HomeMy WebLinkAbout04-0450 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of
~/ Register of WJlls for the ,
' - t ' ' - _Decease. County of ~~/~ in the
soc . Secur ,y No. g f of Pen y v ;ia
The petition of the undersigned respectfully reCresents that:
Your petitioner(s), who is/are 18 years of age o[ ~d~;-appl I ~ ~'-~'for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
~ecendent was domiciled at death in ~~/~ County, Pengsylvanig, w~h
h /.5 last family or principal residence at ~
' ' '(lis~ street,
Decendent, then ~ years o~ge, died
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal prope~y $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not dOmiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
as follows: ~~ .
situated
Petitioners after a proper search ha ~/8,, ascertained that decedent left no will and was survived by
the following ~c'.:':e (if ar~y~alld heirs:
Name Relationship Residence
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
~:g ~, ~ol}~Opr/~. H~ . ~¢, h/oIl~w~ P~
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COVNTY OF
The petitioner(s) above-named swear(s) or affirm(s)that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affirmed and subscribed
belbre me this ! et 77/ __ day of
No. ~., / -d~) t'~- ~'/~
Estate of ~¢~ ~.',~/ ~-~c, ~ , Deceased
GRANT OF LETTERS OF ADMINISTRATION
~'~ I~ .A'9~,,~'~ ' in consideration of the petition on
AND
NOW
the reverse side hereof,~-i~.factory~'~ proof having been presented before~n~e,
IT IS DECREED that J ~'~ ~ ~ ~~ ~[~ 4~
is/~e entitled to Letters o~ Administration,' and in accord with such finding, ~etters of Admiffistration
are hereby granted to ~ l~t~[ D~ ~ r~A ~ { ~ ~ ~ I~3 ~
in the estate of ~~ '~'~ [ ~ {~
/ ~ ~ Register of W~~/~
FEES
Letters of Administration ..... $ ~Y~
Short Certificates( ) .......... $~ ATTORNEY (Sup. Ct. I.D. No.)
~ _ TOTAL $ ~ ADDRESS
Filed ~Z( ....... A.
PHONE
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Offic~ for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Local Registrar
P 10328852 ~'
· ~~,!,~:,,,
No. ~ APR 2 6 ~04
Date
H108.144 Re~. 1/~1 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
~ . (Coroner)
~ ~te[ ~ ~[e ,.~96 ~ 4975 '~'~
4 ~rel~ Ave.
Mt. ~lly ~ri~e, Pa 17~5
~iel ~. L. ~ilor
0 Feb. 2, 2~ . ~s~i~ter
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717)240-6345
Date: 08/02/2004
RYNARD JUDY L
4 MOORELANDAVE
MT HOLLY SPRINGS, PA 17065
RE: Estate of RYNARD ADAM DANIEL
File Number: 2004-00450
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORP~3kNS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 08/21/2004
Your prompt attention to this matter will be appreciated.
Thank You.
GLENDA FARNER STRASBAUGH
Clerk of the Orphans' Court
cc: File
Counsel
Judge
Cumberland County - Register Of wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717)240-6345
Date: 08/02/2004
RYNARD DANIEL M
4 MOORELANDAVE
MT HOLLY SPRINGS, PA 17065
RE: Estate of RYNARD ADAM DANIEL
File Number: 2004-00450
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 08/21/2004
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
Clerk of the Orphans' Court
cc: File
Counsel
Judge
~ERTIFICATION OF NOTICE UNDER RULE
Date of Death:
W llNo.
Admin. No.
To ~e Register:
I ~ffi~ ~t no6ce of ~n~d~ ~t) ~ required by Rule 5.6(a) of~e O~h~s' Coug Rules was
se~ed on or mailed to ~e following beneficiaries of ~e above-captioned estate on
/
Notice has now been giv n to all persons entitled thereto under Rule 5.6(a) except
Date:.
/'/
Signature
Name
Capacity: ~rsonal Representative
_ _Counsel for personal representative
CERTIFICATION OF NOTICE UNDER RULE 5.6(!!)
Date of Deam: ~
~11 No. ~D ~ Admin. No.. ~
To ~e Register:
I ~ ~at nofi~ of ~neflc~ inte~) ~ required by Rule 5.6(~ of ~e ~h~s' Co~ Rules
served on or mailed to ~e following bcnefici~es of the above-captioned estate on ~
Ad~e~
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except_
Name
Telephone ~.
Capacity: .. ~Personal Representative
Counsel for personal representative
STATUS REPORT UNDER RULE 6.1
Name of Decedent:
Date ofDeath:
Will No.: '~
Pursuant to Rule 6.12 of the Supreme Cou~ O~hans' Cou~ Rules, I repo~ the
following with respect to completion of the administration of the above-captioned estate:
1. State.whether administration of the estate is complete:
Yes~ No~
If.,~. an ' state when the
2.
,, s~e~ ~ No,. personal,r~r¢~ntative reasonably be~~/~~
· . mat the admlmstrat~on will be complete:
3. If the answer to No. 1 is Yes, state the following:
a.Did the personal y~resentative file a final account with the Corn?
Yes _ No
b. The separate OChans' Cou~ No. (if any) for the pers~al repr~ntativ~'S
account is:
c. Did the personal representative state a~ account info'ally to ~ pa~ies
~~~ in interest? YeSc~~4o~~ ~ ~' ~~ -
c. Copies of re leases, join~~~~~~~
info,al accounts may be filed with the Clerk of the OChan~' Cou~
~/~O~ ~ and may be attached to this repo~.
Date: ~/~
Name .
~Z [~~ ~ ~~ Telephone No.
~ CapaciW: ~Personal Representative
' ~ Counsel for personal representative
,REV-1500EX,"-QjJ'
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
f{,~.? D .
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DEC8~rS Ni/;eFIRST, AiJMIDD;;.r;;; D.
DATE itDEATH J,MM-DD-YEAR DATE DF BIRTH (MM-DD-YEAR)
U -0% -dOG a -I
(IF APPLICABLE) SI07rJOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1. Original Return
o 4. Limited Estate
D 6. Decedent Died Testate (Atlach copy of Will)
D 9. Litigation Proceeds Received
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust {Attach copy of Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
3, Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedu~ G or L)
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8. Total Gross ASlets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent Mortgage Liabilitie? & Liens (Schedule I)
11. Total Deductions (Iolal Lines 9 & 10)\ UI1IfI1/MJrV)
COMPLETE MAILING ADDRESS
tltf6! 6, CO/Y7f/O (iV/o Onv~
fh:;eniX/ ;I z- f%o3&-
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(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
/~ I J1, 50
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12. Net Value of Estate (Line 8 minus line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to lax has not been
made (Schedule J)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
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19. Tax Due
14. Net Value Subject to Tax (line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES
FILE NUMBER
- - -,iP0!/ 12 CL !i S'1.2
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
IC1ft; - ~
II
~
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x ,0 (15)
x ,01/5: (16)
x 12 (17)
x ,15 (18)
-gq J1, 39
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY }JU~BER
-N 111 -
D 3. Remainder Return (date of deafh prior fo 12-13-82)
Q 5. Federal Estate Tax Return Required
({L 8. Total Number of Safe Deposit Boxes
D 11, Election to tax under Sec. 9113(A) (Attach Sch 0)
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(8)
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(11)
(12)
(13)
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-31 3</, 3q
(14)
-tic J.. , 05'
(19)
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS
CITY
974(p)
- '10,;;. , t)S'
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
JJfA
Total Credits (A + B + C J
(2)
-0
3.
InteresUPenalty if applicable
D. Interest
E. Penalty
...;;>CV~ - ~ % ..:J..OiCf-L - 1.//'1 K/7oN'" ) TotallnteresUPenalty ( D + E )
rfUne 2 is greater than Line '(+ Line 3, enter thediffe'rence. This is tneOVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(3)
(4)
(5)
(SA)
(5B)
4.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes ~
a. retain the use or income of the property transferred;............................. ..................... D ~
~. ;::::~ :h~e:;~:i~~:~s:~t~~::;:~shall usetheprop~rtyt:ansfe:r~d~rlts income;.: B t
d. receive the promise for life of either payments, benefits or care? ......... .................. .......................... 0 r
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
3. ~:~h~~~::~;:~na~~~,::~::~;~~::~~~;ble upon;~;;~~;~~;~~~~ntor~~cu;i;;~;~i~~;.~~;;~;;~; ..'::::::::::. B fi
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .... ................... ................... ......................... 0 )Zl
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalties of pe~ury. I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete,
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge
tnve,
/,~ 05
OF PREPARER OTHER THAN R PRESENTATIVE
ADDRESS ~
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse [s 3%
[72 P.S. ~9116 (aJ (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse ;s the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. s9116(a)(1.2)].
The tax rate imposed on the net value oftranslers to or lor the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. S9116(1.2) [72 P.S. s9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV'1508EX+(1'97)~
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
!?t.jnard-j fJdem; D.
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ESTATE OF
~~~':l~ER
Wlf - fJDL/6()
ITEM
NUMBER
1
VALUE AT DATE
OF DEATH
DESCRIPTION
.JJIJ/ngs OC[W/Jt (membt.f5 Ftrsr fee/vOl
Crec/jj f)JIlOtv Wrlf5Je,,;PIf) :/1- /gLf4~q
{lJXWfrt m/clrIc e UXlJ tv I:z f? {VeL t1J
C/OJe OctOU/Jf' j:)UDUse. If IWS' OVerdroWN.
--10, gq
.?l
/q1& P/tjIfJOu'f-h JSDf/s IOtlD"/
CJOOlr'J, fYllle I '-i"~
(otY fY/orlCe! volue. - ,8/(j-t !3?oK ,e om
if c9 3aS"'
TOTAL (Also enter on line 5, Recapitulation) $ ~;X 5'-1 I /1
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) .
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
/!IjnarCL-J fJdoml D.
F1LE.6?lMBER
~04 - OOLj.cJD
Debts of decedent must be reported on Schedule I.
1.
ON
FUNERAL EXPENSES: .. ~. 9 ro '(!". . e IJJ[J .. ff!/;n q 'RIO /
!3JSlC SlrUlceS I7e/-O I O/Te'C/(),.. f- 'S,
Un/:JoJ mIlA ) tl f3tLritl/t'iJ/)f()In:!f; (/rtnelJClfJ S&l/ ta
!fetxJram/? of </-he My) C{}J/( ef ( WI/oarl va )
. /iLr7em/ Cf/{;em?(!.<j I memoYio/lOfJen
~ /101101V / YlWIT'j) !/ISltOrS 12" (}JSIif
YfrotJIlS;CI~ ser()la J IJr;,lu7oCAJJed9men f {'ords
1rcllJSferof remOt/15 t2Jfz1rJwl/Jtn1e.,
COJKN{WChj F!Mer{'ol" fiJmtll1 COr: t&1~tltrcJ:1/ 61.
ADMINISTRATIVE COSTS: aOfh (;{!r f7!J('tlfeS x' 5" ) /) isr .
Personal Representative's comm'A'itnj II ( (j){?flIJf1/0~ ~ ~'1)
Name of Personal Repres'n'ttti/e(s~ ~
AMOUNT
ITEM
NUMBER
A.
~-8'3D7. 50
B.
fatal
1.
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2. Attorney Fe.AJ I ~
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
. nard
&. {!om. I /0 f)1~
City f ii/ x ~ State Z ziP%50~
Relationship ot Claimant to Dece,?nt {fPf{)~(}(j j:{Jlher
I \ /!. ve m It!nrt5Ij/l.O()j.Q I1J III
Probate FeeA) ~ 7~7/CX/ ')
Accountant's Fees AJ I A-
4.
5.
~
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ / / /!? %, tlJ
(If more space is needed, insert additional sheets of the same size)
BUREAU OF INDIVlDUA'tl~ES
INHERITANCE TAX DIVISION' ..'.' '
PO BOX 280601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
n'1t.PPRAISEI1ENT, ALLOWANCE DR DISALLOWANCE
'-' OF DEDUCTIONS AND ASSESSI1ENT OF TAX
ZM] Y 20 PFi 12: 41
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-23-2005
RYNARD
01-28-2004
21 04-0450
CUMBERLAND
101
A..o...t R..d tted
CLERK OF
OiRP'n'Mi''' (YY:"T
JUDY RVN~~AE:~:~".:' 0_>'::_:,xn
4468 E CAMPOBELLO DR ' ,
PHOENIX AZ 85032
*
REV-lS47 EX AFP (03-0Sl
ADAM
D
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
~l!V-"M4"Yf.~.m~'1m'.'Wtm.W'.!WI!Il'rl'lM!'t.mr.lWAlMFIWf~.'lt'CUNlM!'t.DYt'.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF RYNARD ADAM D FILE NO. 21 04-0450 ACN 101 DATE 05-23-2005
TAX RETURN liAS: (X I ACCEPTED AS FILED
I CHANGED
I~ an assesSMent was issued previously, lines 14, 15 and'or 16, 17, 18 and 19 will
r~leat ~igures that include the total ~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. A.aunt of Line 14 at Spousal rat. (15)
16. Amount of Line 14 tax8ble .t Lineal/Class A rate (16)
17. A~nt of Line 14 .t Sibling rat. (17)
18. Amount of Line 14 taxable .t Collateral/Class Brat. (18)
19. Principal Tax Due
X IT :
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule Al
2. Stocks IIl1d Bonds (Schedul. BI
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank >>-Posits/Misc~ Personal Property (Schedule E)
6. .Jointly Owned Property (Schedule F)
7. Transfers (Schedule S)
8. Total Assets
III
(21
(31
(41
(51
(61
(7)
.00
.00
.00
.00
2.254.11
.00
.00
(BI
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. funeral Expenses/A~. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liebilities/liens (Schedule I)
11. Total Deductions
12. Net Value of Tax R.turn
13. ChBritabl./GoYer~ent.l Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estat. Subject to Tax
(91
(101
11,188.50
.00
(11)
1121
(13)
1141
NOTE:
.00
.00
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
AI1DUNT PAID
DATE
HUI18ER
INTEREST/PEN PAID (-I
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure propel"
credit to your account,
sub.it the upper portion
of this for. with your
tax P8Y11eni.
2,254.11
11.188 liD
8,934.39-
.00
8,934.39-
1191=
.00
.00
.00
.00
.00
.00
.00
.00
.00
IF TOTAL DUE IS LESS THAN $1, NO PA VIlENT IS REQl/lRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE OUE
A REFUND. SEE REVERSE SIDE OF THIS FORtI FOR INSTRUCTIONS.I