S, Number of 18fo dOPo,ltD (Attach copy 01 Willi LA.J trulllAttech copy of trultl box" Inventoried All corrBlpondence and confidential tax Inlorm,tlon .hould bo directed to: ODRRE. 1~""T :~'h!"'N" :~tn~O~S~~'I~~1 O~,~; Zip CA~OU, ~ATIDN RfctpllUllllon 1, Reel ell.te (8chedule AI ~, 810cke and Sonde (8chedule B) 3. Clololv Hold stock/Portnorlhlp In,tor.1I (Schadulo 0) 4, ,Mortgagel .nd Not" (Bchedule P) 6. O"h & MlloollonoouI Porlnllal Prop.rtv (Schodule E) 8, Jolntlv Owhod Property (8chodulo F) 7, Tranllort (Sohadul. 0) 8, Totol Oroll Amultot.1 IIno. HI 9, Fun.ral Exp.n", Admlnlltrlllv. OOlll/MllcellanoouI EXllen'" (Sch.dulo H) 1 0, Debu/Mortgag"/~I.nl ISchedule I) 11, 1'otal Deductlonl Ilolallln" 9 & 101 12, Not Value of eltate (IIn. 9 mlnu.lln. 111 13, Ohorltablo Bequeltl (Schedule JI 14. N.t Value ,ub/ect 10 lax IIIno 12 mlnut IIno 13) ( 11 ( 21 (31 .!>>~ ~10,1!'l~__ ( 41 (61_--.JCO ,00 " ( 61 ( 71 (81 as\~,o, \5~_ AECAPIT. U~ATION ANP TAX ( 9) (10) (111 ' '8 ~~' '51, (121 A.I5IQI , '1\ (131 (141~1~lb,ql{ , ComputoUon of Tax 16, Amount of IIno 14 laxoble ot tl% rete IInclud. velu.e Irom Soh.dule KI IS, Amount of line 14 tmbl. at 16% fete (Include voluol from Sohedul. KI 17. Principal tax due (odd I.x from IIn.16 plull.x from IIn. 181 16, Total Pilor paym.ntl: ' (el Amount Peld (bl PIUIDllcount ' (el Mlnullntef.lt t9, Bolonc. Du. IIIna 17 mlnuI IIn.161 Mako Oh.ok Povebl.lo: Reglll.r of WIIIII Agent · · · P~EASE REOHeCK MATH · · · (161 ~SIC\ ID,9 ~ x,oo"_lj5 '5 ~j., (IB) x.no (171~.ltl~ (181 (191 Undor ponoIU.' of p.rJury, I d.clare that 1 hlv' oxemln.d thl. return, Including Iccompanvlng 'chod~lo' and Itlt.m.nll, and 10 the b.lt of mv knowl.dg. Ind bell.f; It II lIue, cortil ond'complete, Dlclmtlon of pr.par.r oth.r th.n tho, pmonol reptoIontotlv.l, bmn on 011 Information of Which prepar.r hOl -~~ ~4~ ADDRSBe ' . DATE SIGNATURE OF PRaPARER OTHER"THAN REPRESeNTATIVE ADDRESS OATE \'. . (\ t', If' '~ :'P " I " tlo_j[i: fi t:,(;'-', C;~;J ... ~ :~: IP! 3tH ',-J_',,) ~~I! ~ 1"1:) _J (41 ASSE'rS a1\L1\NCE1\SOF JULY 1, 1981 Inv~ntory (at oost) );>roviaion for obsol'enoe CAsh $127,775.17 (10,000.00) 4,291. 86 $122,067.03 Total ASSl1lts f,lIASJ;~ITIES outetanding Invoioes Withholdin~ Taxes (Employees ) N.S.. Loan $ 9,1:1.6.89 2,157.60 12,460.00 520.00 2B2.13 4+1.03 270.62 7 5 . 9..Q. $ 25,2940.07 96,772.96 Advertising, 'rV ~ June 'l'elep\1one Pa~nt ~ Cabinet Repairs 1ll1eot;do - June Wi,ndoWC1ean & 'rrash P10k;Ul? June 'rotal Liabilities Net Worth " . , ,'l'he real estate listed 6nthe balanoe sheet of the Form 1065 was jointly owned betweendl;loedent and her husband and1that reported on Sohedule Ill, Item 1 hereof. ~J ~J N ..... III lXl ~, '" ~:ct (J\ 0 III '" 0 l"1 '" r- ..,. ~ . ..... . , N rol rol VI- ,~ r- III eo N a'~ (J\ 0 ~ eo (J\ III l(1 ..,. ~ VI- +J 'M ]~ ~~ .- (J\ III ~ N (J\ 'Mill eo 0 l(1 III :allll r- M Q l"1 (J\ . .... . , ", lit ~ N rol N ,.., VI- I=l 0.jJ , eN> ~ '@~ Q 0 Q 0 Q ~ '~ 0 0 Q 0 Q III III III III III ~ ~~ , , , , . 0 l"1 M, M l"1 M' VI- ~ ~ ~ ~ 'M rol f!l . I;l l I!S I Q) Q Q Cl 0 Q ~ 'S iii c::l 0 0 0 Q 1-1 · 0 Q Q 0 0 ~ So , , . , . l"1 l"1 l"1 l"1 l"1 j P;4'l Vl- E III ] ~ l(1 ~ +Jill 'I"IQ 1 ~rol N ~~ (J\ ..,. ~ (J\ eo (J\ l(1 III 1 l"1 N III (J\ l(1 +J~ , , . . , (J\ \ll r- eo 0) ~ I ~ VI- ... , ~ . l'll ~I \ll l:: eo (J\ Q . r-. r- r- 0) H (J\ (J\ (J\ (J\ (J\ H rol t-l t-l rol rol . , IJ \.,;'...."' r ~ \ ~ \ q II \)t.c. U.S. Pa, ,net'ot:q~~'\)'i>t.'( 1 or ,,,..I /II ~~ ~t\~Otl"hO\\'1 ~'l~e.\!. It H., t:,.,~ ~%~~I'\J\tll IJI.I.~ - ~b\{~\. ri,~~r. Hum, 'II!::, M3t. Qlly 0' town. S"t" iii'iiZiPcod, or p" Q Chlo .method of tloounllnll (I) O..h (2) Acorual (3) 0 Other (,tlaeh Ixplanallon) I, 11th. p.nnmhlp IlImll.d Plnnmhlp fill pm t 0' In'lIu" .1!!..,.,..,... 1Ion')f , t ! .. I . , . t t I I . I_ II hi, 'nnmhl I Innor In .nOlhor Inn",hl I , . , 2 Amonlhbl.blll II ,. S "n,'ru,Ilon,) IMpORTANT-rill In III IPpIlClbl. IIn.. Ind ',h.dulll, If yoU nlld mOil 'P'OI, III P." I 0' Ih, Jnllru9t10n" Enlor .ny 11.11\1 'P.,I,"y .1I00l1.d to th. p.nnor. on S,h.dul. K, IIn'll, .nd nol on th. numb".d IInll on (hi, p.,. or In S,he 0111 A Ihrou,h J, Ill' arm rlCllpl, or 11111 '~if.I,\;n~l..,~\,9..1 ~ Mlnu. ,,'u/H,.nd ,llIoWlnIll '..",!q, ""'''''''''''' 8,'I.n.. ~ ..l!! 'Z ~ " I Co.t of lood. .old Ind/or operol/onl (80h, Idull A, IIno 114), 'i , . . , , . . , '\1-9' ..!.. 3 Oron Profit (Iubtllot IInl a ,from ifnI 10). . . . . . . . . . . s:-;) ,,'5" /" ';.J.., ' 4 Ordln.1)' Inooma (lOll) from othll partnmhlp. and flduolarlll (atttoh Itataml~t) . , , . II Nonqualifying dlvldemfl. " . . . . . . . . . . . . . .. '. I Intereat, '. t . t I . I I t t , t I . I I " t.. I I I 7 NIt InCOml (lOll) from rlnta, (Sohadula H, line 2), . , . " '" " o Net Ihoome (lOll) from 10yollIl' (atllCh ..hadula). . . " ""'" II Net f.rm profit (Ion) (atlaeh Sehadule F (Form 1040)), . , '. ,...,.. 10 Nat alln (lOll) (FOrm 4797, !Inl II). , , . , , . , ,. "".,. 11 Othar I"coml (atlaoh IOhadula). . . . ; , . . . . . . . , , . . , . 18 TOTAL Incoml 10" oomblne linn 3 tllro h II . , " "" U. S',IIIIII Ind"a,.. (olhor Ih.n 10 Plttnm) $,,,", "I.. \, ":'13b Mlno'lob. er'dIV""Y'IIi'IO:,e,o.\,S.I.n.. ~ 14 Guaranteed paymants to partnar, ('ee pas. 40f In,truol/on,) 1\-tJ.:'!:.-.- , ',' -. '~!I' 111 ' 111 Rant. . . . . . '. . . . . . . . , , . . . . . . . ,~~\).,~ , Ie Inter..t (aoullon-... poa. 4 of Inolruollono). . . . . . , . , , , ;~~"., 18 17 Tax...."',\~$lJt'I'~..........., .,'. .. I.. ,.,.Ir I()' J 18 Bad debto (101 paa. 4 of In.lruollono)., .,..".,..,." l!.. I III R,palll. " . . . . . . . , . . , . . . , .. "...., 111 J 'or~ 10 Dopraolatlon (~ohadul. J, IIn. Il); '. . , . . " ., ......,. 11(1 1'. I ~ Q "1 ' 11 Amortlut!on (oUach oohedule) . . . . . . . . . . . , . . , , , " .:.:... III Depletion (other than 011 and a... .Uaeh "h.dula-It. paaoll 0' Instructions), . , . , !!.. 211. R.tlrement pllnel et~, ("e pase S of '",truollonl). . . , , . . i . . . . . . 1131 23b tmployee blnlflt prosram, (a.. P'SI B of InatruCllons), , , " ""'" 13b 24 Other deduotlon. (.tlloh oohe~ule), , . .', , . . . " ", "',~ '" 9 ~,l.'~i', .!L 211 TOT ~ dlduotlone add II 11130 throu h 24 , ,. '. .~.". ._J_l. 28 2e Ordlna Inoome Iou ,ublraot line 211 from'lInl 12', . , , , lis c e U e - Ie age 0 n. tue! on. 27 Invontory at.!!~slnnlntqf Yler (If dlffe"nt froml'st Ylar', oloslng Invantol)', ~tlatoh ax planation) , , 28e Purch"" $i.~,:1.111.rJ... 2sb Mlnu. ~0I1 0' lI.m. wllhdllwn fOI Plllon.I UII $.....I~~1i~...... ballne, ... 2" COlt of labor , , I . I . I I I I , . t . . . . , , I t t . . I . . 30 Material, Ind luppllea I I I I . I I , . I I I I I I I I fl. . . 31 Otl18t coata (attach 'Chtdule) I t I I "t tIt . I It. . I , . . . 32 Total (add linll 27 throuSh lU). . . . . . . , . . . . . . . . . . 33 Inventory at I"d of year I I I } I 1__ I _ I , t I I , . I j I I . I I t I 34 Cost 01 oods 'ole! subtract IIno 3S from IIno 32 , tntor hata .nd on IIna 2,.b va, . , "8888 II ~r .*alllti r I""'J, -1(1." i,. h. Utmlfl _ hit It urrl; 1/'1$11/(11111 UClllnp.""n. Ie . II ti In &. t'MI'! t, ." II I. Itu" &olin I nd 'oUlPI .r' flIlD!t.l' ~f'P"" (QlhtrlhU !tlp.nl) I' bUtd 011 ill IIIIo"nIIlD1 " .~,,~ PIIPIII' Sl,n - ~', ' ' " H8re , n.~,"", " ~blla lOp.'..', ~ ChtCk II P,ld lI.n.,,,,, ..".om, end d.lt IOY'd Preptrer'l FI'm's nlln' (or ~ t.I. Use Only YOUIO, II "",omploY'd) , And add',,, liP Cod. 1065 ...",".~ /'0' r-'f"~"II"'H. ,-- ~@80 J - - - =( - f~~~ If. - - - .' flGI'!I. ..Ii II '1 'onn 1~'8 (lt8~1 Sch'dull K--PARTNERS' SHARt;S OF INCOME CREDITS liilfr Iho 1010' dl.trlbullvo .mounl I~r ..en .pp ,.. . I.m Itl. Nqlll fnl., ..eh />frlnfl'. dltfrlbUII,. .h". on 8.hodu', K.j, I r. I I h du' ~ 01 ,e n ,. _ I, Dlltrlbut!y. ~ Ire It.m. a I Ouar,nl"d p.ym8nl. t~ pertn.rtl (l) D8duotlbll by Ih. "'rtnmhlp (P,.I 1, IIn. \4) . . . (I) q8plt'lInd b~ Ihl plrtn.rthlp (... p,., 4 ~lln.lru~tlon.). . . . . . . , . . , . b Ordlnlry '."oom. (IO'I);(PI"; I, IIneaar, . , , . t t i , t , " , , , t . , f . . ...",.,. .n...nn ~u... . Addltlon.l .llr.I'yllr d,prtcl,tlon (lIoh.dul. J, IIn. l). . . . . . . . , . . . " . . I I I ......... .......... ...... I Groal f.rmln, ortf,hln, Inoomt. t . . , I . . , , I I . t . . i' . . t . . . , ,.,."... ......... '....., 4 Dlvld,nd. qu.llryln, lor 'Molu.lon ('"80h 11.1). , . , . . , . . . . . . . . , . . . I '........ ......... ...... . N.t .hort.t.rm C.plt.1 '81n (loll) (8Qh.dul. D. IIn. 3). . . . . . . . . . . . . . " . . ......... ......... ...... . N,t lon..t.rm O'Pll.I..ln (10") (lIoh.dul. !:l. IIh. '1). . I . . , , . . . . , . . . . . . ., N.t "In (loll) from Involunlt'Y conver.lon. due 10 c..u.IIy or Ih.1I (Form 4684) . """ .,0Ihsrn.t.8In(lo..)undertlollon a.n. . . . . . . . \o,,~ I' . , , I .. .. . N.I,..' J. (In') Irom 8.11'.mplo~m.nl (1I0h.dul. N, IIn. 12) 1~~O~'1' . . . . . . . . . . 10 Ii Oh.rltlbl'-Gontrlbutlon, (IU,Oh-Utt)1 eO%..'.IIltt......"'..!...Il. SO%;..."....II"'.lll.IUI';. 20.%""'........"..",,,,'1i II Oth.r II.mllt\l d,duollon. (.II.oh Usl).. .. .. .', ,....... U llllp.ntl.ooounl IlIow.no.,. ....,... ,. . . , . . . . , . . II Job. or.dlt. . '. . . ~ . . . , , .. .. t I' , I . . 'I .. al Tm, p.ld b~ ~.ul.t.d Inv"lm.nl oomp.nl.. on undl.lrlbut.~ o.pll.lll.ln.(.I\'oh ,Oh.dul.). . . a4 IPI~m.nl, for p.rtn." 10. K.O.h PI.n, (Typ. 01 pl.n ......,..,..........,................,). ..... bp.~m.nl.forp.rtn.r.lo.nIRA. . . , . . . . , . . . . . . . . . . . . . . . P.ym.nl. lor p.rtn." 10 IIlmpllll.d ~mplo~.. ".n.lon (BEl') , . . . . . . . . . . . . 11 I 'orelsn laM's p.ld (... pea. 8 of In.lruallon.). .. .......,... b QIh.r Inoom., d'd~ollon.. .10. (.II.ah .Oh.dul.). . . . . . '. . . . . . . . II Oll.nd 'U d.pl.llon, (Enter'mounl"';'not lor p'rln.r'. u.. ........................,...",......,). .,. l '1 BP.o""~.loCl'.a lI.m. (.\ltoh 80h.dul')1 I 8horl,IIIm o.pll.1 ..In (101')' . . . . . b Lons.ltrm c.pll.l.tIN (I~II)' . . . . .. """ I . . . . . . . . . . Ordinary 1.ln (fon) t . . , . t t I'.' . . ., . i , ,t . t . , , d. Othlr .' . t. .. . 'I I ,,' t. I t, I t I".," I i ',' I ,,' , . . le T'M prelerlno. II.ml (I" pea. P Of InIlrUallon.)1 I "oo.l.r.18d d.pr.ol.llon on ,.,1 PIOperlyl (l) O.rtlflld hl.torlo .Irualur. reh.bllll.llah (161(0) o,.morllllllon under 1111) . . . . . . .. ............ ...... (I) Low'lnoom' ren\ll housln. (161(k)) . . . ., . . . . . . .. .....,. ....._ ......... ...... (I) OIhl/ .Dvl/nm.nl,...I.I.d 10W,Inoomt hou'ln.. . . . . . . . " . .. ... .......... ......... ...... (4)Oth~r n.l~top'-rt)' '. i . . . . . . . . . .. f . . I I , , " ., I .....,..It ".".... ...,.. b Aoo.l.r.t.dd.pr.ol.tlon o~ ps"oh.1 prop.rIy ,ubJ,ol to .1...., . . . . . . . ',' . . . , .......... ......... ...... Amortl..tfonl 0 ......."Ulllllt'''''..........i' 'cI."......"U...II'".hIH..I..'. ...,....""'..Il.nl...I.......1 f ......,.."".....Ilil...."';'.. ,....."... .......It' ......, e, R.Urv,1 rM 10"" on bad d.bl. of IIh.nol.lI,l.lIlutlonl ~ . , . . . . . . . . . , . . . ........... ............. h IltPltlIOn(olh,r th,n ol! .nd 'U). ..' . . . . . . . . . . , . . . . . . . . I (l) E~a... Int.nalble arllllnl co.tlllom 011. a'., or ..olht/mal W'IIS; . . . . . . . , . . ,(81 Ntllnoam. from 011. I"i or ..0lht/maIWIII.,. ., . '. '" .. a,' InllrallcnlnVlllmlnl, ind.blldnllll ,'nvtIlMsnt Inte,"t IIpen'el (I) Indlblldnllllncurrad bllor.la/l7/69 . (I) In~'bt'dn"'lhourt.d b,'ore lI/lll1a. bUI ,fl.r 12/l6/6P . . . . , . . , (II) Inatbl'dh'" InOUlTed .Iler ll/IQl1e. ...,.......... b N.I Inv18tmshllnoom. (1018) . . . . . . . . . . . . . . . . . . . . .'. . . EMOh. '~ptn"s from "n'l I.... prop.rIy". . . . . . . . . . . . . . . . d EM oln, 10 ' m c~ 'II Iln 0" I horl,tllm c. 11.11011 from Ihvutml I ro.rI , . . 10 Ploperty N.w . 3 or mot. bull", Ih.n B ym.. , . Qu.llllt~ lot proplrl~ be or mOl. but I.s. Ih.n '1 Y"" . . . . . . I ............. ...... ...... Ihv,slm.nl . 1 ot mOil Ytlr. . """ Or.alll Naw oo!l\mutlr hl.l1w.y V'hlcl. d hr morsy"" . ."., Ou.l1tlld pro. "" ."o,ndllu,,, I 1 or mOI~ YII,. , I . ,. ., U..d f 3 or mot. but I.." thltn a y..r. t , , . , . I Ih......... ..'..... i...... prop.rIy . B or m, ort bUlln. Ih'n 7 y"", . . I . . ,h 7 Ot mot. ~.'r. ii' I I , .. I , . 'hlal. I 3 or !l\OIl ur., """ DEDUCTIONS nc. rrl" In, "mk' I,,,,,,, 'lh'PI'I""hI, ~ I ,t. "'I:!''',::or.''''''\N'' ..n;.f,~.r..~n'. 10.1'" .u............ ....... "" . . . . . . . - . . . . . , - . . . . .......,....... ,....,...... . . .............." ,.... ...... . , ............ ...ill ,..... ............, ..hUt i..... U..a eommutlt Il I ellall lor "oohol utld 'S IU'1 . b NOhcOnv.hllon., louro. lu,I,olldlt o U".u"d 'cr'dlt, ftom cooperatlv.. . ............ - . . . . . I It. , tit., , . , . II . lI.h" 'j t t I . . . . '. . . . .i.... r.,m 10UlIUO) .Schedule L-BALANC~ SHEETS t" AIIETe '>.ge 9 01 InltrucUonl) at"tlnill'OclluyW Po.o 4 - It 0 fUtu 1 O..h . I It. I I , I I . I 2 ~f" II. end aocounl. r.oolv.bl., . . , , . Mlnu. allow.n.. for bad d.bh, , a 'nv.ntorl.. , . . '.....1 "'II. ',,, hl'!)l" , 4 Oovlrnmlnl obllllllon.1 a U,S,"fII'~"lAlfrln1\I",.Tli" " II et.t./ lUbdlVl,lon. 01 e,t.t., ,to" , , , , II Ot~'r ourr,nt m.t, (IIt.oh lOh,dUl.), ; . , !I Mortus, and r..1 ..tat, lo.n. , , , I!l 'I;.' 7 Other Inv..tm.nt. (.tt.oh .o~.dul.) (,,~ W 3(~' , 8 BUlldln",nd othtr d.pr.ol.bl. ....t., , , , a Mlnu. .ccumul.t'd daproola"9n, , . , . . D.pl,tobl. ....1. $'r~'!\bo.j, "",~", ti i- . MlnU. .ooumulat.d d.pl.tlon, , , , . , 10 Land (n.t 01 any amortintiOn) . ," " U Inlanalble ....t. (.mortinbl. only), , , . , a Mlnua eooumulatad amortization, , , , . , 12 Othlr ....t. (aU.ch 'oh.dull) . ,. '. 13 Tot.t'....t. I t t I I It', I LIABILITIlt8 AND CAPITAL II , .1": , 14 A.oount. P.y.bl. . , . . . . , . . . .......................... U Mort","; notll, .nd bondl pmbllln Imlh.n IYIIr , ~ ....::-:-:::::::::::::..... 18 0 th Ir ourr I, n" t IIlb lilt '.1 (altloh ,'Ohl d, ul.) , , , ~. .....::::.:.............. 17 1111 nonrloour.. lOin. (attach Ich.dull) , . . .11..................1....... 18 Mort,'III, nOlll, .nd bondl P'Ylbll In I (-'M 11!,0tl I ,. . ,......):""i~:;;.:"T'i. 10 Oth,r lI~bl,lltl..I(""lll.t..I,.J~I.) {"''''Ii''.''' _' .).n:.....l{'r;~..f:~. 20 Partnl" oapltl accoun., , . , , , , . ,).', " otal lIab III.. a d ca Ital , , , , , . to, ,:. ~ Schedule M-R~CONCILIATION OF PARTNERS' CAPITAL AOOOUNT (S.e PIge ~O of InltrucUonl) " (ehow reooncllla\Ion 01 ,'ch p.rtnlr'. o.plt.1 'coount on 8ch.dul. K~I, It.m "I) , - ,C.dl"lV ,,,.... d. "f'.' nOl/""d'd ., LOIIII ft'l I""',d ~ b, 0..1101 IO,III.".d (1'111110. '11' I, "'I '."1 . 'I no,. " ,01,., " 01'1 I, ItIM't1!,'ll,"d !,.e'."l.I"IIII'," dlmn, UU'IIIl' a6.' ; tI.blt Il"ml un.llow.blt ~."lIt110nl ~ . I IIv . r j- "- Cn 1. " - e" , 2. ,~ '. I," 1c e U e - ee I e 0 nl rue on. 1 Ordinary lncom......, (paa. 1, IIn, Ie) , 7 Nonqualifying dlvld.nd. (pa8' I. IIn. 6) I Oultlntlld p.ym.nl, IQ p.ttner. Ineludld on 8 Inler..t . . , ',' , . . , , SehldulI K, IInll \.(1) Ind 11(2), . , . . NIl/noom. Irom r.ntal 01 r.al IIt.t. , S N.t IoU from ranta' 01 r'.1 ..tet.,,~ 10 "It ,"n f,om Fo,m 4717 (pI..I,lIn. 10), , 4 ".t 1011 f,om FQrm4717 (P... 1, IInl 10) ,. , .. _' 11 Tota' (edd IIn.. 7, 8, 9, .nd 10), , , ~, ...' .. II Total (add I!n.. 2, S,end 4) , , "r Ii' 12 Net IIrnlns' ~ from "If'.mploy, ;r,:, \ ' r,~, 8 IIdd IIn.. I and II, (1I1Inl II" 10", '.a' t'\ ,I!"I tI't'-' m.nt (,ubtr.ot IIn. 11 from IIn, e), I'.J, due. IIn. 1 b thl amount on IIna 6" ~ 'I ~ Ent.r on 80h.dul. K, Iin. 9, , " AddltlonellnformeUon Required 1!L .!!l. "lWll~:I:~b'Jr~t'~~~~t~~~ r.,\~\~Mf:'p'II~:ft~lrnp,I~~'J: v"J!L L Will th. chll.C II' 0 I,.ny Iilb 11I1111, ','n se,h, IdUII. L (, b '.1,' n, c, i orll,O' Sill. '"ncy or .Vlhbtlty? It "VII," III1,h. .tll.mlnt Shllll), elhlr thIn IIn. 17, bh".. to nOnllcourll or b,eom, ,lvln,lh. norol Ind Idd/III DI Ih. ,"ncy(a), , . . , covorld by . ,vlllnlll or .Iroltor IIl1n..m.nlln the fulurol 'I ' '_ If "VII," .nler tho Yilt(\) .nd Imounl(\) of thl Inllclp.l.d :w ~ 0 AI"y IIml durlnllhllu Yilt, did Ihl p.rtnlrlhlp h." !n chon," ~ .,,,......,,'''''',,....,,.,.,,.....,,,'..,,,,....,,..... ~ ~ I,nll, 1111 In O',III,n'lulI, 0, othlr 'UlhOr,ItY OVII I, blnk .c. "I P.rtn"lhlp Inlo,m.IIQn Qn Inlern',"on., boycOllln,. Fo, Plrt. ~ "~ counl, IIcurltlll mo,u nl, e" olhor fln.nOI," mount In I nor'l rlPOrtln, IIqulrlllilnl!, III Fo'm 6713, W, i';!, tOil/In ,ounlry (III P'",IO ot InliruCIIQ")I, , , , , (1) Old p.rtnltlhlp hlVI OP'"l1onl/n I boyoellln, omtryl, - P 'Wlllhl p.rtnlllhlp Ihllllnlo, 01, 0' I''"'';rot IQ, . for,l,n I t,ulI wh/,h ..1,I.d durl', Ih. cU'''nlll' Yllr, wh'lhor 0, nol (2) Old Plrtnlrlhlp plrtICI~.II In or COOP'llt. With In nll,nl' Ihl p.rtnlllhlp Ot Iny p.rt",r hlllny blnlll,llI Inllrlll In,ll? lI,r.1 boycolll, , , , . " " It "V..,.. you ro.y h.v. 10'1/1. fo'm13S20, 3UD-A, or 126. SOld I n"'hl fll. Form 67 ", , , , , , , SOl .. 1001 I"ltuOllonl., , . . .' , . , p ",' II. I!' ........-....-q.. x. --~ ^ SCHEDULE K-l (Form 10115) o".rt..", tI 'h' r"""1 1.1,,.,1 R,,,... 1,..1.. ",rtner'l I Inti n num r P'rtn.,'1 nlml, Iddrlll, Ind ZIP ood. rl'.~' ,,....., . 1\'.) (:':'1 L , l ' ',' ',' ' Partner'. .....r. of Inaame, Credits, Deductions, . .4.-1880 I) j.. ra, NI.nd" IW !teo a' nlC,lya" j-, ) (' " b.,lnnl". ........I. .14'(..'"'''''''''''''' le80, Ind 'ndln, ",,,.....l1.,f\l~.,',, ....""'1 ":".~:,,, Cop~ 8 , (For Form 10811 R.cord.) .!!..1!.,rshl 'I Inll n num r. Plrlnmhlp'l n,m., Iddllll, Ind ZIP oode -..---.,.' " --/.' ' 'f ',' I ,"', '/" ' It,~ , / " , ' "I, ! ,..r. ..., ............... th........O.....,.. <i. .t............ f .It!.. Ho ~ l' (I) Did plrlnlllhlp Inllru' IIrmlnlll durin. .hl ,11,1, . _........ (II) Did p.rlntrlhlp Inlllll' dllllll. du,ln:. .hl ,1111. ' , Q Enl.I plrln'(I percenllll Ofl (1).ml~I.:t{~" (II),~:I" PlOfIllhllln. . . . . . ......,.;1.,....,96 ....,.'.::L....,.. 96 Lou ahlrln, , . . . . ........~........" ...:.!'..........." Ownlllhlp of Clpl..1 .. . . . . . . ~ ..o+'..!.~.l;..,..96 Tlml dlvolld '0 bUllnm . . . . . . ., \ (...:.:\..........." H IRS OIn'" Ifjhlll p.rtnlllhlp mid rlMn ...........L..,..\....,....... I Whll IIPI of Inlll,II Ihll plrtnlll ...............f.,~'..:,;,.....:........ J P.rI"If. Ih." of IIlblllllll (II' PilI 7 of Inllruc,lonl)1 1II1...lItd M"" 111m (1II,1"'"td III" '''11111 Honftcou"., . ............................, .......~..,...f,....~I.,.... othtr t t . ....H...................... .,.....(....~.)~I..;......... K Enlll tol.1 .mounl of IIlblllllll olhll Ihln nonllCOUll1 fOl Ifjhlch 'hl plrtn., II plo'lclld 1IIInl'lo.. .hroulh au, Illnllll, 1100 1011 ","mlnll, Of Ilmllll III.n,lmlnll 0 WhiCh Ihl pl~n"lhlp hll knOlfjlld,ll Incurrld blfa" 1/1177 . . . . . . ,.......~~.....,...:;..... Incullld I<<er 12131178; . . . . . ............~.;............ A (I) DI'I(I) p.rlnll .cqulrld In, p.rlnlllhlp Inlllllt dUlln.lhl (II) Did plrln" h.Vt In, plrtnlllhlp In'"1I1 blfolllll/17f . . 'I plrlner . nonl,lldln' IlIlnl. . . . . . . . . o (I) II plrlnll . IImllld plrtnll (III Pili 2 of Inl'ructlonl)1 . III) r.' ''Vllt II olrlnl, .110 . ,Inllll plrtnlll. . . . D Idl u..n.. IVIr"onlllbu,. prop..., olhIP Ih.n man., o n. p.,1n.rth pr . , . . t , . t . . II ''VII,'' '",III I ellll '0 Plrtnl'lhlru of oonlllbulld PlOP.", lolhll . In monl') .. Ilmlll) of oonltlbulon 10 Ih, p.rI' n'f1hlp . , ....................... b V,'u. of oontllhu'Id propelll In "I" lbov' .. ,,"Iclld In \h. ptrlnlfl 0101111 _nl .<..'Ii...i............ (II) Did prrln., .... rOlil.. . dlll,lbo',," 01 II h.n monll from h. p.rtn,,.h pl. . . . , , , . t . II '''{It,'' .nllll I ellll 10, Plrl"IIIAIO of dll,rlbulld P,oP.", lo.hll h.n monl1l .1 tlmlll) of dll"lbu Ion 10 Ih. ptrl. n., t . '., ,..,................... ~ P.rtnl(1 .hl" of .n, PI.,m8 1011(11) from . IIctlon 481(0)(1) IOllvlIl (I,'" "1m or vldlo "0', IIOlIon 124& oro,.rt, IIlIlnl, f.lln, or 011 .nd III Plopelll) for whiCh Ihllllxllll. . co" "IPOndln, 'Il\oun' 01 nOnllCOUfll IIlbllllY ,,'hl ,nd Of thl ,III In whiCh 1011(11) DC UIII ,.I'lf3~1 :,'~I::I~~~ ., I~..~,:~:II~~IW. I, Ifj'th'''"l'' to' ,..". '"11I' UOIIIOlIIIlIll..II,o" dIlUII,1 '"~ ~. b V,'u. of dlllllbu'ld plOplIII In "." .boVt II ""Iclld In \h. ptrlnlfl ~plt.1 account ,..,....,.............. I WII .n, plrl of .hl Plrlnl(' Inllfllt IVtr ,cqul"d from .nolhl Irtnlll tOano la an ,. fM,.n un. e \, I, C"II",""." ., 'fl4' fMr ,-.....-.. 'l~) (, ',.',J" , 0, OllullolI" ,hi.. lI.m "Motu" .. 1040 fII,.. ..I., thl ...." III ..IUMII .,U a . Gu"lnt..d plymlnll 10 plrtnln (I) Oeducllbll by Ih. plrtn'"hlp, . . ..~~..................... 80h.., Plrt 111 el) alplllllzed by Ihl plrtn'I.hlp . . . . . . . . . . . . . .........:-.................., 80h. E. Pitt III b Ordlnlry Inooml (1011). . . . . . . . . , . . . . . .' 80h, .. Pitt III a Addlllonlll111I'y..r dlprtolallor\ (BIIII ....,.......,..,............). . . . . . 80h,E, "Itt III I Groll IlImlnl or II'hlnllncom~ . . . . . . . . . . . . . . . 80h, E, "Irt IV 4 Olvldlndl qualllYlnl' for .xolu.lon '. . .,. . . . . . . . . . . 8'oh. B, Plrt 1I,lIn" II Ntl Ihort,llIm olpll.1 ,lln (lOll) . , . . . . . . . . , . . . 80h, 0, IIn. I. 001. f or I . Nlllon.,I.,m olpllll,lln (1011). . . . . . . . . . . . . . . 80h. O,IInl,10. cal" 01' 7 N,I .lln (lOll) fromlnvolunllry oanv,r.lanl dUI 10 ollullly 0' Ihtft. . . .............................' Form 4884 . OIh., nil Illn (10") und., ..tllon lall '1' . '.' . . . . . . . ..TJ'..~'\i'I.:r~,.... Form 41111, IIn. 1 . N.t ._,,1.... ~'l") tr.", .alr 'M,I~~II1."l, ,.,., r ". . . . , , I . . w~.,..':':....,,:....."'.., Soh. 8E, Plrt' or Part II 10 . Chttltlbll eontrlbutlonlt 150% ,........"...1.... 80% ......'1.........., 10% ................., "...."....,.,.........,..... Soh. A, Un.ll or aa b Olhll Itlmlzld dlducllohl (1"loh 111\). . . . . . . . . . . . ..............,................ ,!l'J.B!ll~,~~NN"""HH, II EJtPln.. aooount'allowlne.. . . . . . . . t '. .. . . . . ............... .............~_ II Job. credit . '. . . . . I . . t . . , . . . . . . . . ..."......... ",........... ~:r~,.I"'a~ln' 81, add word' 11 Tlx.. plld by r.oullled 'nvnlmlnl oamplny . . . . . . . , . . . ............... ............. 'If :rr6d., 14 . Plymlnl. fot Plrln.r 10 I 1<.01h Plan (TYPI of plln ...,......,...............,) . ................ ............. Form 1040, IInl Ie b Plym.nl, lor plrtn,r '0 In IRA.. ....,.... ............................. Fo,m 1040, IIn. as , PI minI r n.i a 81 I fled F , I SCHEDULE K-l (Form 10SlI) 00"1\1II"'" \tit T"",," 1._1._'....." .rin.r'. Id.n n numbtr PI~ Olm., .ddr.", .nd " . Partler'. , .'1 of IICOIIS, Credits, Deductions, .-1880 \ ~ OII.nIl., ~., lOBO 0' n~VI" ~ I>> th ..lnnlnl ~.AW'1.4J~':"''''''>i "80, Ind endl", ,~",~""I..h(.,, ........ 11~.~ Copy' ' (For Form 10811 R,tcOrdl) ,. 'OAV/'D a ,C.HIDJ'~'-( ".rtn." Ip'l d.ntllYlnl numbtr Plrtnerlhlp'l nlm., .ddr..., Md ZIP Ood~, " ' -;;r~ ~M P ~ I-/g ,'P!'~ A (I) 0.1.(.) PlMII .cqulrad .n, PI,rtn.nhlp Inl.rIII du~n. Ih' rear ......................-..................................... (11) Old Plrtn" havt .n, p.rtn.rthlp lnl.m\ btlOft 1IIIm . . II PlMII . nonralldlnl .lIln1. . . . . . . . . o (I) II plM.r "lImll,d p.~n" (II. PI'" of 11II\1\l0\1oM)1 , o Ill) rJ;,l:~~!"t~~lt,"\\\t~..:~~n~:~,~.~ h1 m~"'i II "V.... en\ll'l I ''''', \0 ptrtn.rth=of OOIItflbul.d P'roHrlY (OIhll .n mon,,) II \Im'\') ot oontllbu to 1M p.rt. Mtthlp . . 'H.............._ ~ V.lllt of OOIItllblit.d proPlrl1ln -.. .bM II "ntol.d In \lit ptrtll.I" MDlt.1 _nl ....'If'..'.......'Ii..' 01) Did Mil"" IV" m'jVU dlll,lbull,"" .r ."~n m. .t front ,hi ,.rtn.I"t~lp, . . . , t .',. , . II "V..." Inl.n . ..111 ,\0 rtll.:!p or dlJ\~blit.d PIOH'" f~h" .n mon,,) .1 IIm'll) of '_1ItI1b n to 1M Plrt. ..... ~", . ........u............... .!!L. I' (I) Did p.rtn.rthlp Inltrllll.rmln.t. du~n, th. ,..rT I . - (II) Did P1rtnllthlp In,I"1I1 dICit." du~nt\ll' ,.,'1 Q Entlr PlrtlI.f. ,.~nl'" 011 0) J\1'~I::" prom aha,l", . . '. . , ....~~...." ,.... ......" lost attlf1", . . . . . :.-...~,.'...". ... ...." , OWn'rthlp 01 "pllll I . . . . . 'I~~" ..,. '11m. d.yot.d 10 bu.ln,,, I . . . . f1'eTTR~ .~' ..,. H ,IllS OInt.r "hi" p.rtll.lthlp fll.d "Iurn ~..........f.r.!.J ...1.. I Wh.t \YPI or.nutr " thl. p.rtn.rl ~.................. .. :t.t.41 ""..... Ji ,.rtnlf. "'.r. 01 1I.~1I1\1.. ('" P"I 7 01 IntIMlIot\')1 lIOnllOOVrM. . ',~,~:~,~,~~~~,j ~I:~.I~N~;;~~' Othtr . . . .............,..............u ......................~. KEnt., 10111 .mounl " II.b~"I" oIht' Ih.n nonrKOu~for "hIGh Ih. ptrtn.r It prollCt.d 11.111I\ throulh ,uII.nllll, I~P ,..'"m.n,... 61llmllll I".nl.m.n.. Of "h oh Ill. P'"h.rthIP hll .dpl . lMurrjd III'olt 111m . . I" I . ........ ~'N~. tMUlTtd Int, u/ltnl. .. .. . . .. ....H... ........~m...~ L :.~~~ \\\~o~H'U~~lltlvr~':l =~ "", *liOn 'faopro,,", 1'11I01. "~' 01 011 .n,id '" proptrl11 for Which, llI.ra', I kill,' 're" W'lt~ddl~d .~ou~ ~rr~":lIlr:: ~l~~ occu . . ~ l:l::~ r'\ U=Ir:r. ., t~';lt,!l''''' .!":I::-' I, W,111Mt'=a.... tau,". MOM '''''"'''~ . '"....1... . ~ - ..01'11'1._'" ~I OM ~ ,.., - .. Olllrtil\lft .,. HIM ...'" 1M ....... "' \ I . Ou.,.nl..d p.~mon" 10 p.rtn." (1) Dtduollbt. b~ Iho porinolllllp. . . ....... ..................... 80h." P.rt III (I) ClipllllllOd b~ Iht p.rin,r.hlp . . . . . . . . . . . . . ......... ................." 80h," pert III b Ordinary Inoe,"" (10"). . . . . . . .. .. .. . . . ~ ~ . . un....... .....unn........ 8oh. I, part III . AddItion.' flrlt.~..r d.prtol.tlo~ (B.,II 'IIIH."tu.........t1~....) ., . . . . . ,.......... ..................... 8oh." Patt III I Gro.' farmlnl or f1lhlnalnooml. , .. . t . 't . ,.. t . . . , ._...... .................... 8chi It Part tV 4 DlvldondlqUttlMnll for oX9Iu.11I1'I. . . . . . . . ," . . . . . ........... ................. loh. I, Part II, lint' I Hot Ihori,torm OIpll,ll.ln' (1011) . . . . . . . . . . I . . . ............ ..........:..,.. 8oh, D. IIn.l, clIt; f Dr. . Hit lon.'\lrm olpllol'lln (10")" . . . . . . . . I . . . . . ................ ........... 8oh. D, lint 10, 001. for. , H.t.lln (lOll) from lnvolunllry convoillon. duo to CIIUOtty or Ih.lj. . . ................... ..........' Form 4184 . Othor n,o'I.ln (lo..)und., Ilq\lOn, 1111.r!.' \'1'"' . . . . . " . ..,...u.....To.t:J.Ii.:~.... Form 4,n, lint 1 . HI~'~" tlml.from ..1f'lmpto~.nl. f"'f""." I' . . . . . . . . .....'fIZ..'1..:rI....~.. Sah.II!. Ptrt lor,..rt n 10 . etattlttb1t contrlbuUO,,*\ ISO" ,~...,....."."... 10% ......H..m...... 10% ................... .. ..................._..... Ich. A.lln,al 0' II II Other lllmllod ~oduollon. (,\teoh lilt). . . . . . . . . . . . 11 EJcpon.. t,ccoun'tllow.not. . . . . . . . . . . . · . II Job. oredtt . i;-. '. .. . . .. t. . . t . . . . . . . 11 Till" Plld ~ ,.Iul.lod Invlllmonl compony . . . I . . , . . . 14 . P'~monll for portnlt '0 .l<aoah Pltn ('1ypo of pl,n ~.~..........,..."..,.....) .. P.~mon" lor pi"nllr '1I tn IRA I . I . . . . .Pom'" or n.' .-.,.......---...,.....,.....,--'l"l-.. ..........~.....,..""...."'"""~."l'r~\'P........-'.~.,'-.,.,. ...-. .-......,. "-.~r"'''' .....-...,.. ...... IIl,,'mtnl.llhttrtUyJY nl In 1ft In In c.- A ,,,,,,,.1 ~"'rtll "\1'11, I\' I 71 ~ Z 0.. 614 4 1 P Im,I,," 1'..III1"II.n ... R,/,~~,.~,,~~,~.,.'",:,,~,,"n" UAVlD (. t. HU/H 71~ze..614fj DZ33 ,?.~"/2.G.qll.'J_ . "IAlIIII Hr~I'.r ..~I.. 408 AHl.l NurON RJ~ CH 1 U5EY . 011. .,'1'", "11'" /.t\~::,!.~~I,!,':~Jt:"!""') CAMP HILI. fJA " II .__.~ ad", /7)\' c au,lntl"'" "m'" ,m ~"0 1 70 l! ' Il,~, r In,'l' \""'/"l1l"m 81,.j, "'.. ,,'nl11O"lOnll 01 )Md,.\ll"f\" "" ",. ~,I", I ,u',mn (0)" ~', I 'J ,.," -' , 1:1 I,{ {II, \,..\... Q Chook mothad of acoountlngl H 1.lhlll fln.llttll I ~ aUh" (a) 0 AcClual (31 J Olhll (attaoh a~planallan) ", 0 v.. ,,' No IMPORTANT-Vau mUlt fill In allllnll and IchadulDl, II mci" opaoa II naOdad,l1I paga, a of IlIlIIUCtlOlll, tnlll any Itaml IPaclally alia. aated to the partnlll an echadult K, IIna 16, and nat on Iha numbllad IInll an \1\11 paga Olin Scheduloo A thlaugn J, h 01011 'OOIIPII, ,CI 111.1 , ..,..i,...... ;I.f/'+.)! lb lm Illu,nl..d .1I0wono,,' ,,,' 5',~:.,,~.., elllno. ~ ' h J" ;'1 ,'" ~"'.... ,~ a Oalt 0, I goado laid andlol apalatlonl (sehedllla A, IIna 34) , " ' , ,'...!.. .,~~!. ,I:~, , ~"\[ 3 Orall profit (aublraot IIna 2 from IIno 10), , , I " '" , " , , , "..!. ~ ' 1 i ! if:! ~ Oldlnarylncpmo (Ion) tram alhar pnrtna'lhlpl and,flduclalln (attach IIatamant) ...i.,,' - D Nonq~.llfylnB dIYld.n~.', .1 I . I i I _.' I I -,' I I I' I' I I , J... .. I Intlr..t. I I t I , I I I j I , I I I I I I I I I I I , . 1 ~ ~ -- 7 Ne\lnc,oml (1011) from rantl (Sehedula H, IIna ~), , , , -1..., "- S Nel Incal11a (Ipll) flam loyaltlel (attech ochedllla) , ' , J.. _ ,,-",",..-.-, , Net farm profit (Ioee) (allaoh sehedllla F (Form 1040)) , ,i - - , - ~O Net gain (loot)(Folm 4797, line 11), ' , llL .. ,,,.....' ,,' 11 Othar loooma (atteoh lohadule), , , . , , , , , , ,.u.. ."....,..,~_~M. 12 TOT"~lncOl\1a, 1111" oamblnellnll3thrau h 11 , , >>_ 5'0/ t.{ I(.",:L~, 130 SlIIIIII 'nd Willi (O\htl th.nto~.rtnero) ,,~:i"'I,~..;,:;~,,;'./1ab lOll Jobl Crldit ,,,'~,, ,BlllAOI ~ .!!! _ .!t., '1. 0 () , ,) ~. 14 OUlrantlldpaymantltapartnerl(leaPlee~a'lnOlrllotlanl), , , , '" ' , , . ,14, -' " II Rlnt', I I " I 1 . I , , ,t , ! I , t 'I I I I I I " I I 1!... ~ --"," 18 Inter..t ','" , , , , , , , , , . , . , , , , , , , , . , , , , , .!!.. I.I~ (, ,',,, '1." 17 Tax.. .....1.,...'1; ,\ I' 'T','.' I . I I I t I' 'I .,. t 1 I t 17 :, r ~:. ~ ,.~: 18 Bed dlbt,o (Iat paga a al Inlllllctlane) , ". , ' , J!. "'--' ~, " R.pal,.. I It! 'I I ,,. I I , 1 I t 1 , I I t t . t I I '18 ',6';'../1 '" J 120 Dopreclatlon (SchedUlo J, IIna B), , " " I' ' ,liD /,,! Il'" \) , ", 21 Amortlaatlon, (tittoch echadula) , , , , , , , , . . , " "" ii- -.....- 22 Dlplltlon (Olhar tnln 011 and gll, attllch eohedule-ata paga 601 Ir\atructlonl) , .!!....' ,,,.. , 13. Rltlr.mlnt plan'l etc, (... page 6 of Inlt,ruotlonl)., (Entlr,number of plana ....".,."".,.....) I , 1 23a ,. ""',"""".' 23b Emplov.a baneflt programo (lit pas' 6 of Inelruotlon.) , ,,' aab '''' 24 Other deduotlane (attaoh aohedula), , , , , , , , , . . , , , I " ,114 r.,m 1065 U.S. Pa. ,Iershlp Return of Incomt.. u'.ndt"utI9rt, .' fhnl ,tt. ....IIIAln. r, 1"', tnd .ndln, ..10, J 28 :rOT"~ deduotlanl (add linn 130 through 24) , aD - , , , , , , . 211 Ordlna ' , , , all e . U. DD age!O n_true on. a7 Invantary at bUln"ln. of yelr (If dllf"ent from lilt vear" 91alln8 Invaolary, a"lch uplonetlan) , !t- 21. PUllh111l $"I.M""7.~!.:"~I,.I,Y,,, 28blm oolt ot lIoml wllMrlwn t91 ..rlll",1 Ult $,:"..,\:o.I,~~J",,,,,,,,,,, eelenol ~ 2110 II COlt of,l.borA ., 1 It! . t . I ! t I I I I j . I It. . It'. t I Ie; 10 M.terlal. end luppll.. , , I I . . I . I I' ,.. I t t I , 130, 11 Olhar caote (a\tach ach.duIO) I, ' "". '" ." I . ' !l- II Total of IInl. ~7 \hrouI" S 1 . t I . I , I I 1 I . f I I I, tit . I I,., S2 II Inventoty at end of v..r ! . t , . I I . I I . , t t . I t I I I' I ~a3, 34 00 t of oadloold Ollbtllet IIna 33 flom IIna 32 . Enlor h'" and an 11"0 2' abava", 34 H '" ,." "10, I' ... ,... "10 AI "UI~{ ~IO " "l,m"n" I " I ' ''" " .m," . '" · ,~. , :i """,,.n 101o,lot., o,dllll" ., ""'''' I' '" 'IR t"",II' I '" .~ II "",mill,"' oh I' ,"",,,, '" '"' "o'WII, I ~ "1".II":'~'.,:r':'~ p.n." ~ ~:~'I I ! i ~~~~:~~:m. (Of ~ IrJ~:~"I' D. If I yours, II 0, '1,"impIOYld) .nd odd.l.. liP cOd' mID79 .-. ., ' ..t,'. 'iI W" 4,1 ",' t l; 7 t"....:!.. ~. "7 5'/, ~;j.. , lit. 1+,1, '1., I~. #.'1,... I." , ~.,',. t~ t.f l ,... """'.... 'I , . __,..t ,~' '.. . .."', lJ f " ',..' I ~ J / ~ .0," ,wt ''". .t " ;Ull ,~ r.,m 1065 nUIII"'tl\loflh.T",lurr inllln.,flIUI\U,S'J'f14!- It flltnclPlI bu~lr'U 1&11,lh U.. N.nlO c..~II"J~{"f f" "f(I"i~(;"l ~".n~"p", ~2(,', In.II~~I,lon,'1 I~ 1 -rlo/" 1.,1,"; I' .';',' 1,Jt 1'1 '" . P"..,.., ~9~'" 'rUNIIt' ~Ib~; Numb.. .nd 11'''1, ,,- (In P41t U pi 1M tllcll_on,) I. ... I' " 1"'1- I~ t "",, 'h_\'J_~ -, I "~ WU ~ '$.' .fil ' q hI"'" ,,~. n" ,,,.' pi.." Oll~ or lot'n, et.ii', Ind JIP Dod. , ", Pllt 12 olln.bu.c IOIlt> op,rltynl, ' """ i.. 'J', .:'. " f . " tr'1' II ,VDI, , IMPORTANT~rllllh III IPpllclbl1 linn Ind ,ICbldUI.., ,II 1110'1 Ipue II, n"dld, 1,Ie Inl,lIucllon b, Enler eny Items IplclellY a II Ihl, 11I~1~'tli'" .lIuul.d 10 Ihl plllnell oD 6chedul, K, line 16, Inllud 01 on Ihl num~lIed Iln.. On lhll Pile or In, SchedVI.. 0 Ihreulb J, M VII Qi...,N. 1 II I $"','_'1../,'.' '1b Lid II " $ X:",", :""1 .... tv 'Z.~1 l!. -'/, 'H. I a'rOIl tee. p I or u.. ,\,.".:1r.l"I. ,I'I'.~'.H... ." re urn. an I ow. nett ,...u......,,,.,~,,..,\..._P. 'I\~',... _ 2 COlt 0' 800duold and/or operatlone (1lno 34, $chodule A), . , . . . , . . . , , ..!.. J .1 'a , 11 \" ,"f" 3 Oro.. profit (Iubtract IIno 2 'roil)' IIna 10), , , , , , , , , , . , , . , , '..!.. '/ ,,,,.... ~ I,' ,1/ ,~, 4 Ordinary Incoma or (Io.e) frolll other pertnetehlpe and f1duolarlee(alloch Ilatement) , . ',.!- ~ II Nonquftllfylns divIdend., . , I I , , , , , ; I tit , I , tit ; I -!.. .. -....'....- e lnt.r..t I I I , , , " , I I I I . , , I , I , , I , ., I I I It..!.. ,...i... .,......,. I 1 Incomo or (10") from rente (schedule 1:1). , . . , , . , , ,-. " . . . , ,-1-' .' 8 Royalties (_Uach tQh_dul.) I , . I , . I , , I I , I , , I . . . I , . -!.. ".-.-......,.,. ...d 9 Net form protlt or (10..) (allaoh schedula F (Form 1040)). , , . . . . , , . , ,..!.. ,..,.....~..',., 10 Net gain or (loaa) , (Form 4797.11"811) I '. . ; I It' t I I , . . I I I I ...1lL ' . 11 O'ther Inoome ,(Ittach achedulo) I I I . I I , , , I , I I I I I t t t f Jl. 12 TOTAL Income (add IIn.. 3 throueh 11\, , , , , , , , , , , . , , , ,Ill /o'~d III. fl ;li~j' 130 Sallll" end Wig" (olhtr Ihln 10 plllnlll) ~~IT"~..:',~,,,~.'Ub tOIl JDbl Otldll $,,,~=,,,, Bllenc, l-- 130 l.-/..:.' 11'18, .. I 14 O"atantoed paymente 10 partners lIdo line 14 lrielruotlon), , , , , , . . , , , ,14 --~..-_.. liS .____..! ' I lIS Rent, , , , . I I , I I I I I . I . I , . , t t tIt I J_, f , ~~ ~~I:::et,~>;~>...; :', ': : : : : : : : : : : : : : : : : : : : : : : ~~ 4)m 7': ~/J ls Bad dable (Ita 11'\0 1B Inetruotlon), , , . . , , , . , , , , , , . . , , .!!.. - .."" '''''' 1}. ~~ 1, ~'- 1St Repair., I . I I I , , t , , I I , t , , I . , , . t , t t , ,19 - I -- - . l!a Depreolatlon (180 Inetructlonelor Schedule J), . , , , , , , . , . . . , , .!2- I, I ~"\l. ,oi ~; 21 I Amortll8t1on (attlch aohodule) I I . I I , I f I , I . I I I , I , , ,!!- ~ 110 22 Doplotlon (othar than 011 and oal-allech eohadulo-eeo IIno 22 Inenllotlon), . , , , . 22 -.---,.. E t b..... 2S. ....-,-,'.'. 230 Retlromonl piano, 010, (u. line R3e'lnelructlon), ( n or num .r 01 plane ....",,,,,.....,,..). . , - '. . l!3b Employoo bonaflt programe (Ita IIn~ 23b Inetluction), , , , . , , , . . . , .!!!! " 24 O\har doductlone (attaoh ,ohodula), , . . , , , , , , . , . , , . . . , 24 't 'J' I if ~ '. '1 ,~, I J '_I ..I._'j 2D 'TOTAL deductlono (edd linea 130 throuoh 24) o" , , , , , , , , , . . , ,!!!... !"~ :::L_'" lie OrdlnolV Inoolll~ 1I0a'.; i.ubtroot line 25 from IIno 12\', , , , , . , , . , , . ,26 '7, (:,'; ':' It.\. Sohadula A-COsT OF QOOOs eOLD ANO/OR O~IONe (8oa IIna, ,2 InslruQtlon) ., 27 Invarttol)' at ~e8lnnlno or yont (Ifdllfllln' frpm I..t YMr'l clollnllnvlnlory, elllch explln,Uon). . , , t: 11- <) '!. , :11 '" ,'. 'I,), 2So Pu/chm' $/J'1..rl,"'~'I,...!.!.,2eb Lall COIl 01111"'$ wllhdltwn for pIIIDnel till $ ...."t!,~/,!.'.\.."...., SlllnCI l-- 280 '~ '1, 10 t I, 13' 2i COlt of-l.bbr . . , , . , I t t , :. "f" t t , , . t . . .!!... -............ 30 Materiel end 8uRpllel i I t t t I , t f , , It., .. It' ; t .!2- ..,--~, ,-, 31 Other cotta (attach schedule) It' ,I '. f ,', I I t f' . I . . !t.. ~~, .:., ~1 32 Total of IInel 27 throush 81, I I . , I I I t t I I I , t . I . t t ft. 32 ~... ~ '., ,7..2- 33 hwtnlory at end of year, ,I It .' , I II,' I I. f , , I . ! It' . ,',t 33 10. ..1"'" 'i"':} 34 Colt of goodl eol:.L(.ubtr..~lno, 33 Iroll) IIno 32), En!!r hOlo .nl!.~ 2, abovo , , ,34 I~"'L" /.' I) -] ,\1 "I 3Da Check volu.tlon mothod(a) uud ,tor tolol oloelno Invollto!}'1 ~Coet q Lowar?' ooat or marke,t 0 Other (attach explanation) 3Db CheDk If Form ~10 or olhar Ilatemont la attaohod for adopllono!\lrO Invontory mot hod , , , ,. , , . , ., . 0 3De All ycU enl'led In ",lnullelu,IDI! 0 VII It-! No, If "VII," eblck II YOU Vllued youl,lnventDry InlDceldlnC,a wllb 'IIullllonl IIcllon 1,471-11. 0 3ed WII Ihlll ehy I"blllnllll ehlnle In delll",lnlnl QuenlllllS, COil, or YIIUlllon$ belwtln openlnR ,nd clellnllmnlory!, . , . 0 VII 'JlJ No Ir "Vn," ottaoh a.planatlon, ' t( nelt' PINIII" 0 ""IUty, l~ t't' wt .,arn nt h. liMn, 11le: U hi 'c~omp.hYI"l Ie I uliS .n~ t1U.minU, dOl'" U 0 rnr knOVf..t h . t I ,IIU', I count. .h' utnplfl', D,Ult'l 10" of pre~.'" (othar IUn tU~rtl) II baud Of! all InlOlll1illon 01 \ll'hlch prapirar hU In, ~n'wlttl.a, ~ ~ 91 n8Iu" 01 8"',., tlltt1"., patt ' lK p rr.".rer'ello. Pr.p'fI,'I, loelel ...urlly no, ~ aid Ilanalu" ,~ ' I Plap.,ar'l rlltn'l name (or OUII, Inlormlllon II ..1I,.mplo .d),Y Ill.: addr,," a d IP C10de ~ R.illld In Aeeotdlnce with the Rmnu. Acl 01 197e end Ih. fn,,1Y Tn Aet 01 1971 U.S. Partnership R~~urn of Income 'or "':~" "" 1~1!' or !ill"" Il1lbl, rur hulnllllll -JILl! I ,HOB, '"d '"dlhIUtriC.,,,.3..L_..,,, 1t (,. ~@78 ;,' '( D 1~'I'llf Ij'!~IIIIII.. M, .e.~~ t.G. '1 to::' 1011. j,,'nllllllll,d, - "n"- ('\ '." \..1"',' \....'i f {I'" \t~~ 'lI,'.".It~'l'IIJn, il'-i:I~~!OI' ,~~n",~,.Ij r..' ' "/~\. ... I" ,', \, ( t,,,,'f __0' ,_ J I CheDk II ..II. employed ~ 0 I artnershlp Return of II me , ren C"L~NPAR YEAR 1911, or oth., ,tl/llbl' y,Ar b"ln~'nl " \) ,ptrtmtfltoflhtT,Utllry ~ "~I I.......' , J \,' .... f ,~ fII n I ~ 1'\ [I' ,.,,~.J ,.....,!, .+,~.... ~,""..-...""',' 1~77, ,nd .ndln. ~..;..'".." .....'Il'......",.,::':..... ,,,,,.,,,.., Ill"""" A Plln~lp.1 b,II,llItI. ",!lVIIl M C ( \ t 0 lm,ln" '""Un..'i," tit. r;U~:\PII~.I~,.:"'nllfm~~1 ~i" ,.llno -n': ;.:''','1'\ ~'".I?I::: ;'" /"i" 2'3- 12. <.,:)... :d . PIlncl,,1 I!t9dl" 0' "1"(1&' 5 Numb.r ..,d ,treet It Dill ~lItlnn. "mm'ftnd Il~"'\P:n l'H Jftl'~!\~!~ i~'S' R' ~ - '( I/~ ,;. 'j I ~"I \., .. 'OC,- ll~.t.~ o ~t::'t~l.r~{"'~ll"nlll" M lOllY 01 lown, 81',~0nd.zi~ Cod~; ',., ..' '. .;, ' Il:'\~~~~ "~~I~\~I~t a W""hlfpartnerahlp n U8 ne.. at 8 en 0 " tit , I I I I . t I I I . I I ,I .. 0 H How manymonlha In 1977 wu Ihll partnarahlp In bUlinl"I, , . , . , .'. . , . , . . ,. '" , 11. "I~.."" ~ IMPORTANT-Fill In all appllO$bla linn and Ichadulll, II Ih. apao. provldad ia nol au"lol.nt, .ee Inllrucllon Q. Enll. ,ny'llImIIP'9'll1y IlIoellld 10 Ih. partn.rl on Seh.dull K, IIn. IS, Inllead 01 on Ih. numb.rld IInll on Ihll plSa or In Soh.dulll 0 Ihrough J. (Sea Olnlllllnll,ruellon p,) I \l' "1"" ).:. b I 3 Un 1)3 1,' {:j",,' ..,/ l,,'a Oroll IlellplI 01 11111 $ t.. .y.,.. .\0,..\.,...., 1 Lm rllUrnllnd allowlnOIl $ ..../ ..:T.".............. a'i,nea ~ ..J. ....:..... a La.. coal of loodl aoid and lor operatlona (lint, 34, aohtdul. A) , . . , . , .' , . ..!... !.' il' S", It;, a Qroll, profit I I I i I I I I I . 1 I t I , I I I I I I , t I I I .3 .. " \" i~.... !: ~ 4 Ordinary Incoma (Ion) from other partnerlhlpa and flduclarlea (allach ataltmanl) . " ..!- -...-., J 0 Nonquallfylnl dividendI (atlaoh l'lt""'ooa InmUOllon 0), . , ' . . , . , .!... _.~~ - 8 Inter..t I I It ! I 1 I I I I I I I I I I I t t , I I . I ~ - 7 Rent" (Boh,dule 'H) I I I I I . I I . 'f I f I I . , I I I . I I I :L- a Royaltl,. (allach aohadula). . . . , . " , , ., .. ...,..!.- 9 I'M farm profll(lcn) (allaoh Schldula F (Form 1040)), , . .. ..".. JI_ 10 Nat Baln (10") (Form 47~7, IIna 9). ,', .. .. ' . . , . lSL 11 Othar lnooma(allaoh a~h.dul') . , , , .' , ., ., .", " l!.. 12 TOTAL Incom' add IInll 3 Ihrou h 11 ,..', " ..". 18- 13 Bala,la, and 'waBII (othar Ihan 10 partna,,). .. , '.. ... ". 1!... 14 Guaranleed paymanh \apartn"1 (I" Inllructlon 14) , ,. ,. " ,. l1- lts Rent . I I t I I I I I i I '; I I t I I , t I I I I' !I.- le Int.teat (attaoh Ichedule) . . . I . ; I ,I . I I I I . I I i I I lI- 17 Tax.. (a"~Oh lohedu!tt) rot/,,; ?ti;~;.JI:I.,fll~r;~" I . I I I I . I . I . tit 1Z- ~.'., 11a aad dl~h (Sch.dul. III you uoo rll.IVa mlthod) , .,. .., .., !!.... .... UI A.p~lrl I I I t 1 . I I , , . I' . 'I t' I I I' I' ,!!- , .ao Dlpraclallon (sao Inalructlons for Schadulo J) , ,. "'. 10 I 21 'Amortlzatlo'n(attach lohedule), I I , .' I , I I I .., I I I . . , l!- ......-I...h - : 22 Doplallon (altaoh sohldull-ael Inllruollon 22) " ,. ,. ,.!!.. . ' .. ...... aSa Retlramon\. planl, eta. (100 Inllrucllon 23a), (Enter number of plana "'................). ,. U!.. Ub Employoo bane'll proBrama(saalnllrucllon 23b), ,.. ..,... aab 24 Other d.ducllons (allaoh loh.dull) . . , , , . . , . . . . . , , , , . , 1.4- a6 TQT~~ daduotlonl (add IInOl IS IhtOuah 24) , . . . . " .. ,. !!!.. I. 26 Ordlna Incoma 1001 sublraot line 26 ffQm IIna 12 ' . ,a6 ! I" ' ',! 8ohedulaA-tOat OF GODDB SOLP AD OR OPERATION8 Ba_ Inllruollon 2 a1 Inventory al b.a1nnlnB oj yaer (If dlll.I.Mllom lilt YIII" clollnllnvlnlory, I!lleh I~pl.n.tlon), . , ,C @l..., ~. ~ ,~ ~~ .".~ 2ae PUlehlll~ $ ,/./.~7,1:i'J.:ij. 2ab L.II COlt, olll.ml wllhdrawn lot plIlonftl un $ ....\.."............... Ollln" ~ ~ I s' .s" ,~', 10 Co.t of labor, ,I i I . I I . I , . , i . I I 1 , I , I , I I, I , I . at ,1,~,"'_""~" 80 Material end .upplle. I I . I , I I I 1 I 1 1 I I 1 1 I I' . I . I aD ---..... 11 Olher OOlls (all_oh sohadul.) ", ".". ".... fL I ~ ' i f.. r rr.- sa To\el of IInOl 27, Ihrouah S1. . .. ,..""",...,., aa. ',:; r / (" J 03 33 Le.. Inventory 8t, end of yea~, . I I . I I I . I I \1 ,. 1;1' I U-tf:l', 3 J ,~7' .:l""O S4Co$\ of Hoodl aOld, Erltlr hara end on IInl 2, abovl . , , . ., ,," 8 . ..' " ,;\ IT 8S(e) Oh.ek vllultlon mlthod(l) ulld fOrlolal elollnllnvlntory; CJ Oolt (0) II you ara . mlnullelur,r, e~lek If you v.tuld your Inv.ntory In It~ld. o LOWIIOf coil or m.lk.1 Cl OIhll (II ,jolh"," a\lleh tlpllll!\Ionl Inca wilh IllulltlonllCtlon \.471-11. 0 '(b) Qh.clI " thll II the IlIlt YII' LIFO Invlnlory, mllhod WII ldoplld (d) W.. Ihlle any IUblt.nll.1 olltn., In dllllmlnlnl qUlntlllll, COI~ or Ind ,Ulld 0. II eheekld, .\l.eh Fo''" 910. . V.IUltlCnl bltwlln oplnl,. .nd ololln. Inv.ntoryl 0 VII Q. No II "VII," 1I110111lpllnlllon, ntl n,,"\,O,"I~IJ; ttu. It iV"i,tnill'd 't.t'~illllilehjd\iI.ucorilp'i\rr,n uIU,Mit\tIn'fH,tMIO ,. 0 t IIOW'."" ,Ui,1 I. fU, tOff"'! '"4 umplt .. PM'iftliOn 01 fIt.pal'r (othtHhtn l"p'~tt) 1& bUtt! on" Ihlolm'lion 0 l'l'hle P,.pt'fI hn t"', kll\hil'I._.t. Form 1065 U.S , ~~77 .,.."'" ._~ t '. .. '.:': I.",", ..-r: .::1 . . /,/1 '-1l'" ~ 'I.,",';~ --"- '..,..,...._...~., .---....., '} 7 :1/ ~ :rrr .;J.:i. r' ./., I ".:. J .' ~'I~ U" ~ -, _.....~...,- ,'..............,-.... 2.,1 I , ., - tt I,. ....... ~ ,.,tla nt.p.It'" tI.n.Hi" Ina la',nUlYI". numb., ,... IntttUO'U:ln" ~Yout ,tln.lY,. 1--- /~" r-~>' ,. j II". /. I p.,. " .t..t.......~.,................................;............:,................................ ~Plld ptep,t.". .C1are" (or employ.," ntm,,' ,aCUt", tnd la,nUfy'n. nl.lmb." ,..,. 1065' U.S. .....rtn.r.hlp Return of In""me " ,~~ lQA~INDAR YEAR at,. or oth.r,,...bl. V"!_~~'I_?..nln~ , ./ ".",.,......,1},\.......l...:::':..",.......,.......... "'6, .nd Indln, ,U:1.fii-I".."",..,.:;I....~."......"..".........1 ........" Nlm. ,." ~@78 =r'tnllf Ihl "...." .llth.ftll".rYl" a ,~"f", ,,,''"' I~I"", (." ..,. . if IlIth",U'llt> , . D 101""" 'u..lIn..llon ... , ''''~.. .-, .? ].. .I :!. ~ ''l':''.J I h.I"" rHI nt, 1111 P.... ,'Inllml,,,,. ,.. _~:l/l-j Clly 0' l\lWn, 8t.t./ .n~ ZIP cod. ,. ',"', If' I" , .,1, ""'010 common," \\/O!"" L\,:'(~ !:~\) t; G \":":-1;'.. (,') ~ :; ~r: '.):,.:. IMPORTArft-Flllln all ~fJPlloa I. IIna, .nd .oh.dul.., It Ih. IIn.. on th. .0hadul81 Irl nol .utllal.nt, .It In.lrucllon Q. tnter !MY 111m. IptCl.1I1 .lIoc.l.d 10 th. r'MIrI on Sch.dul. I\, linIn, Inlt.1d ollh. numbmd IInll on thll PII' 0' In 8chldulll D Ihtou,h I, (III O.nlrlllnllrucllon P,) .. IT rrifili'liIl!iial "Iurn, - Chick h"a r If 11,1. I. . IImllld p.rtnOllhlp, (11.1 G.n.rllln.lruollon 8(3).) h O,olt 1 LII., 3 Gro" 4 Ordln D Nonq " . Inllrl i 7 Rlnll . ROYI I Nil f 10 Nil 0 11 Olh. 1 13 Sal.r 14 Paym 111 Rlnl 1. Inll' 17 T,xI 118 Bad 19 RIp' 20 D.pr III Amo aa D.pl I.. fill ber ISb Em 14 01111 III 211 Ortl~n "hl~u" A-cl a7 Invonlol)' ... P.'Chllll lit Coal of 10 Mal.,lal 11 Olhtr a II t,lal of II L.u: In 14 CO'Lof Invonloty .Y!'!~!!1IQn 1T1!!h04 .. _____. __ Wu Ih"l annuhalanllll oh~nSI In tho wlY you dltarml"ld quantltlOl, co'11 or valuatlonl bllwaan thl op.nlns . end tloalna lnv.ntotlo.'. . I , . j . ',' . I . . . I It. f . I I I I . I I . 'Cl VI' 'G. No It "Vea," .\lach a,plan!.!!en, U,,4" .tn.lIlt\ .f JHII!Urt, I dUIUtlht' I "aw, .umlA" Ihl1 'flu'''. I"dlldl'" .non'IlU'I'" tthtdultt Ind ""'M'~"I 1M t. 1"_ "',,..' my tRowINI' Ind .,"., It I. Ifllt, ""141, "II' toM~I. to If .,."U14 "'. ~,..." .Ihlf lh." ~,t"" M "'1m..,. 'ht ".pattl', tJtC tr UI" It bUM oft 'II I.fthnllolt.f ,h ell the ,up",' hu IIIr ""IN", Numb., Ind It'"' (If'.... ., . ;"-'j,' -........,'.... .-n'I'" J,~ 11'" ' '. I, '.II? II ,-- a I'" or- . f'l" II~I harl . 1(, ..). 1 ,'~" ..r\ r.c.lpll 0;';'.1.1 $ ,IJ.~'I"Y';;'~'\:]~' lb Lilt r.tuml ,nd 'lIow.ntll , .....!"J,,:../..~/....... ..I,ncI .. 10 ~~:~ . .. T t " I~ :; ,I~ '/ - Colt 01 .oc>t1. .old .nd/or operatlonl (IIn. 34, lohldull A). , , . , , , , . . '. - . " I,'" " ~ pmfll . . , . . . . , , . , , , . , . . , , . . . . . , , . I :.... 4 ,,', o.i" - al)' Incoma (Ion) Itom olhlr partn....hlp., .yndIOlI.., Ila, (allaoh .1.llmlnl) -.-...--.. , . , - Ullllylo. dlvl~.ndl (allach 11.1-1" In.lruatlon D) . , , . , , ..L ..,.....-... . , , , , - al . , , . , , . , . . . , , , . . , . . . . , , . , . . , ..L ..........0- .. - (8chldul. tl) . , , . , , . . . , , . . , . . , . . , , , , . .L .-::.-......'.. - - ItlOI (allach lohldul,) . . , , . . , . , . . . , . , , . , , . , ..!.... - "m pro III (lOll) (all4Ch lahldull F (Form 1040)) . . . . . , . . . . , -- iL - ,dlnlry e~ln(lo..) (Form 4797, IInl 9) . . , . , , . , . , . , . . ......-.... - r Incoml (dllaoh echedut4) , , . , , . , , . . . , . , , , U.... ,_." , . ,.' I I' '0, ' - TOTA~ Inooml (add IIn.. 3 Ihroush 11) . . . . . , , , , . , 11- '.'.. U.~. 7'#2. h - III and wa," (olllllr thc~ 10 partnl,.) . . . . . . , . , , . , , , , . , 11- 'i." Inl. 10 partnarl-S.IIII.. Ind Inl.rOlI . . . . . . , . , , , . . . !.L - - , . , . , , , . , , . , , . . . . . , . . . . , . , . . !L ..---...' - "I (1lIach ,oh,dul.) . , . , , . , . . . , . , . , , l!.... ......_..'f'O . .1 , , ~ C? ':'il~ ,., :.~ I (allaeh .oh.dul.) ... . ' 'I' leI)'..' :ol( '-" . . , . , . , , . . , . . . . u.... ,f I , -t, , . , d.bl. (Sohldul. I II you Ult ","rve mlthod) , , , . , , , , . . . , . , lL. I~\' r:r Ira , . , , . . . , . , 19 , . , . , . . . , . , . , , , . . 20 W Iclatlon (Sollldula J) . , . , . , . , . . , . . . . . . . . , , , , - rtlutlon (c\loch echldull) , . , . , . . . . . . . , , . @L --- - 011 on (allaoh Ichadula--alt In.lruollon U) . , . . . , . . , U ...---....". -- - Irom,"1 pl"ni., lIa, (olh.r Ihan amounl. far pcrtner'-II' In.lrucllon 23.). (Enla, num. ........-... . of pion. .."...........".) Ph , . . . . . . , . , . . . . , . , , , . , . , - plo,.. blnlflt prolraml (.It In"ruellon UbI m.. .-.. ~... , . . , . . . . , . , , , I .. 1'j'ii r d.~ucllonl (allaoh Ichedulo) . . . . . . . , . . . . , . , , , , , BL I~ TOTAL daducllon. (add IInll 13 Ihrou.h 24) , , . . ,., . , . , , , , , all ol">T7Jt.:T 'l:lr ,ry Incam.iIQ.,i-lllnl 12 ''''-''nl 26\i.1t Qcnllallnllruallon 111. . , . . . , . iA q ..!. 1.'0;:: n oaT OF gOODS 10LD AND lOR OPERATIONS 11la. In.lruollon al at baslnnlnll of yaar (II dmlllnl flam 1111 Yllt'l clolln,lnv.nlory, .It'Ch 'Xpl.nlllon). . . , . 8L ," 'I"I'.I,J ~:-a .,. 'I 1'1" - ",~ '(' t. ~', .H.~'~' ~ ' . $ ..,....". .~~......... 18b L.u coli olll.ml wllhdllwn fe, plf$on.I UII $ ..... .. >..'.. ,'"..... S".nc. ~ .~l _ 'j .... - Idbor . . , , . . , . . L -- , , . . . . . . . . . , . . . , . , - and .uppll.. . . . . , . , , , . , . . . . . . . . . . . , . . !L ....--...- - oota (allaoh .ohtdull) . . . , , . , , . , . , . . . , . , . . lL , ~. ')/ .., - IIn.. 27 Ihroush 31 . u.... : ~ .?: .:~ , , , , , , , . . , , . , . , , , . . , . , n'~ - vlntol)' II Ind of year , . . . . , , sa I"~, "' , , . , . , . , . .. , . . . , , ie."To (, ~, I , - sood. .old, Ent,r hn,e..!!!!iln IInl 2, abova. , , . . , , . , . . , , . , . : ~I'J .. ~ .................;...... .......- ....0... .... .......... .ji;..i~;.'.i'~.;i';,i";'M.;';tM;"" ... ........... ":...~.....tI............,, ...... ,.......,...o.\..~.......,. ~ ...,.. 'iji~.i.;;""'" p;i;i;,; 'iihi; ti.;.'''''~ft.;';;'';'i~bi;''' I..... M';m" eft;' ii;' ~."" .... .... ........., .............. ............ ...........0.;;........... I,; . . . , .' ~STIONS CONCERNING PROP~.RTV T~AtillW 1, Old ',deOOdent, ViIt,hl,i1t,wo, ye~rs of deat,h, ,"',ake any transfer,o"f, ~ny m, ,at,erlal part of hl~ astate without receiving valuable and adequate consideration?, (Answer "Ves" or "No" ,j NQ 2, Old deceden,t, within two,Y,e" ars Ofda~th,' transfer property from hlmse,lf/herself to, himself/herself end another p~rty or parties (lnoludlng a spouse) In lolnt ownership? (Answer liVes" or "No".) ,No . ., . 3. .If the answer to one or two above Is liVes" and the transfers are cl~lmed to be nontaxable, provide the following Informallon: . . . . a, Age of decadent at time of transfer, b. COpy of d,eath certificate, c. Affidavit by ,tile a,lIendlng PhY, slclan Indicating tho stat"e, of decedent's health at time of trMsfer, d, All other Informatlonsupporllng riontaxablllty of transfet. . 4, Old decedent, In his/her Ilfetlmo, mak,e any transfet of property wlthoutr ,ecelvlng a valuab,le orad,e, quate consldsra, lion therefor which was to t~ke effect In possession or enjoyment at or after his/her death? (Answer "Ves" or "No" ,) No a, Was'there ",y possibility that the property transferred might teturn to transferot or his/her estate or be subject to hl,s/her power of disposition? (An~wer "Ves" or "No",) " ,. b. Wh~t was the transfetee's age at time of decedent's death? 6, Ol~ deoed, entln hls/het lifetime make any \tansfer without reoelvlng a valuable and adequate consideration therefor . under whlchtrensferor expressly or Impliedly reserves for hls/het life or any period wtllch does In fact end before his/her doath: a, The possession or enloyment of or the right to Income frQm the property transferred? (Answer"Yes" or '!No" ,) ~o b. The right tb designate the persons who shall possess orenjtlY the properly transferred or Incomelhereftom? . (Answer "Ves".or "No".) No 6, If the answer to five b. above Is "Yes," waS the right reserved In decedent alone ( j or decedent and others (), , 7. Old decedentlnhls/her lifetime make a transfer, the consideration for which was transferee's promise to pay Income , to Ot for the benefit or care of transferor? (Answer "Ves" or "No",) NO 8, Old decedent,at any IIme,transfer property, the blJ1eflclal enloyment of which was subject to chenge, because of a,.reserved power to alter,.amend, or revoke, or which could revert to decedent under terms of transfer or by operation of law? (Answer "Ves" or "No" ,) NQ. 9il! the answ,er to eight aboVe I,S "v,e,s\" was the power to alter, amend or revoke the Interest of the benefiCiary reserved In the decedent alone ( ) or deceden and others ( ). . 'WV....3 tlH (Io.1QI COMMONWeAl. TH OF 'eNNlnVANIA OEPARTMeNT OF ReVINue TRANIFeR INHeRITANOe TAll RaBlOeNT nECIDINT SCHEDULE "0" II11NBPI01ARIB8 IIn./ruo/lom on R,v",' Sid" Eatlte of RUPY Ill. Chidsey " IVID ' DATB OP II1lNIlP10IARIBll AND ADDRIlB88B RIl\.ATIONBHIP DBOIlDIlNT IIIRTH INTBRB8T O~ IIBNBPICIARY DlIvid C. Chideey " 408 At'linaton Road " 17011 " Husband 8/24/06 Disolaimed oamp Hill. PA 'lee Joanne D. Tavlor , 520 old orohart'l Lane , Camp Hill, PA 170ll Daughter Yes , 8/08/30 100% . , , , , , ., ! , .' , , " " , , , .- .- ..---".--.- ," , " , , , " , - , , , , . , , " ' I , . , , '- , , .- . , " Thl Ibove ~n..fI\'I18rll. wIre Hvlng It the time of the decedent'a delth 1l1l0ept for the following I NAMIl DATB OP DeATH N/~ If Iddlllon.llp,o, II n.o....rv I uaa aW' k 11" th..tt, \ \ ::I ~ ~ 1 0 r~ ,..l j ~ ~ . ~ ...t . .~. ro1 ~ I ! I 00 \ 0 t:; "l' ~ ~ i \ ~.~ i ~ 0 0 ii . z z 0 ~ ~ z ~ ~ l:\.i 't8eJ9WI 8/tuop800P 84t }O 8n19^ lllllJOI.U 84l ~l80IPUI. " 'l80J8tUI,8/lU8p808P 84l }O IlB8lU80J9d 84l8l80IPU\ 'E 'AlJ8dOJd P8UMO AIlUIOl84l }O 8nI8^t911J8I.U 18l0l84lll~801PUI '~ , , "P8481Iq8lB8 80Mdl48J8UMO lUIOI 84t 8l0P 84l pUO l,jJOUMO'OO 84l }O lUllpaOep e4\ Ol dl48uolt'IOl pUO 880JppO/8WOU 84l 8pnlOUI "'a,, 81nPll40BJOl 8uoltOM8UI1l4l \.II pBloOIP\.lI" AtJllddJd 18UOU9d 119 BQl108eO "''V,, 81np940B lO}8UOllOM8UI 84l UI P8l80\PUI 88 fltJOdOld 100l 118 Bqllotla ,~ . ., ' . ., 'lUll 8lanB IB8J l81"l'PBpnIOu\ eqolBl\l WedoldBlqlBuBlul pue 81Q\Qu8l4l0a 'dI4UO^I"m8}O l4Bll 4l.IM 8luauBllUlol,a sellled JO filled le4l0U8 llHM A\lUIOlluopa09p 84l Aq P9UMO 'IQU08led PUlllB8J / fltJ,edOJd 118 BpnlOUll8nI.U "a" e,,~pB4QB "B,. a,natHos DNill'c1WoogmN61~ '. . . . Utll.4n m,4 13.80) COMMONWFAL TH Of fINNIVLV"NIA DlPARTMENT Of RIVINUI TR"NIFIR INHIRIT"NOI T"K RUIDINT DIDIDINT SOHEDULE "P" STATEMENT OF DIiPTS AND DBDUOTIONS ~lf_ ~ e.tateoL....BUI?Y...Jh.Ohidsey DatoolOeath 6/29/81 FileNo, ~J~~~~443 WHI1N CLAIMING THEPAMIIoY eXIiMPTION, COMPLETE THE FOI.LOWIN9' Clohnonl DAVid U, ChidslilY. Rolatlonlhlp to Docodonl HU~band Clolmonl's Addroas II tlllln of Docodont's Doalh 408 Ar1~nqt~pil 9~mo ~,i11. PA 1701l D"n N"MI\1' PAVII RIM"IIKI "MOUNT 1 Mus e1mA Funeral Home 2 Brao e 3 'l'ealers Flowers 4 David C; Chidlile 2 000,00 I 1-___.___ 5 MoNe s WAllaQ& & Nurick 1.L6.~.O, 00 6 HoNees Wallace & Nurick need ;.~.o.., 00 I hereby cartlly thet to the best Of my knowledge and belief eKpense. and eKpense. 91 administration submitted to the e , ~ ; i o DElfTS AND oeDUCTIONS ARE ALLoweo IN THE SUM OF $ AT % TAX RAre REQIBTER OF WILLS PATE 'S,l.BiIHS "II x ,,%8 ilSn A~VSsa:>aN SI il:>VdS -1VNOI.LIOOV :II '.,qep .~,DUIADd 101 Allllql.uodul '~I pGIUn'sD 'D~ o~'" uomd .~, Aq peuDI' Gq ,.nw 10101 G~J. .t , , 'pGWID\~ DUleq IqGp ~~DG 10 lunOU'D G~' 10lUa '9 'plWIDlo ,qGp ~~DG 101 uwnloO '~IDWGl 1~,ul UOIIDU~ldxII'llq 0 OPI^Old 'S ...Aod ~OD. 10 SOWDU G~' jllul .~ 'PIDd jO/PUD p.unoul so", Iqop ~ODG ~OI~M UO G'Dp .~I Itlua 'E 'po"11 WG'I ~OOG 01 mqwnu O^lIn~..uoo uDIUV '~ 'uwnloO lunowo '~I UI PlwIDI~ IunOWD G~I pUD uwnlo~ '~IDWlj G~I Ullluolldw.n AIIWDh, HilUS 'IU'P'~'P '~I 01 dl~,uoIIDIIIII~/'I~ pUD .nlppo 'IWDU ',IUDlUIDlo '~I 'IO~IPUI'PGw.IOIO DUI.q '1 uOlldweu ~\lwOI '~I II 'l ,,~:>S ONI.LilldWO:> ~O;l SNOIJ.::)nl:lJ.SNI ~ ~ () ~ >t t~. .-~ V',J ~. ~.~ 11.1 ,'11 t. :x 'C~ ~~) ,--.-' j'-,~ a "_,'t", ~. , 'd e; " " , ~ ... --"'() " . ~ j ,~ ~ f CQ I"; 0 "" LI.o ~ P 0 ~ ;l; ~ ~ i ~ 0 z i i ~ lj ~ m ~ 8 ~ 'UlnlG~MOJ. IWoo"I\Onpl^IPul'O~'VcI WlOI uo pGllod.l Iq PlnO~i wOII ewooul GlqOXU! 'I~.L ....Odlnd xOJ. oWO~UI OIUO^IA,uU'd 101 GlqOllO,dll'l 0,10'" uo DUllGI'IUIWPO UIPtWlOlj.d "~I^lnlOI'IOlOll'IUIWPO 10 10lnOG~G U~ I~IGWOU rG^1I0lUO"ldll GlOI',uo 01 Plod UOllo.uldwo:> IlUON , " ,""'0, II0I",ul OIUO^IA',uUOd G~I Aq 10 III'" 0 Aq nod ~ol~M ~IG"O IIul080 AIUOGlqoMOIIDII UOlldwnG AIIWDIO~.L 'IUGPGOGp G~I '0 Plo~nno~ Iwol I~I 10 mqwlw 110 O~M "uIlod 10lUIlOdo Aq PGWIOIO Iq uoo,UOII~,WlllO 1~I'PII~o 10 '.nodl ~on. OU '1 Gll~' IUG^G G~I ul 'uolldWIMIG~1 wlolo uoo P\o~..no~ IU'O' 1~'lo llqWGw 0'1 o~'" lu.p.oap 1~110 PII~O AUD UG~I'II~,Bll,le~/'I~ P'Illjlol 'O~ nnod. G~I II 10 'unodl ou '1 Ile~," 'oIUO^IA.uUlcI ul pG\IOIWOP pllP o~'" Iueploop 0 10 nnodl 0 Aq pewlolo Iq Aow UOlldwllll AllwoI V " '11npG401 'I~I OlpG~OOIlO oqplno~. plwlolo DUI'q IIqGpl~1 101 Allllqoll','IolU '~IlO 1,IUlpIOGp e~llloddn' ol',~u'PI^a'p'III'1 Ujnl'~ llo.L 'ouoIIlI~ul I~I WO~M ~IIM IIIIM 10 lllllDo~ I~' 10 IO^OlddD G~I 01 loolqnl 110 G,DIU uo l,ulDDo powlolo 8uloq'lqGp IIV ....U.dll. 101lnq PIIOI.llO~IO pUoi'~IOlU OAOlD 10 IUOI'qwoI 'Iollollnq 0 10 1.00 '~I 8ulpnloUI ".uldllG 101lnq puo 1010unl''''I AIOlonpll"", AIUlOIlO 'UOIIOII'lulwpo 10 "00 I~I DUlpnloul IlqowlDllI 110 'WGIIIG~IO,'OIOI" 10 IU'PloOP I~I Aq plunoul IIqlp 01 UOlIlPpO ul '1101" GlqOllOl lG~/IIl\ I,uloDo IlqllOnplp GlO l\IOGp 10l\/11~ 01 101ld IUlpllI.p G~I Aq pGUnOUI ulIlllqoll PIII'IID1Un ~ . -. . HOI.LVW~OdNI XV.L B:>NV.LllfBHNI 'VyaNBO . - . INFORMATION --.....--- Thll dooumlnl II Ihe Nolloe requlrad 10 be given underSaollon 709 01 Iha Inherlllnoe Ind Elllla Ta. MI of 196\. 112 P.~. aeollon 249111, It Iha II. II plld Wllhln Ihree (3) monlhl Iller Ihe deoadenl'l d..lh, I dllcounl of ll% 01 Ihe II> plld II IlIowad, Inherl\lnoe TI. beoom.. dellnquant nine (9) monlhs Iller Ihe daoNienl's dallh, Inlar..1 II ohlrged II the rile 01 II. (8) peroanl per Innum on Ihl Imounl 01 unplld II>. ISEE EXAMPLE BELOW) , ExAMPLE: If I bllll,oe Qf II> dua of $2,000.00 II In I dellnquenl alllul Ir'om 3-3-80, Ind plymenl II mlde Qn II- 23-80. Iha Inlernl II olloulllld II IndlOlled below: ' .- Inp 1 O"e,mlnl Ihe rile QI Inlerell from Ihl tlble bilow, STIP a MUltiply Iha blllnoe Qf II> dUI by the rile 01 Intarelt. STRP a Add Ihe ,Inlareol 10 Ihe blllnoe Qf Ie' due. Inlereol !rQm 3'03-90 IQ 1l~23-aO Aeoulll In: 2 MQnlhl. .010 200lYI . ~~ RI'e Qf Inuireol . ~lm allano' QI I.. due RII. 01 Int1N~fuST $2,000,00 x .01336 $ 26,70 Blllnoa QI II' dUI Plus Inllrell IQ ~ QI Plv~lnl 1+1 Ilx In Inler..1 IQ Dill 01 Plymenl $2.000,00 . 2S,70 '2,026. 70, .. - .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ,- ..... ~ .. .. .. .. .. .. .. ... .. .. - .. .. ... .. .. .. .. .. .. .. .. .. ... .. .. .. .. .. ...- .. .. .. .. .. ... .. .. .. .. .. .. .. I mQnlh .001l 4 mQnlha .020 1 mQnlhl ,0311 I 0 monlhl ,060 2 mQnlhl' .010 II mQnlhl .0211 a monlhl .040 11 mQnlhl .01511 3 mQnlhl ,DIll 6 monlha .030 9 mQnlhl ,0411 12 monthl ,080 1 dlY .00017 I I dlya .0018S 2 I dlYI .00311! 2 dlYI ,00034 '2 dlYs .00203 22 dlYI ,0038 3 dlya .0001l1 13 dlYs ,00220 23 dlYI .0038S 4 dlya .00089 14 dlya ,00237 24 dlYI ,00403 15 dlya .00086 III dlYI .002110 211 dlya .00420 6 dlYI ,00101 18 dlYI ,00287 28 dlya .00437 7 dlyl ,00118 I 7 dlYI .00284 27 dlya .00484 B dlYI .00t311 ,B dlYs :00301 29 dlYI ,00411 9 dlYI ' .001112, 19 dlya ,00319 29 dlya .00488 I 0 dlYI ,001S9 20 dlya .003311 30 dlYI ,001l00 .......... r........................... ~.. -............ ~ ................ -..................................................................... Any plrlY In In"rtfl, Inoludlng the CQmmonw8IIIh Ind Ihe peraQnl1 repraaenllllve. n6\ 1IlllfI.d with Ih, IPprllum.nt Ind ,llaenmenl mlY obJlcl wllhln IIXtv (601 dlYI Iller t.o.lpl 01 Ihll NQ\loa II provlll.d by , S.otlon 100 I of the Inherlllnoe Ind 61111e TI. Aot QI 1961 172 P.S. aeo. 24811 - 100 \l. MAKI CHICK OR MONIV OIlOIR PAVA'~I TOI"RIOIITIR Of W1LLI. AOINT" OeTACHTH~ TOP POATION OF THIS FORM AND SUBMIT WITH YOUR PAYMENT TO THE REGISTER OF WIL~S POR THE COUNTY SHOWN ON THE' AEVEASE, SEE THE INHERITANCE TAX INSTRUCTION BOOK FOR ADDRESS, ( ( " . r' " " ,,: \.11 ; ~ ,.,'., ot 1''' Olloounl: Int'tlll: To "'Mil Ptymenli If Iny I.. du, Iv p.ld wllhln thre, (3) montha IlIp, Ihe deoedenl'l dlllh. I dlloounl 01 Ilya petoenl (6%) 01 Ihe tlX Plld lalllowed, , Ihe dlleounl petlod II elleullled In ellendl' monlho. exlmplo: dale of dulh 1 - 111-82. dlloounl p.rlod explr.. 4- 16-82. ' boapt for IIX on I IUlure Inlerell. Inherlllnee IIX beeomel dellnquenl al Ihe explrollon 'of nine (9) monlhl from Ihe dlla 01 delth. . InherU.noa II. \"n I lulUre Inl.rUI beeomu dellnquenl II Ihe explrallon of three mClMlhl Irom: ' - the dlle of eleellon 10 preplY or ,. the dlle of de.lh 01 Ihe IIle lenlnl or Innultanl . InlerUI II elloullled on I dilly bull Irom -d.llnquanl dlle 10 dlle of plymenl on Iny IIX unpaid on dalinquanl dlle - dlle 01 IUI dlllnquant plymant 10 dll, 01 plymenl on Iny unplld bllanoa. , Interll' II' ehlr9.d It Ih. lollowlng rolea: Oallnquenl Oo'e AnriuII Inlere" Rita Ollly Inle,,"' Peelor 6/27/43 to .nd Including 12/01/8 I '1\/82 10 .nd Inoludlng. 12/31/82 1/ 118~ to .nd Inoludlng 12/31183 6% 20t. 16% ,00\>,184 ,000648 ,000438 : ThOle ..talto thll baoome d.llnquent on or belo,e Oeoembor 3;, , 981 will mllnllln I eO';llInl Inlerul rite, The rate In affect whon Ih. lor Ilral baeom.. d.llhquen\ Will "mlln oonltlnl ~nlll Ihe dohnquenlllx bllonee 10 POld In lull. Thou utllel ,hIt become dallnquent on 01 aile' JanUlrl' I. 1982 wlll,oOrilaln I vlrllbla Inltrut rile. ThuI, Ildl Ihl' temllM outall~dlMg Irohl ell.nol' V'"10 cllendl' Y.lr will bo lubJ6el to the qlfferenl tllea in olloel on eleh Jlnul'y t. Inleroal I. olloulltad II lollows: INTeREST . BALANoe OF UNPAID TAX X NUMBeR OF DAYS X DAILY INTeREST FACTOR. , If I II' bllance ramlln' oUlllandlnp lor mo,e lIiln on. cllendl" YO". e I8P""IO i~'ere" delermlMlllon mUll ba mId. 10' BIen yelr II Iha Ippheabla rail. 10nll' ona e"eu,.llon II nee....'y If Ihe ..tile mllnt,'na the eOhlllnt Inle,,,1 rile,) , Any Nollea I..ued alI'r Ihe tax beeom.. dahnquenl will ralleel In ,nle"a1 ealoulallon 10 IllIeen (16) dlYI beyond Ihl dl" 01 Iha nolloe. "payment ',~ mlde Iller Ihe Inter"l oompulallon dlle IhOWn on Ihe NOlloa. Iddillonll !nler.., mUll bl elloullled, D.ltoh Iht'loP porllon 01 Ihll Nollee Ind lubmll wllh you, Plymenl to lhe Reglallr of WillI 01 Ih. eounw Ihown on Ih. Nolloe, . Add"" InforMlllon II 1I110d on plgl 13 01 Ihe booklel, 'Inllruollonl lor Inhetll.noo T.. I\.tur~ 10\ a Ruldanl D.cedenl,' . M.ke eh.ck or money Ordet plYlblt 10: R.glller of Willi, Aganl. QJ ~ . , ~ ,\4 ~ 8 1"\ :II t'8 :;j~~ :'8< 'lj,'tl P< m ' ~.-i~ ~ j'~ t,..j r-t ~ ~ 8J u :.: U tt :l <<I Z ~ 0 w 6 Vl 16 Will. '" W ~' III n:~ u ... ~ 0: U VI ~ . ~ j ng ~;$[om :l ~ 0 . \!! , a. ~ III 2 ~ w < W J: :z u I l dl l.l;.J . IU ''\,