HomeMy WebLinkAboutPetitioners exhibit
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IN RE: ~:STA TE OF
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IN THE COURT OF C0r210H PLEA S OF
CUHEERLAHD COUNlY, PENl-:SYLVANIA
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S!1P.A STO:E HIJ~LF.R,
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. ..h.N !ILLJ~G~D INC(~1FiTLl'rr
: CRFlMNS' COURT DIVISION
:. :NO. 407 ORPi-'....;NS. 1978
6.!~.f:2.IJ~I1El\:.'"!._OF g_~~~ ~DIAJi
AI~D l~CU. Augunt /g, 1978, at d:OO O'clock ,P. M., upon
consideration of the Petition filed herein and upon hearing
testimony frc-:n CRAIG JURGE!~SEN. H. D.. the Court finds frOl:U
r;nid testimony thlJt the \<:elfsl:c of $!,R.-\ STONE HILLER \\'ould
~ot be pro~oted by heL pre Bence in Court at the hearing held,
i Dod the CO~trt furthe:r finds from the tcstimoi1j that the sold
I S!;R.l~ STO:ffi 1.jlLLSR is un3ble to 1:-'1n-3gc hEr property, is likely
to diGS ip:lte or bccC!J:? the victim of designing per-cons; it is
thErcfo:ce ordered Dna cJtrected thu.t' the said &/\P.A STO:m HILLER
be and she 18 hereby adjudged an ip.c~D?etent and F^RHERS TRUST
ca-r.PANY J Carlisle, Pennsylvania is ap?ointed gu.:lrdian of her ,.
(:s t.:t te.
By the Court
S!JJcdL /. ~
P.J.
P~"illtON€;2. 15
EXHIBIT "A"
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Pe T l TION €f2 IS
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~ . SENDER Complete items 1.2. and 3
o Add your address in the
3 reverse.
RETURN TO space on
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1. The following service is requested (check o~ef
~ Ilt Show to whom and date delivered ._G:
D Show to whom, date, and address of deiiv~rY.~_ G:
D RESTRICTED DELIVERY
Show to whom and date delivered, ... ... .~_G:
JJ II RESTRICTED DELIVERY
~ ~~~~~~;~~S~~eA~~~~d~~~sFo~~~lt;y,$0 i
JJ
Z 2. ARTICLE ADDRESSED TO
JJ B. F. Stone
~ Elizabethtown, NC 28331; I
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3. ARTICLE DESCRIPTION
REGISTERED NO CERTIFIED NO,
INSURED NO,
464870
(Always obtain signature of addressee or agent)
I have received the article described above.
SIGNATURE D Addressee D Authorized agent
6. UNABLE TO DELIVER BECAUSE:
C~liMl
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*GPO 1977 - 0 - 249-595
S. S. Hiller Estate
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SENDER Complete Items 1 2, and 3
Add your address In the RETURN TO space on
reverse
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The following service is requested [check one).
~ Show to whom and date delivered q;
,'l Show to whom, date, and address of delivery '_~___G:
LI RESTRICTED DELIVERY
Show to whom and date delivered
r j RESTRICTED DELIVERY
Show to whom, date, and address of delivery $
(CONSULT POSTMASTER FOR FEES)
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~ 2, ARTICLE ADDRESSED TO
JJ Mr'. Jake W. Stone
ri Box 483
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-l 3 ARTICLE DESCRIPTION:
JJ
m REGISTERED NO, CERTIFIED NO INSURED NO,
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(f) 464871
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(Always obtain signature of addressee or agent)
I have received the article described above
SIGNATURE L] Addressee [] Authorized agent
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6 UNABLE TO DELIVER BECAUSE:
S.S. Miller Estate
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en . SENDER: Complete items 1 2, and 3
Add your address in the RETURN TO
reverse
space on
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1, The following service is requested (check one),
Xl Show to whom and date delivered
D Show to whom. date, and address of delivery,
i::.1 RESTRICTED DELIVERY
Show to whom and date delivered
:.J RESTRICTED DELIVERY
Show to whom, date, and address of delivery $---
(CONSULT POSTMASTER FOR FEES)
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~ 2, ARTICLE ADDRESSED TO
JJ Miss Ruth Stone
ri 61 Maxwell Road
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-u __Chapel-Hill, _N~_2751~----------
_-I 3 ARTICLE DESCRIPTION:
~ REGISTERED NO CERTIFIED NO INSURED NO
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JJ
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- - --- ---
464869
(Always obtain signature of addressee or agent)
I have received the article described above
SIGNATURE '] Addressee D Authorized agent
1 --:;ri .--- . .
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6AttOF'~-LIV~---- ! -~T~~-
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5. ADDRESSrComp/ete only If requested)
6 UNABLE TO DELIVER BECAUSE:
CLERKS
INITIALS
-A-~pn, 1 Q77 - 0 - 249-595
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The following service is requested (check one)
~ Show to whom and date delivered .
" Show to whom, date, and address of delivery
~ j RESTRICTED DELIVERY
Show to whom and date delivered
JJ RESTRICTED DELIVERY
~ Show to whom, date, and address of delivery $
c (CONSULT POSTMASTER FOR FEES)
JJ
z 2. ARTICLE ADDRESSED TO
;:g Mr. Steven J. Stone
~ Route 1
~ Orrurn, NC 28369.
. JJ 3 ARTICLE DESCRIPTION
~ REGISTERED NO I C=;~~D NO I INSURED NO
~ (Always obtain signature of addressee or agent)
o I have received the article de'scribed above
SIGNATURE 1 Add . . .
p ~ f f. v:~o 0 ~ 'p"t'ed ,,0"
DATE OF PELlVZR I ~~~~
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5 AD R S (Camp tf; only If requestt1j) : O. \"b \ '{
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6 UNABLE TO DELIVER BECAUSE
f__._._nu. -
S. S. Miller Estate
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CJ') . SENDER Complete Items 1 2. and 3
,I : Add your address In the
~ ::::: reverse
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RETURN TO space on
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RETURN TO spac," on
Complete
Add your
reverse
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The following service IS requested (check one]
'X Show to whom and date delivered
Show to whom, date, and address of delivery
RESTRICTED DELIVERY
Show to whom and date delivered.
1 RESTRICTED DELIVERY
~ Show to whom, date, and address of delivery $--
~ (CONSULT POSTMASTER FOR FEES]
JJ --'
z 2 ARTICLE ADDRESSED TO
JJ l1r. Randolph C. Stone
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~ 532 Avenue M.S.E.
~ WinteLJ-laYeIl....EL 33RRO
JJ 3 ARTICLE DESCRIPTION
m REGISTERED NO CERTIFIED NO INSURED NO
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464866
(Always obtain signature of addressee or agent)
I haveleceived the article described above
SIGNATURE [; Addressee LI Authorized agent
, 2<A-4,k.~~~
DATE OF D~~RY' t: .
'/~ _1. ~~.~ _75
5. ADDRESS(Complete only If requested)
-{:rGPO 1977 -0- 249-595
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POSTMARK
6 UNABLE TO DELIVER BECAUSE:
CLERK'S
INITIALS
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-{:rGPO 1977 - 0 - 249-595
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PS form 3811 Aor 1977
IN m:: ESTATE OF
IN THE COURT OF C0I:1HON PLEAS OF
cmffitRLA1W COUNTY, PEN!1SYLVA:~IA
SARA. STm-U: HILLER,
O?:PHA1~S' COURT DIVISION
I~O. I~07 ORPEAl1S' 1978
AH INCOHPETENT
NOTICE
'1'0 I~J-,L PARTIES Il~TERESTED IN SAID ESTATE:
liiJ'iICE IS m::IXBY GIVEN ths.t F!~miERS TRUST C01PAlri, Guardian
of the above-entitled estate, has filed the enclosed Petition
pn::ying for the Court to exercise its jUG[,"1nent for that of
Sm-a Stone l~ill(>r, the i.ncnlpctLnt, \}:i th respect to her estate
..
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<:.r~' ;; u:~: u:-s ;:.nn r .~YTl. t
the c:.1id fc:r: r:"!:"s Trust CCF;pany to D'al:e
an ;,nrn.l,'ll eh;; 1':i. t r,ble ~:Lft of $6,000.00 iron the annual income
of the jnccr"l'c~l:ent to L;-: f"Jette College.
A hco.rine on s,dd P{~titi0n sh2.11 l)(! held in the CU8berland
County Courthouse, Car1i[;lc, Fcnnsyl vania, on I""'rsola.~ the 'L{ ~
f"'\_ '- ~ ( : 1> 0
da.y of I~c..e~~.er- , 1970, at 0 I clock, p.. H. in Court
f.001!'l :~o. I
[it.: ...'1dch tit,e you H[,~Y p::esc::nt ~vidcnce to show
cause ,;:hy Eaid Petit:ton should not c.e c;rr:r.ted.
\';ILLIA!'l F. YJ'~RTSOH. P. c.
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EXHIBIT liB"
LLI..... F. "''''RTSON. P. C.
IN RE: ESTATE OF
SARA STONE MILLER,
AN INCOMPETENT
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 407 ORPHANS' 1978
AFFIDAVIT OF SERVICE
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )
SS.
I hereby certify that on this date I sent by certified
United States Mail, return receipt requested, postage prepaid,
to the following persons, a copy of the Notice of a hearing
on the Petition by Farmers Trust Company, Guardian of the above
estate, for permission to make inter-vivos charitable gifts
from said estate, together with a copy of said Petition:
(a) Jake W. Stone, Box 483, Amherst, VA, 24521;
(b) B. F. Stone, Elizabethtown, NC, 28337;
(c) Ruth Stone, 61 Maxwell Road, Chapel Hill, NC, 27514;
(d) Steven J. Stone, Route 1, Orrum, NC, 28369;
(e) Bernice S. Porter, 3808 Craven Cricle, Norfolk, VA, 2351
(f) Randolph C. Stone, 532 Avenue M.S.E., Winter Haven,
FL, 33880.
WILLIAM F. MARTSON, P.C.
Byf)~ K. O~
NOIl~ :1-2-
,
1978
Sworn to and subscribed before me this d:?~ day of '7}~ ,
1978.
~07~ ~
Notary P lic
" !~ ) . '-'JOj-,ji'y
'10:'1;:';';:"
,)/ 1
LAW OFFICES
WILLIAM F. MAHTSON. P.C.
p~ ,1.,tON f~ 's
11121"
€'1t H-I f.3 IT I~
~.
.
"
~@77 I
for the ~... !anJ'ry 1-Ol'<err.:,.. 31, 1977, or other huble ~,.. b'E;nninr
4J tHlt fume oind IOltlai ,Ii JVIOI return, 21'1'. 'Hst nlme~ ~~~ H'::!,~I, of both)
~c
~"R . S f\~~
~ oj g, P"..nl home .dd,ren (Number .nd ,"eel, includinr .p.r1m.nt number, or rur.1 roule)
~!: 7 8, 8 W. So u-tVl S-\-.
:;: ~ 0 City, tcwn or J'!\lt "lfice, St.te .nd ZIp.\code ~
:J5 ~ '~ "R \ \. OS E, .-~. J 7 0 J 3
, 1977 endinr
. 19
Your social s<<:urity numbet'
Ill; t../c2i 1195
s.
I -M; \\a~;:
Presidential Do yOIJ want $1 to go to this fund? . II _ No Note: Checking "Yes" will
Election ~ . . . . . . . . . . . -I::: .- not increase your tax or re-
Campaign If joint return, does your spouse want $1 to go to'this fund? No duce your refune'.
Fund
1~rr.i;::r,"i";,7n.",, 1 ~~ Single
Check Only 2 -- Married filing joint return (even if only one had income)
Married filing separately. If spouse is also filing, give spouse's social security number in the space above
One Box 3 and enter full name here ~...__m"""'''''''.m.__...........................___.........................m.mh.m.....................___
--
4 -- Unmarried Head of Household. En!er Qualifying name ~.............-m............--.--...h..h-.... See page 7 of Instructioos.
5 Qualifying widow(er) with dependent child (Year spouse died ~ 19 ). See page 7 of Instructions.
'~-'~"ItH .11,-"",-11 L8J 0 0 )
Always check 53 Yourself 65 or over Blind Enter numb., of [I]
. !><l. l~ ch eeked
the "Yourself" 0 0 0 on 6a and b ~
box. Check b Spouse 65 or over Blind
other boxes if
they apply. c First names of your dependent children who lived with you ...... ....--..--, .--... ..............---.. Enter number of D
children listed ~
0 d other dependents: <""""-,,, ~., '" ..".,.., (5) Did you provide more
.. ~ll/~ ; rrwnlh, j'Hd have income 01 thin one.h.1I of de, ~D
GI (l) Name ,j, your ,hOln'" ~750 or morel pendent's support? Enter number
:I:
~l \\ JJ rH or other
N dependents
::: ~~
'"
E Add numbers ~
.. entered In boxes
tl. 7 Total number of exemptions claimed. . . . . . . . . . . . . . . . . . . . . . . . above ~
-
0 JI,I"',lllr~'1
m , . " (Att.ch Forms W-Z, II un.vall. 8
>- 8 Wages, salanes, trps, and other employee compensadon. able, see pore 5 01 Inslructions.) . . . . . . . . . . .
c. 9 I, a 33
0 9 Interest income. (If over $400, atta~ Sshedule B.). . . . . . . . . . .... '.' . . . . . . . .
(.)
.s::. lOa ' , (II over ~400, aUlCh) "3 '3 3 I. , I 00 ; 10c 33 :;;'81
u D'Vidends Schedule 8 __ ...;>....__.______~...--, lOb less exclUSIon .m.............:____....... Balance ~ ,
III (See pages 9 and 17 of Instructions)
::
< (If you have no other income, skip lines 11 through 20 and go to line 21.)
0
III 11 Slale and local income tax refunds (does not apply if refund Is for year you took standard deduction) . 11
III . .
GI
c: 12 Alimony recl~ived. . . . . . ........... . . . . . . . . . . ....... . . . . . . 12
13 Business income or (loss) (attach Schedule C) . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Capital gain or (loss) (attach Schedule D) . . . . . . . . . . . . . . . . . . . . . ..... 14
15 50% of capital gain distributions not reported on Schedule D. . . . . . . . . . . . . . . 15
- 16 Net gain or (Joss) from Supplemental Schedule of Gains and losses (attach Form 4797) . 16
.
17 Fully taxable pensions and annuities not reported on Schedule E. . . . . . . . . . . . . . . 17
0 18 Pensions, annuities, rents, royalties, prtncrships, estate!; or trusts, ete. (attach Schedule E) . 18
..
0 19 Farm incoml~ or (loss) (attach Schedule F) . . . . . . . . . . . 19
:I: ....... ...... . .
... 20 other (state nature and sourte--5ee page 9 of Instructions) ~.. U'n._nn. ..n _'h.. U... 'nn. .,u .Un..u'_ 20
..
"0 21 Total incomE!. Add lines 8, 9, and IOc through 20. ~ 21 3",,'5. I 14
.. . . . . . . . . . . . . . . .
0
>- H.II'II.., .,.1 JI rt~~r&.{1}I.~ (If none, skip lines 22 through 27 and enter zero on line2B.) "A.1ff:~
..
c 22 ~ ~~~~__4>':1
0 22 Moving expense (attach Form 3903). . ........ . . . .
~ - ~~~:f{(/f0,; "/
.. 23 Employee business expenses (attach Form 2106). . . . . . . 23 ..~
0
.:.: 24 Payments to an individual retirement arrangement (from at.
u ~ Z 0 ~ ;~fJ:/'/./.<<::' ,"' ,./
~~. ';m/"ij'1f::i~f"?~
G tached Form 5329, Part III) . . 24 /. ~:/':;' Z ://'/.W;h /./ //
.II: ............ . . . . ..a!
(.) 25 Payments to a Keogh (H.R. 10) retirement plan. . . . . . . 25
.s::. /.z~ ~IJrmg/
. % z' % ~0'~. M. ..
u 26 Forfeited interest penalty for premature withdrawal 26 ~~t*:dWf~~~?; ,J
.. . . . . .
%: z "/. Z'///"k" / 0z""
~ Z7 Alimony paid (see page 11 of Instructions) . . . . . . . . . . 27 ~~)j%f~f;;~:fff!~!j;..:.:i
. 28 Total lIdjustments. Add lines 22 through 27 ~ 2B
lit . . . . . . . . . . . . . . . . . . . . . .
oa
.. 29
c: 29 Subtract line 28 from line 21 . . ... ........ ... ........... . . . . . .
30 Disability in<:ome exclusion (sick pay) (attach Form 2440) . . . 30
........ . .....
31 Adjust~d gross income. Suhtract line 30 from line 29. En~p.r here and on line 32. If you Vlant 35: / /L/
IRS to fiFUrE" your tax for you, see pa2e 4 of the !nstruction~ . . . . . . . . . ~ 31
I Spouse's social ~urity no.
For Privacy Act Noiice, see
page 3 of Instructions.
. ~ Yours ~ 'K E. t \ REP'
t '.~J Spouse's ~
":"-- -~--~--_.--.....----_. ~ -
PeTt ItoN ef2,. '5 ex Ht'3 rr 'Ie"
rorrn lCJ40 (1577)
32 Am,"o, fmm Ii" 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " . ~13 5. / '+
33 If you itemize deductions, enter excess itemized deductions from SChed~le A, line 41 . . . oj _
/fyou do NOTnem;,e deduCllo",. 00'" mo. .....,.................. '.' 33 0
C'uliooo /f you h"e u"'''",d 'ocome aad cao be c1a'med .. . depeodeof 00 you, P"oof. W!!!N!fii"'''',,",<WHM.
return, check here ~ 0 alld see page 11 of the Instructions. Also see page 11 of '~.';~%.';;;f1f{1d?!!: ....<
fhe In<fMfioo. if, ~.J%fiif(-;:> .J
· You.re m'nied Clio. · sep".le "'um ood you, 'pou," nemi". deductioo.. OR g.~.~.V'3;
C> You file Form 4563, OR I I
· You "" du,I,.t'l" .lieo. 3 S II tf-
34 Tox T.bl, 'ocome. Su",<acI Ii", 33 fmm Ii" 32. . . . . . . . . . . . . . . . . . . . . . .. 34 ,
~~~._~;0~@~//Z:"-://","
Nol" See '""mclion< f" Ii" 3S 00 p.ge 11. Theo Cod you, fox 00 the .mouof 00 Ii" 34 itIit~_~.~1;~~/. .~t.. <:;~
10 'he Tox T.ble<, [0'" 'he 'ox 00 Ime 35. Howe",. ,f 'me 34 " more thoo $20.000 fl.ti!7F.M4f!;J%f"'"","
($40.000 if you checked bo< 20' 5) 0' you h've m"e "empbon, :hoo 'ho," cov,,"d '0 Ihe !!iffii.~:~~~~..itk:':}~
Tox T'b'e< fo, you, 1'1<0" ,ta'u.. u',' P.rt , of S,h.dul. TC (Fo"n 1040) to f'gure you, '0<. You ~._~.~.*~ji!~;.i~::Wi:;';'~:i
IoU" '1<0 u'" 5cl"<ul. TC ,I you f,'. Schedul. G (Fo'm 1040),' com. Av.rng<og. i!@o~P$4.%*,7%~
35 Tax. Check if from 0 Tax Tables or ~ Schedule TC 0 0 0 . 0 . . . . 0 . . . . . . . . o. W;~/~//97'';-/4r::~/''::
36 AddItional taxes. (See page 12 of Instructions.) Check if from 0 Form 4970, 0 Form 4972,
o Form 5544, 0 Form 5405, or 0 Section 72(m)(5) penalty tax . . 0 . 0 0 . . . 0 . " 36
37 Tol.l. Add line, 35 ond 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 37 _
'. .W~.~.dt~~%'?:,~~/,~/,..::-;;;
38 Credit for contributions to candIdates for public office. . 0 . o. ~ _ .-~_~~W~WJ%;I..;<~~
39 Credit for the elderly (attach Schedules R&RP) . . . . . . . . 0 39 W~B"'~W~~;~::Z#f.:, '.' .;-,
- - ~~a.:?{;0":;:~~~..t:0' . '/
40 Credit f" chitd 'nd d,poodenl cue "pen,,, ('H'ch FO'm 2441). ~ _ _~.~.. W1f~D~0,~'~. "?:~f.. '.' .;.. 'C.;
. 4 8 41 ~." %;; ~;f}ffi~J~///
41 lo"'tmool cred,1 (.H.cb Fo'm 3 6 ). . . . . . . _ _ ~_~ ~:W3f$~3;~;".~3J
42 Foreign "x credit (,H"h FO'm 1]16) . . . . . . . ~ _ ~.@fi~....~$1t~~;/. :1
. . W.f& W~~@,i;f@,~?;~;:/,:,
43 Wook 'ocoo',v. (WIN) Cred,t (./f'ch F"m 4874). . ~ -~~.'.~fl~~.~-.~..fif::%;;:'..'J.'::i
44 N . b d't (tt h F 5884) 44 ~~~ %%._~_2'~~;%"//7-
.W 10 >ere, '.c 0'10 . . . . . . . . _ _ !I'di' /~<<~$'i'm
45 s" p.g. 12 of In.<mction. . . . . . . . . . . . . . 45 .~.dlf"".$.i;.0J
46 TOI., <<edit.. Add Hn" 38 th'ough 45. . . . . . . . . . . . . . . . . . . . . . . " 46
47 B.I.nce. SUbh,c' Ii", 46 fmm Ii", 37 .nd eol" differeoce (but not ,." 'h.n '''0) . . . . ~ 47 :. 9, 8 Lf {.
48 S.II'.mploymoo".x (.!t,ch SCh.du'. Sf) . . . . . . . . . . . . . . . ~
4. Mioimum t.x. Ch"k h". ~ 0 OOd .!t,chFoom 4625. . . . . . . . . . . . . ~
50 T.x 110m recompUting p,i".y." inv"lmoo' credit (a!t.ch FO'm 4255) . . . . 50
51 Sooi., $OCu'ity f.x on tip incom. no' report.d fo .mploy" (.H'ch FOOm 4137) . 51
52 Uncollecl'd .mploy" >oci,1 secU'ity tox 00 tip, (lmm FO'm W-2) . 52
53 T.x 00 on 'Odlvidu'l "liremoo' a'''ogemon, ('/f'ch Fonn 5329) . 53
54 To,./t.x. Add lin" 47 'hmugh 53 . . . . . . . . . . . . . . . . . . < . . ~ 54 ~ R L/ c..
55 Total Federal income tax withheld (attach Forms W-2, W-2G, and _..."'U.~
W-2P '0 1,,0') . . . . . . . . . . . . . . . . . . . . . . . . . " --'!., -'-.-~r,MJ
56 1977 "lim.,.d fox p.ymoots ('nclud. 'mouot .1I0wed as credit _....~.._
f'om 1976 "Ium) . . . . . . . . . . . . . . . . . . . . . . . " 66 7,.s oa _ -Jj./~~fr~~h
57 ["nod incom. c"dit. It lino 31 ;, uad" $8,000. ." p.g. 2 01 ~.~~
Instructions. If eligible, enter child's name ~'''''''''-'''''h'____'h'''___ ~_ -_~_~.~.'.'-A.~
58 Amount P"d with FO'm 4868 . . . . . . . . . . . . . . . . " ~-.~_w:~w;W/. W~~
5' [XO"'F/CA ond RRTA 'ox "i1hh"d ('wo o,mo" employ.",) '" ~ _..~___~.~....
.0 C"dit fo, F'd...'t.x 00 .peci.' luel,. ofc. (.H'ch Fo'm 4136) " ~ _'. ~4f!;_
61 C"'it l<om , ""',te' 1'~'lm'" Com,,,y (,ff'd> '0,," 2439) . . . " ~ .. _ ..~.;::._
61. S" p'ge 13 01 100"u,tioO$ . . . . . . . . . . . . . . . . . . 61. ~.d!b&JB
.2 TOlal. Add lin" 55 thmug' 61. . . . . . . . . . . . . . . ~64 .~ I ~..b 0 c:> 1_
63 If line 62 is larger than line 54, enter amount OVERPAID. . 0 . . . . ~
54 Amouo, ofl'" 63 to b. REFUNDED TO YOU. . . . . . . . . . . . . . . . . . . . . . . . ~
.5 Amouo, ofline 63 to b. c"dit'd 001978 e<tim.ted tox . . . . ~ I .5 I I ~~
66 If line 54 is larger than Iir.e' 62, enter BALANCE DUE. Attach check or money order for full amount I" I I
"y.bie '0 "lot'",1 '.v,".. S'~I"... W,ite 'ocl,1 ,,",u'ily 'umb" 00 'heo' 0' 100'"" o,d". . . ~ .. 0/ 3 to
(Ch"k ~ ~ if '''10 2210 (2210f)', 'I"'h.d, S" "",1401 'O$I,uctioo..) 1f~~.#4'.@W'~
",'" ,."",,, of ''',u'Y. , ,,,,,,. ,"" , h", '''m,"oO '"" '''um. ''''u''" '''om,.ny<o, '<hoOuI" .no "".men... 00' '0 roe .."
of my 'o'....d" '0' b."el. n ;, ',ue. ~"e". OOd 'ompl"e. Oeol.~tion of '''p"" (0,"" ,"00 tup,,,,) f, b"oO 00 .It ;n'o,m"'M of
""kh P"p"" h" ooy k"Owl.d,~ ~ ~ I e--/6 _ 'IE? 30)
.. ~ ..,,~. ..,"",,, '"' d. "''',' 'Om " ,'C. i"..~",o,.
y", "'""'~ 0.,. , ::B_~.~.~R._~_\sj~.E.~~_..____
.. --c;'.'ct.~.(?-\t\iJL....B.,..l::M,LL.__
" ~". ..,'"..,~ """,""o,""y. eo," ~'.. ~ I II .s
"eo "eo" '"'y on. h., '""m., y ,... ".,,,,,;".,,,_ "' .~o?... ..m,. ...._. .., ....".'". "om.i
Pag~
-
~ch"..jul~s A"'B (Form lO4Ci 19.'7
Schedule B--fntercst and Dividend Income
P~ee ;.
. . N;tme(s) as shown cln Form 1040 (Do nol enter name and socIal security number if shown on other side)
S~K~ S. M', \\r:="R
Your socia} security number
11 l1L.f..2 iJl/95
-
~i-:Jjln Interest Income (1}q; ~ j" Dividend Income
1 If you received more than $400 in interest, complete Part f. 3 If you received more than $400 in gross dividends (including
Interest includes earnings from savings and loan associations, capital gain distributions) and other distributions on stack,
mutual savings banks, cooperative banks, and credit unions complete Part II (see Note below and page 17 of instructions).
as well as interest on bank deposits, bonds, tax refunds, etc. (list payers and amounts-write (H), CN>, (1), for stock held
Interest also includes original issue discount on bond~ and by husband, wife, or jointly.)
other evidences of indebtedness (see rage 17 of InstructIOns).
(list payers and amounts.) ~ RR;II\ h'tN~ r>\'E'\2CG) ?O,'I'5J
}.1r=R~;\ ~(t'lc..h, ?\E~c.e
F 6 ~ \---I. ~Jt, '-.4.. S 1-t'\;-\ ~, "I t-<c... r=F:~~~R 'i-~~~\-~ T~c.
~/c -ti. g'f7- &J;Cj47 551. - _~/C#-8Lf1-!J9'qLj7
..h2ds"'p:=:1t~ \\ '?"I ~ au I'd 'vJ'E:$"\ 'EO ~ N r1stl
UNio N t>~c.;J;;-c.. 5/0
"'?oo \~p -r~~oMe ,~ V"S I r;..,~ -g~f~ lEH~R S/18
~ 3-7.;;J.51~J./.'i ..59/
J ~ ~c"1 ~c- ~~~ Elec 3 :) .;l.
L. ~\R"i E-t\ E. (~ H~I'= ~o~: \) -
--
"T '-' <" "r-'\ €. '-T Q.. v '5 T
::J. '3 -7.;z.S Lf -5 J..j 9 /" 8~
-
,
4 Total of line 3 . . . . . 3}) 38/
5 Capital gain distribu- , . ~
tions (see page 18 of
Instructions. Enter .4&
here and on Schedule ~
D, line 7). See Note
below . . . . ~%.
6 Nontaxable distribu-
tions (seepage 18 of ~~
instructions) . .
7 Total (add lines 5 and 6) . . . . . .
8 Dividends before exclusion (subtract line
2 Total interest income. Enter here and I, 8 33 7 from line 4). Enter here and on Form '33J3BI
on Form 1040, line 9 . - . 1040, line lOa - - .
Note: If you received capital gain dlstflbutlons and do not need SchedUle D to report any other gains or losses or to compute [rJ
the alternative tax, do not file that schedule. Instead, enter 50 percent of capital gain distributions on Form 1040, =.
line 15.
D:r.r.lllr:J foreign Accounts and Foreign Trusts
If you are requireal to list i'lterest in Part I or dividends in Part II, OR if you had a foreign account or were a grantor 0#,
or a transferor to .~ forei n trust, you must answer both uestions in Part 11/. (See page 18 of Instructions.)
1 Did you, at any time during the taxable year, have any interest in or signature or other authority over a bank,
securities, or other financial account in a foreign country (except in a U.S. military banking facility operated by a
U.S_ financial institution)? - 0 Yes t8J No
If "Yes." see page 3 of instruct:ons.
2 Were you the grantor of, or transferor to, a foreign trust during any taxable year, which foreign trust was in
being during the current taxab!e year, whether or not you have any beneficial interest in such trust? 0 Yes ~ No
If "Yes," you may be re'1uired to file Forms 3520. 3520-A, or 926.
SCHEDULE TC
(Form 1040)
Oeportmenl of Iho Tr<uury
lnt.!m.1 Rtv~nue ServicI
po Attach to Fo/m 1040.
Tax Computation Schedule
~@77
Name(s) as shown 011 Form 1040
5 \:\RP\
S, \V\;\\5~
Instructions
Who Must File.-This schedule is for
use by taxpayers who cannot use the Tax
.ables and for certain taxpayers who
must itemize deductions. If you must
itemize and the zero bracket, 'Tlount on
Schedule A (Form 1040), line. 40, is
more than your itemized deductIOns on
Schedule A, line 39, YOu must complete
Part II before figuring your tax.
Part I.-You must use Part J to figure
your tax instead of using the T?x Ta bl~s
if your income on Form 1040, rifle 34, IS
m~re than $20,000 (more than $40,000
if you are married filiing a joint return or
are a qualifying widow(er)) or if you claim
more exemptions than covered in the Tax
Tables for your filing status.
You will also need to complete Part I if
you figure your tax by using Schedule G
(Form 1040), Income Averaging.
Part II.-If you are required to itemize
deductions and the zero bracket amount
on Schedule A. line 40, is more than your
itemized deductions on Schedule A, line
39, you must first complete Part l! to fig-
ure your Tax Table Income. Tre new zero
bracket amount must be adjus :erl by cer.
tain taxpayers who must itemize deduc.
tions. This computation is necessary be-
cause the zero bracket amount is built
into the Tax Tables and Tax Rate Sched.
ules.
You MUST itemize deductions if:
(a) You are married filing a separate
return and your spouse itemizes deduc.
tions (unless your spouse is described in
paragraph (b) and enters earned income
on Part II, line 3),
(b) You can be claimed as a dependent
on your parent's return and have $750
I Your !>O<:ial security number
1'7: '-/J..1/ t/- 9 S
or more of unearned income and less
than $2,200 of earned income if you are
single (less than $1,600 of earned in.
come if you are married filing a separate
return),
Note: If your earned inca Ie is more
than your itemized deductions on Sched.
ule A, line 39, enter your earned income
in Part II, line 3, unless you are married
filing a separate return and your spouse
itemizes deductions. (See page 11 of the
Instructions for Form 1040 for a defini-
tion of earned income.)
(c) You elect to exclude income from
sources in United States Possessions
(see Form 4563 for details), OR
(d) You are a dual-status alien (see in-
structions for Dual-Status Tax Year on
page 4 of Instructions for Form 1040).
~ Tax Computation for Taxpayers Who Cannot Use the Tax Tables
Caution: Read the Instructions before completing this Part.
1 Enter your Tax Table Income from Form 1040, line 34 .
2 Multiply $750 by the total number of exemptions claimed on Form 1040, line 7 .
6 33> G{4
}-2- J,aoo
8 31) tJ. I '1
9 /80
1 35 J 14
- I
2 1.500
.
3 33,~1'-f
10 General tax credit. Enter the larger of line 5 or line 9.. .. .........
11 Tax. Subtract line 10 from line 4. Enter the difference (but not less than zero) here and on Form
1040. line 35 .. . . . " . ~
r:r-:f.i.TIr:J Computation of Tax Table Income for Certain Taxpayers Who Must Itemize Deduc!:ons
Caution: Read the Instructions before completing this Part.
1 Enter your adjusted gross income from Form 1040, line 31 .
2 Enter amount from Schedule A, line 40. . . . . . . . .
3 Enter amount from Schedule A, line 39. (If you can be claimed as a
dependent on your parent's return, see the Note in the Instructions
for Part /I and check the box below line 33 of Form 1040.) .
" Subtract line 3 from line 2. . . . . . .. .............
5 Tax Table Income. ADD lines 1 and 4. Enter here and on Form 1040, line 34. (Do not make an entry
on Form 1040, line ~13. Disregard t~e instruction on form 1040, line 34, i nd go to the Note below
line 34.) . . ~
~-I
.. 1 I I
I-_..~....~- ':W~_~~Jf.;:.
.....~~~'i'~~?@/C,0' ;
~~ ~v/~:/"/z /(f';;//:(/' ,
~~J8jIA~~~;.
4 I I
5 I I
.. .
4,
~. .
Form 2210
Underpayment of
Estimated Tax by Individuals
~ Attach this form to Form 1040.
D.parim.nt or lh. T"osury
Internll Revenue Service
~@77
~ -., - -
i
1
f
?
I
Name(s) as shown on Form 1040
5 \\ B. Q s. \'1\\ \ \ E ~ I, -rt ;s:j.J.iY J49rS
, ' _'_ _; '._, ' How to Figure Your Underpayment (Complete lines 1 through 16)
If you meet any 01 the exceptions (see Instruction D) wrich avoid the underpayment penalty for ALL Quarters, omit lines 1 through 16 Old l:!! directly to line 17.
1 1977 tax (from ForiT! lC40, line 54) . . .'. . . . . ., . .' ~ '. -
2 Earned income credit (from Form 1040, line 57) . . .' . .
3, Tax 'credit claimed for spe:::i2l fuels, nonhighway gasoline and lubricating oil (flU'" Form 1040,
, line 60)'. . .
'4 Minimum tax (from Form 1040, line 49) .
5 Social security tax on Uiiicported tip income (from Form 1040, line 51).
6 Uncollected employee social security tax on tips reported on Forms W-2 (from Form 1040,
line 52) . ' .
7 Tax on a'n'individual retirement arrangement (from Form 5329, Part IV or VI included on Form
1040, lin~ 53) ~ .
8 Amount from line 61a of Form 1040 .
9 Total (add lines 2 through 8) .
10 Balance (line 1 less Ene 9) .
11 Enter 80% of the amount shown on line 10.
. -- ~'I' . -- --' ... - _" ,_
~,
,
,
" .
..
. ' .
, '
. . . .
I
t
~
t.-
r -
f
r
"
Due Dates of Installments
June 15. 1977 Sept. IS, 1977
Apr. 15, 1977
~~~
~-
. "....
,,:;.-..:' -.
r
i
15 Total (add lines 13 and 14). '.
16 Underpayment (line 12 less line 15) OR " ,.'
.. , 'Overpayment (line 1!3 less line 12) . .., '., :..,
. : ','- , , Exceptions Which Avoid the Penalty (See Instruction D) ,
-- '.. . .... .. _ (Farmers and fishermen see Instruction H for special exception)
f'
J
f
t ',"
,
i
17'"Total. amount paid and withheld from January 1 .through
the instailment date indicated. . .. . . . .
18 Exception I.-Prior year's tax. I
1976 tax ...'. ., _ . ~ . $ 7j I 3 8
19 E~ception 2.-Tax Of!' prior ye'ar's income using 1977 rates
and exemptions (attach computation). . . . . . .
20, Exc.eption 3.~Tax on "annualized 1977 income (attach
c~mp'utation) ..'..-.;'........
21 Exception 4.-Tax on 1977 income over 3, 5, and 8-month
periods (attach computation). . . . . . . . . .
I, 8 7 "C.~
25% of 1976 tu
1.78'--/
Enter 25% of lax
3,750
50,*, of 1976 tax
a. 5 6 Cj'
Ent~r 50% of lax
S G;)S
,
75% of 1976 tax
S, "3.s 3
Enter 75% of tax
.r.-_-
Enter 20% of tu
Enter ,40% of tax
Enter 60% 01 tax
Enler 90% of tax
Enler 90% of tax
Enter 90% of tu
i'
~ .
j'
,
1
!
~
t
.
l.
f
~,
t,
t
!
...
_AI
.' %/~'1:W0~
~f1,~t&;:~
?; %/' 0~ #$~
-~~,~~
~~~~
_&'ffi~J
..~-,~
-.
Jan. 16. "978
~
, ,
7,.s 00
100% 01 1976 tu
7,/38
En:er 100% of 'tax
~$::;W~
I ~~~:~ I
~~#-
" ,How to Figure the Penalty (Complete lines 22 through 26 for installments not a't'oided by an exception)
. '- ... ... .. 1..:",_ I .. 10-'" .. " I
..- - .. - . , '-'-, -
22 Amount of underpayment (from line 16) " : ' , ....
. . . . . . .. ' ,
- '.. .. .. " ,', " , ., ..
..
.' , .. .. , "
23 Date of paym~nt (see Instruction G) . .. : ", - . -,
. . . . . . .
24 (a) Number 01 days after .due, dJt~ 01 installment to and including
'- ,
" date of payment' or January 31, i978, whichever is earlier . . ". ..
. , -,
(b) Number of days from and including February 1, 1978, to and " ' - .. -
, '!nC,luding date 01 payn:enl or .~priI15, 1978, whichever is earlier. - "
25 (a) 7 percent a year on 'the amount shown on line 22 for , '"
. .... . , - -, ~ -
t~e_~umber ?r days shown on line 24(a) . , -,
, , . . . . . " -
(b) 6 p.ercent a year on the amount shown on line 22 for "I .
- , the number of days shown on line 24(b) . 0', ~
. . . . . -
26 Penalty' (add a~ou':lts on lines 25(a) and 25(b)). Check the box on For';; 1040, line 66, and show this amount
in the bottom margin as "Penalty for underpayment." Then increase the "Balance Due" or decrease the "
amount "Overpaid" accordingly . . . . . . . . . . . . . . . . . . .
. . . . . .
___ #.:.......-=-...o:~~:.....-_....:~~.._:~_.:....,-~-..,-.:;, ...---.- -~-- - --'~-~~~~ .~_-:...
- ..
.-.----..:......- _':'-..:..:.-.-- '-~~-'-- -~ -
Form 2210 {l9m
Ctj>lr1menl 0{ tTle TreJ~ul)'-lnternll Rtvtnur Service
U.S. Individual Income Tax Return
~@76
This s;::ue for IRS lJ~t onl,
~
.~ 1040
. 1976 endIng
. 19
I t;7ir':f~u~7+9$
8
G
...
III
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...
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c.
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(.)
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fa
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.
G
...
..
GI
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....
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c
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., ~
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... 0-
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.z: ...
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GI ....
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(.) ....
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en
for the year January I-December 31 1;76 or other laxable year bcc,nn,nl!
h.mso~;rn~'d.nt nS.n: in.\,.ls 01 both) I f'Al i U
Pr,,,nl hDm' .1d,",s (Numb.. .nd str,d. indudine ""7m.nt numS" JUri' routel
7 B B VI, SoU T !'\Iace labelT:e
Cil,. H or post OHite\S~t. .nd tiP code ? ~ J 7 c I 3
'-.: p.~ ~:S \E:, ,,~
1 ~ Single (Check only ONE box)
2 0 Married filing joint return (.ven if only one h~1 income)
3 0 Married filing se,larately. If spouse is also filing give
spouse's social security number in designated space above
'and enter full
name here ~
4 0 Unmarried Hea
to see if
you Qualify ~
5 0 Qualifying w
spouse died
;:;:1<-
Last r.ame
Please
place
label
on form
you file.
Make all
ne-cl'ssary
c".nies
en label.
For Privacy Act Notification, I Spouse's. social ,security no.
see page 5 of Instructions. :
O~~'I Yours ~ K E. Ti "F- ~ 1)
pellOn Spouse's ~
6a Regular M Yourself 0 Spouse Enter number of I I .- ^: ;~
~ boxes checked ~
b First ~3mes of your dependent children who
(: 'ed with you
~
...
en
...
.=
LA:
~,' /: . :"'~"
~_z., ,-:::1
,~~~:m
- ~ .-;>.i;
Enter ~_'j)
number ~ _;/ :'~'/;:~
C Number of other dependents (from line 7) . ~ _ (;/{~
d Total (add lines 6a. b, and c) .... ~ I
e Age 65 or older. ~ Yourself 0 Spouse ;~~~er
( Y f S of boxes I
idow(er) with dependent child (Year Bind. . . . 0 oursel 0 pouse checked ~
~ 19 ). See page 7 of Instructions. f TOTAL (add lines 6d and e) . . . . .. ~ ~
(b) R.I.tionship (c) Month. li"d in your (d) Old de""nd.nt (e) Amount furnished for dependenl's s";:,,)(t
hom.. If born or died h..e ,"'om. ot ~i50 --------
durine year. writ. B or D. or mor.? S, YOU. If 100% By OTliERS intlud.
writ.: JJ.L ine dep.ndent.
VI
C
~
c..
E
Ji
d of Household. See page 7 of ir,structions
7 Other dependents:
(a) H.m.
$
$
I I Yes Iml I No I Nol.: If you theck Ih. ..y....
- - ~ - - bOl(es) it will not IntreH. r>ur
Yes % No III or red utI your refund.
Presidential Election ~ Do you wish to designate $1 01 your taxes for this fund?
Campaign Fund. Y If joint return, does your spouse wish to designate $1?
9 Wages, salaries, tips, and other employee compcn~i1:;uii ~A~,t:,t~':o~~se ~;rrn';lr~~~;:'~I.i.
10 D" (Se. P.;;es 9.nd) '30 ~ II: . 100 :
a IVldends 16 ollnstrutllOns ........~;;.J.. ........., lOb less exclusion...... ..................., Balance ~
(If gross dividends and other distributions are over $400, list in Part I of Schedule S.)
11 I t t . {If $400 or less. enter total without listing in Schedule B}
n eres Income. If over $400. enter total and fist in Part II of Schedule B
12 Income other than wagl's, dividends, and interest (from line 37)
13 Total (add lines 9, IDe, 11 and 12) .
14 Adjustments to income (such as moving expense, etc. from line 42)
15a Subtract line 14 from line 13 .
b Disability income exclusion (sick pay) (attach Form 2440)
c Adjusted gross income. Subtract line 15b from line 15a, then compl€te Part III on back.
(If less than $8.000, see page 2 of Instructions on "Earned Income Credit.")
tj T~x Table Tax Rate- Scheaule X. Y or zl tj Schedule D
16 Tax, check if from:
Schedule G Form 2555 I OR Form 4726
17a Multiply $35.00 by the number of exemptions on line 6d. .. 1173 /35.1_ I~~~:rr}
b Enter 2% of line 47 bul not more than $180 ($90 if box 3 is checked) 17b 180 :: i:
18 Balance. Subtract line 17c from line 16 and enter difference (but noUess ~han zero)
19 Credits (from line 54)
20 Balance. Subtract line 19 from line 18 and enter difference (but not less than zero)
21 Other taxes (from line 62)
22 Tolal (add lines 20 and 21). . . . . . . .
. . (.!llth Forms W-2.
23a Total Federal Income tax withheld. or W-2P 10 fronl)
. (inclede .mount allow.d
b 1976 estimated tax payments ... c,.d,1 from 1975 return).
. . (Irom plil 2
C Earned Income credit. of Instruttions)
9
10c
3~ N / /
/, B b 7
'-1-, Ci "3 I
30J309
30~ 309
.810, 3 rLl
7 3/8
11
.. .12
13
14
15a
15b
15c
:>3a
16
(If box on line 3 is ch-'~
see paee 10 of Instructions)
17c I 80'
18 7) I .38 -
19
. -
20 ~ I ~ 8
21
: : 22 7 I 3-.8 -=
_~.~g~!f4L<';
I 00 W Pay amount on ii1;~ 25 in "'->
._ _ ~ full. with thi~ return. orile: ;;
W social secunty number on :
~ ch~ck or money order .and ~. - .
,- ~ make payable.'to Inlernal;'
.. ~ R~vt'nue Service. .
- ~.r~$$~.~:f;:j
~ 24 t:?) / 00 I
. ~ 25
\.
23b
nc
23d
23e
B
~
d Amount paid with. Form 4868
e Other payments (from line 66)
24 TOTAL (add lines 23a through e)
25 If line 22 is larger than line 24, enter BAU-NCE DUE IRS
(Check here ~ O. if Form 2210 or Form 2210F is attached. See page 10 of instruclions.)
If line 24 is larger than line 22, enter amount OVERPAID . ~ 26
Amount of line 25 to be REFUNDED TO YOU . . . . . ~ 27
Amounl of line 26 t~ be credited on 1977 estimalpd tax ~ I 28 I .~. I ~W%':P1'i0'{$:~1ft";,:f:fJ,i(3fX~;~~ -
Under penallles 01 perjury, I declare thJt I hIVe eumlneC thiS ret",r", Includln, u:complnY1nc scheduln .r.-d $~I!emrnts. and 10 the best of my kno..1rCCc Ind belle1 .t 11
true, conect. and complete. Creel.ration of prep.arl1' (oth.r than talpayer) is based en all inlorm.tion of whith pllL~p..Irc:r hu Inl lno",ledlL
26
27
28
9b'L
~ Y""r l'lnatur.
h.Ritter, Haayen & Keller
'" Pr.oar"'.s,.o.It....i.n: ~pIOy.:J s n.m.. .f any)
t300rY',~.....sr.1 ;;)1"':
> R~::.~.n~~wa;..: :n:::I,onl) .
Addrn. (snd liP co.:.j
Cau
D.tl
~
SPOLUI'I siCn.1ulI (., 1IIInc JOlntl,. BOTH must lien .ven if onl,. on" hid income)
~
(23-1401013)
~>,l-flf3(1
I' f) "
P~r (r{ON~ r<. IS
--..,.--- - - - _..- - -- - ..
( ,
"r;',m 1040 (1976)
I ~ Income
\l7- LFL - \ 4~ 5"
other than Wages, Dividends and Interest
Page 2
29 Business income or (loSS) (attach Schedule C) . " .. . ...... .. .
30a Net gain or (loss) from sale or exchange of capital assets (attach SChedule D) . . . . .
b 50% of capital gain dIstributions (not reported on Schedule D--see page 10 of Instructions).
31 Net gain or (loss) from Supplemental Schedule of Gains and losses (attach Form 4797) . .
32a Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule E) .
b Fully taxable pensions and annuities (not reported on Schedule E-see page 10 of Instructions)
33 Farm income or (loss) (attach Schedule F) . . . . . .'. . . . .' _ . . . . .
(does nct apply if relund is for year in which you took the)
34 SIdle ir.ccJllle tax refunds standani deduction--<>thers see p.ge 10 01 Instructions .. ".
35 Alimony received . _ . . . . . . . . . . . . . . . . . . . . . . .
36 oth e r.< st.aA .R~:~- ~_ ~~ ~ _ ~.r_~fi\ E ~ ~.~.1~ ~~~;n~ ~.~~ h~ ~_'. ....~._._...._._ ~~ ~'. ~-.-.~'_'.-.'_'_-_~'_'.'_~-.-_-_-.'_-_-.~-.-.-.-_-
---Sb
37 Total (add lines 29 through 36). Enter here and on line 12 . . . ~
~ Ii'] Adjustments to Income
29
30a
30b
31
32a
32b
33
3.)j BT-
"A
......
35
36
37
. q.sO
Lf. ;)..3 t
-----~-~_. - 38
38 Moving expense (attach Form 3903) . . . . . . . . . . . . . . . . -
39 Employee business expense (attach Form 2106) . . . . . . . . . . . . - 39
40a Payments to an individual retirement arrangement from attached Form 5329, Pert IIJ . . . . 40a
b Payments to a Keogh (H.R. 10) retirement 'an . . . . . . . . . . . . . 40b
41 Forfeited interest penalty for premature wit! : awal (see page 12 of Instructions) . . . 41
42 Total (add lines 38 through 41). Enter here ",nd on line 14 .~ 42
~
~t;t1U Tax ComputatIOn
43
Adjusted gross income (from line 15c). If you have unearned income and can be claimed as a
dependent on your parent's return, check here ~ 0 and see page 9 of Instructions . . . .
If you itemize deductions, check here ~ 18!, and enter tolal Irom Schedule A, line 40, and attach Schedule A ] I
Standard deduction-If you do not itemize deductions, checl< here ~ 0, and:
'Jf you checl<ed /2 or 5, enter the greater of $2,100 OR 16% of line 43-but not more than $2,800 .
the box on 1 or 4, enter the greater of $1,700 OR 16% of line 43-but not more than $2,400
line . . . .
3. enter the greater of $1,050 OR 16% of line 43-but not more than $1,400 .
Subtract line 44 from line 43 and enter difference (but not less than zero). .....
Multiply total number of exemptions claimed on line 6f by $750 . . . . . . . . . .
Taxable income. Subtract line 46 from line 45 and enter difference (but not less than zero) ~ .
44a
b
45
46
47
43 ;J b;..~() 1
~ 9187
~~ I
- ~~ 8-~o
45 ~ , D'\
46 /~OO
47 d,'4- 3~ ()
· If line 47 is $20,000 or Jess and you did not average your income on Schedule G, or figure your tax on Form 2555, Exemption 01 Income Earned Abroad, find
your tax in Tax Table. Enter lax on line 16 and check appropriate box. ,
· If line 47 is more than $20,000, figure your tax on the amount on line 47 by using Tax Ride Schedule X, Y, Z, or jf applicable. the alternative tax fiom Schedule
0, income averaging from Schedule G, tax from Form 2555 or maximum tax from Form 4726. Enter tax on line 16 and check appropriat~ box.
~ ;r:1i 4H'I..l Credits
48 Credit for the elderly (attach Schedules R & RP) . . . . . . . . . . . . . 48
49 Credit for child care expenses (attach Form 2441) . . . . . . . . . . . . . 49
50 Investment credit (attach Form 3468) . . . . . . . . . . . . . :. . . . . 50
51 Foreign tax credit (attach Form 1116) . . . . . . . . . . . . . . . . . 51
52 Contributions to candidates for public office credit (see page 12 of Instructions) . . . . . 52
53 Work Incentive (WIN) Credit (attach Form 4874) . . . . . . . . . . . . . . . 53
.
54 . Total (add lines 48 through 53)_ Enter here and on line 19 . - . . . . . ~ 54
It;r:IiI'Cl Other Taxes
55 Tax from recomputing prior-year investment credit (attach Form 4255) . . . . . . . 55
56 Minimum tax. Check here ~ D. and attach Form 4625 . . . . . . . . . . . 56
57 Tax on premature distributions from attached Form 5329, Part V . . . . . . ~ . . . 57
58 Self-employment tax (attach Schedule SE) . . . . . . . . . . . . . . . . . 58
59 Social security tax on tip income not reported to employer (attach Form 4137) . . . . . . 59
60 Uncollected employee social security tax on tips (from Forms W-2)' . . . . . . . . . 60
61 Excess contribution tax from attached Form 5329, Part IV . . . . . . . . . . . . 61
62 Total (add Jines 55 through 61). Enter here and on line 21 . . . . . . . . .~ 62
D;r:"Tia'H1! Other Payments
63 Excess fICA, RRTA, or FIC~LR~TA tax wjthheld (two or more employers-see page 13 01 Instructions) . 63
64 Credit for Federal tax on s1~dal f~elS: noiih;gh~iy gasolf~e;;nd lubricating oil (attach lorm 4136). . . .. . 64
65 Credit from a Regulated Iny~strnent, ~ompany (attach Form 2439) . . . . . . . . . 65
66 Total (add lines 63 throu~h 6Sr 'Ente'r herti"aiit1'ori line 23e . . . . . . . .~ 66
.n:!'1 ~,,~! -'.:~:\
-
" .
. Schedules
(Form 1040)
O';>.ortm.nt oIl~. Trouu".
f,.,t~rn.1 R~"Iue Sel'\'lcr
Name(s) as shown on Form 1040
A& B-ftemized Deductions AND
Dividend and Interest fncome
~ A!1ach to Form 1040. ~ See Inslructions for Schedules A and B (Form 1040).
S ~1<- \;
C' M.II--n
.....:l , \ \ \ E \,
I
~@75
Medical ~nd Dental Expenses (not compensated by insurance Conf1hutions (See page 15 of Instructions for examples.)
Or otherwise) (See page 13 of Instructions.) 21 a Ca:.o contributions for which you have I
1 One halt (but not more than $150) of in- I /~O receipts, cancelled checks or other
surance premiums for medical care. (Be wriiien evidence . . . . . . . S
sure to include in line 10 below) . ~I -
2 Medicine and drugs . . . . L Other cash contributions. list donees
3 Enter 1 % of line 15c, Form 1040. and amounts. ~ -nn-..h_.h.h..n_nnn.
4 Subtract line 3 from line 2. Enter d iffer- . - - ---- - - -. - - - - - - -- - - -. - - - - - -- - -- - -. -. -------. -- -------- ----- ~ ""t 1=
ence (if less than zero, enter zero) - - -----. - - - - - - - -. - - - - - - - - -. - - - --. ----. - - - -----------. -------. D t 1-
-. ~ ~I
5 Enter balance of insurance premiums for - --. - - -- -- - - - - - - - --- .-- -. - -- ._-~ -- --- ------------. -- ----- - ----
medical care not entered on line 1 ----- -- -- --. - - - - -- --- --. - - ---------- - ----------- ------------- l ~ /-
6 Enter <;>ther medical and dental expenses: - _. . -G: k'-
. ----. - --- - --- - - - --.. -- - ----------- ---------. ----------------- eJ-
a Doctors, dentists, nurses, etc. . . 22 Other than cash (see page 15 of instruc.
b Hospitals. . . . tions for required statement) . . . . ~
. . . . . 1=
c Other (itemize--include hearing aids, 23 Carryover from prior years . . .
dentures, ey~g/asses, transportaticn, 24 Total contributions (add lines 21a through Io~ 4-4-7/
etc.) ~ _______ n__hn __ ---n_nOon _h ____ _ n. n. 23). Enter here and on line 37 ~
- - --- --- ----- --- -- --- --- - - - -- - - - - - - --- -. - - -. - - - - - - - - - - - - - - - -. - Casualty or Theft lossees) (See page 15 of Instructions.)
Note: If 'jOU had more than one loss, omit lines 25 through 28
- - -- ---- - -- ----- - - -- - -- - - --- - -- - - ----- - - -- - - --.. - - - - - - -. - ---- and see page 15 of Instructions for guidance.
. ------- ---- ---- - - - - - - - - - - -- - - -- - - --.. - --.- ~ ---- -- --- - -- - -- - ~
25 Loss before insurance reimbursement .
--- -- - - -- - -- - - ---- - - -. - - -- - - - - - - - - - - - - - - - - -. - - - ---- -- - - - - - - --
26 Insurance reimbursement . . . . . .
- ---- -- - ----- --- - -- - - - -- - - - - - -- - - - -- -- - - - -- - - -- -. - - -- - -- - - -_.
-- - - -- -- - - - - - --- - - - - - - - - - -- - ---- - - - - - - - -- -- - - - - - - - - - - - --- - --- 27 Subtract line 26 from line 25. Enter dif.
--- ----------- - ------ - ---.- ---- - _. - -- -- -- - -- - - -- --- - - - - ------ ference (if Jess than zero, enter Zero) .
7 Total (add lines 4 through 6c) . 28 Enter $100 or amount on line 27, which-
8 Enter 3% of line 15c, Form 1040. ever is smaller . . . . . . .
9 Subtract line 8 from line 7 (if less than 29 Casualty or theft loss (subtract line 28
zero, enter zero) . . . . . from line 2~). Enter here and on line 38 ~
10 Total (add lines 1 and 9). Enter here and J~O Miscellaneous Deductions (See page 15 of Instructions.)
on line 34 . ~ 30 Alimony paid
. . . . . .
Taxes (See page 13 of Instructions.) 31 Union dues -
-:Jfl . . . . . . .
11 State and local income . . . . 32 Other (itemize) ~ . - -- -- - - --- - --- --- ----- - --- ----.
12 Real estate . . . . . . . . n.\Q\:\i~~~~~:_::-:~:::~:-:~
13 State and local gasoiine (see gas tax tables) I 7..!3
-
14 General sales (see sales tax tables) . . ~ CJ
15 Personal property . . . . . . I., if to - -- -- ~- -- ---. -- -- - -- -- -- - - --- - -- - ---- -- ----- ---- -------------.
16 Other (itemize) ~D.---------......n..----n ~ 57 - - - - - --- -- --. - --- --- - - - - - - - -- - - - - -- - -------- - ------- -- -- ------
. ---Fo-~~.(q.ti.n.....i.~.i ~_€'N..~~____ - - - - - - -- - -. - - - -- - - - - - -- - - - - - - - - --- - -- - -- -- - - - -- - - - - -- --- - - ----
.---- --- - - --- -. - - - - - - - -- - ---. - - - - - - - - -- ---- -- --.. - - - --- ---- --- . -- - - - - - --. -- - ------ - - - - - - -- - - -- - --- -- ----- --- -- -.- - -- - ---- ---
----- ----- --- ----. - -- -.- -- - - - - - - - - - - - -- --_. - - - - -. - - - - - - -- -- _. 71 - - - -- - -_. - - - - - - - - - - ~ - - - - - -- - - - - - - - --- -- - ---- --- - -- - - -... - -- - - ---
17 Total (add lines 11 through 16). Enter ~, I.J 9 33 Total (add lines 30 through 32). Enter I 9S
here and on line 35 ~ here and on line 39 ~
Interest Expense (See page 14 of. Instructions.) Summary of Itemized Deductions [Q)
18 Home mortgage . . . . . . . .
19 Other (itemize) ~ ...h......hU.......h.........__.__ 34 Total medical and dental-line 10 . . /..5 0 I-
----------- --- - --- - - - - - --- - - -- - - --- - - - - - - - - - - - - - - -- - -- - - - - - -- 35 Total taxes-line 17. . . . ~ 1~9 7
------ ---- - ..-- -- - -- - ---- - -- ----- -- - - - -- -- -- -- --- - - - - - - - - - --- 36 Total interest-line 20 . . . . . . ~. tfL/ 7
--- - --- ----- - - --- --- - - - - -- - - - -- - -- - - -- --- - - --_. - - - - - - - - - - --- 37 Total contributions_line 24 . . .
.
.----- ----..--------- -. --- --- -- -- ------- - ---- - --- --- ------ ---- 38 Casualty or theft 10ss(eS)-line 29 . .
. 39 Total miscellaneous-line 33 / 9.5
-----..----- ---..--.--.--------. ---.- - -_. -- - -. -- - --- - -- -- -- - --- . . . .
...--------------.-----. ----_. - -- - - - -- - -- -- - - -- -- - - --- -- - - -_.- - 40 Total deductions (add lines 34 through 9, 18r
20 Total (add lines 18 and 19). Enter here 39). Enter here and on Form 1040, line
and on line 36 . ~ 44 . ~
Schedule A-Itemized Deductions (Schedule B on back)
I t7r 7C!~J.ut7 ;u9S
"
....
-
Scl,e~uies A&B (Form 1040) 1976 Schedule B-Dividend and Interest Income
Na~(s) i!5 ~hown on Form 1040 (Do not enter name and social SeCUrTl( [Umber ,f shaNn on other sIde)
.s f\~ ~ S~t1, I ~ {L
l!.o..U:::J Dividend Income :~.:..J Interest Income
Page 2
I YOur social security yurc'xr
177 ~t/;;. :/1f9S
Note; If gross dividends (including capital gain distributions) an.d Note: If interest is $400 or less, do not complete this part. But
other distributions on stock are $400 or less, do not complete t~IS enter amount of interest received on Form 1040, line 1l.
part. But enter gross dividends less the sum of capital gain dls- 7 Interest includes earnings from savings and loan associations,
tributions and non.taxable distributions, if any, on Form 1040, mutual savinEs banks, cooperative bar.~s, and credit unions
line lOa (see note below). as well as interest on bank dl:'jJosit!>, bonds, tax refunds, E:C.
1 Gross dividends (including capital gain distributions) a~d other Interest also includes original issue discount on bonds 2nd
distributions on stock. (List payers and amounts-wnte (H), other evidences of indebtedness (see page 16 of Instructions).
(W), (1), for stock held by husband, wife, or jointly) (list payers and amounts)
-
-
5" L" lI'\ [:: \) t} \ e:. ~~_(,1Jg
~-\t~1' k~]) \=\ n~c.h ep
~
-
,
-
3/Cl.57 :
2 Total of line 1 .........
3 Capital gain distributions (see page 16 of .
Instructions. Enter here and on Schedule 0,
Iloe 7). See oote below I t
4 Nontaxable distribu- 4~
tions (see page 16 of 7 7lf~
Instructions). . . .
5 Total (add lines 3 and 4) . . . . .
6 Dividends before exclusion (~ubtract line 1,867
5 from line 2). Enter here and on form 3~3JI 8 Total interest income. Enter here and on
1040, line lOa . . . . . . form 1040, line 11 . . . . .
Note: If you received cap'tal gam dIstributions and do not need Schedule 0 to report any other gaIns or losses or to compute gJ-:-.'
the alternative tax, do not file that schedule. Instead, enter 50 percent of capital gain distributions on Form 1040,
line 30b.
D;f.TiIIl["l Foreign Accounts and Foreign Trusts
1 Did you, at any time during the taxable year, have any interest in or signature or other authority over a bank,
securities, or other financial account in a foreign country (except in a U.S. military banking facility operated by a
U.S. financial institution)? . 0 Yes ~ No
" "Yes," attach form 4683 (For definitions, see Form 4683.).
2 Were you the grantor of, or transferor to. a foreign trust durin g any taxable year, which foreign trust was in
being during the current taxable year, whether or not you have any beneficial interest in such trust? 0 Yes ~ No
If "Yes," attach Form 4683 (For definitions, see Form 4683.)
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LAFAYETTE COLLEGE
EASTON. PENNSYLVANIA 18042
\fI' '1
VICE PRESIDENT FOll fiNANCE
AND
TREASURER
September 5, 1978
Ms. Jane F. Burke
Vice President and Trust Officer.
Fa m.e rs Trus t Company
Carlisle, Pa. 17013
Lear .M;. Burke:
In response to your letter of August 31, 1978, the current book value
of Sara Stone Miller's Pooled Life Income Trust is $31,001. 92. An analysis
of her contributions to the Trust follows:
Date Gift Securities
March 1972 100 shs. Consolidated Freightways
March 1972 32 shs. Beneficial Finance, 5~ Pfd.
,
September 1972 150 shs. Utah International
June 1973 42 shs. Leasco, Pfd.
October 1973 98 shs. Amfac
October 1973 SO shs. Detroit & Canada TUillle 1
Iecember 1973 SO shs. Certain-Teed, Pfd.
December 1976 11 shs. Norton Simon, Pfd.
December 1976 113 shs. Norton Siron
If I can be of any further assistance, please let me know.
S~cerely ,
('i; /7; ,
/ I) , ,} / .' ,\ /
, / L7~ .... !....' /' . , '-:...-~,.,-----
/ "John A. " Falcone
I Vice President for Finance
/
../ and Treasurer
JAF: pab
Pc T I ilOlVEi4'S €)C ifl 0 IT '. e.....
LAW OF'ICCS
YllU"" f'. M.."T:OON. P.C.
EXHIBIT llF" *
13. I give to Lafayette College the sum of One Hundred
Thousand Dollars ($100,000.00) for a special memorial to my
husband, Walter M. Miller. This memorial may be designated
and contributions made toward it in my lifetime.
In such case
my Executors shall deduct from this bequest such lifetime con-
tributions. Unless otherwise designated, all contributions
to Lafayette College made after the execution of this Will
shall be considered contributions made towards this memorial.
*For reasons of confidentiality, only that portion of the Will
of the said Sara Stone Miller concerning a charitable gift "to
Lafayette College is set forth herein.
(? c i I n t7 ,vE(2..t S
EXHIBIT "Fit