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HomeMy WebLinkAbout95-0064`~ ~ r r i l l ntv- uw tx+ li~vcl e- ' / ~ -' r r / °~~ FOR DATES OF DEATH AFTER 12lJ1/91 CHECK HERE ~~ s ~ INHERITANCE TAX RETl9RN IF A SPOUSAL POVERTY CREDIT IS CLAIMED ^ COMMONWEALTH OF PENNSYLVANIA RESIDENT DECEDENT FILE NUMCER ~ f ~ /' ~~ -• DEPORTMENT Of REVENUE (TO BE FILED IN DUPLICATE 7 E°~ DEP1. 280601 HARRt58URG PA 17126 0 01 will not probated VI/ITH REGISTER OF WILLS) - Y, , . 6 COUNTY CODE YEAR NUMBER DECEDENT'S NAME ItAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS Koontz, Gail 1K. 201 E. Burd Street, .~.pt. 202 w SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF e1RTH Shippensburg, PA 1725/ 186-05-1765 10/28%94 Cumberland Co~~t o IIt Anucatq SVRVrvwC, SvOUSF'S NAnE (LAST, FIRST AND MIDDU INITIAIt SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) w ~ 1. Originol Zeturn ^ 2. Supplemental Return ^ 3. Remainder Roturn 'r ~ "' (for dates of death prior to 12-13.82) ,,.u'=oo m ~ ^ 4• Limited Estate ^ Aa. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (for dates of death after 12.12-82) a ^ 6. Decedent Died~F'eTsr~epr~at~ {Attach copy of Will) ^ 7, Decedent Maintained a Living Trust _ 8. Total Number of Sofe Deposit Boxes {Attach copy of Trust) ALiL CORRE5PONDE4+ICE ~1ND'~~[!I~IDIt~1'IAL>;; 't~7lR~01~ ',~' '", ~ ~Y I NAME ~ Joel R. Zullinger .. .. ; COMPLETE MAILING ADDRESS Suite 310 Chambersbur Tr t C Bld g us o. a. ~~ TELEPHONE NUMBER Chambersburg, PA 1 2~1 7 7 7 264-6029 _. L ? ~ ~ ~~ _...~ 1. Real Estate Schedule A ( ) (1) ~...-.. ~ C7 c~O 2. Stocks and Bonds (Schedule B) 2 cp . ~ ':- ~ 3. Closely Held Stock/Partnership Interest (Schedule C) (3) -; -~" I _ 4. Mortgages and Notes Receivable (Schedule D) (4) ~r L~JI ~'. ~ 5. Cash, Sank Deposits & Miscellaneous Personal Property (5) 2, 777 • 87 C: _ ~ n I (Schedule F) i3 =`' CJ p ~ ~ 19,469.02 6. Jointly Owned Property (Schedule F) (b) -,, ..' y _' .-o- -' in o ~~ .-.,, 7. Transfers (Schedule G) (Schedule L) (7) ~ ~ 8. Total Gross Assets (total lines 1-7) (8) 22, 246.89 w 5 880.30 9. Funeral Expenses, Administrative Cosfs, Miscellaneous (9) r I Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (schedule I) (10) 34.50 1 i. Total Deductions (total Lines 9 d~ 10) (11) _ 5,914.80 f2. Net Value of Estate (Line 8 minus Line 11) (12) 16, 332.09 1 13. Charitable and Governmental Bequests (Schedule 1) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 16, 332.09 15. Spousal Transfers (for data: of death after 6-30-94J Soe Instructions for Applicable Percentage on Reverse (15) x Side. (Include values From Schedule K or Schedule M.) __ 16. Amount of line 14 taxable at 696 rote (16) 16 , 332.09 x . (Include values from Schedule K or Schedule M.) oe = 979.93 - 17. Amount of Line 14 taxable at 15% rate (17) x 15 z _ . (Include values from .ichedule K or Schedule M.J ,'-¢ 18. Principal tax due (Add tax from lines 15, 16 and 17.) (18) 979.93 a i x 19. Credits Spousol F'averty Credit Prior Payments Discount Interest o + * 49.00 _ (19) 49.00 ~ ~ 2 ~ 0. If line 19 is greeter than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) I I~ ^ X2 1. If Line 18 is greoter than Line 19, enter the difference on Line 21. This is the TA7i DUE. (21) _ 930.93 A. Enter the interest on the balance due an Line 21 A. (21A) 8. Enter tho total of ling 21 and 21A on line 218. This is the BALANCE DUE. (218) _ 930.93 Make Check Payoble to: Register of Wills, Agent ~ ~ DE SURE TO ANSWER ALL QUESTIONS ON REVERSE"SIDE ANDt1rO RECHECK MATH •+~' ~ ~„ ~ U d l , M n er pena tlas of poriury I declare that I have exommed this return, mcludmg accompanying schedules and statements, and to the best of my knowledge and bslieF, it is true, correct and complete. I declare that all real estate has been reported at true market value Declaration of re based n ll i f th h f . p pa o a n ormation o which preparer has any knowledge. rer o er t an the personal representalive is SIGNATURE OF PERSON RESPONSIBLE FOR fILIN~~ RETURN ADDRESS -~// ,,~~ 11 Broad Street, Shippensburg, PA 17257 DATE ~ URE PRE PARER Or AtJ~R E~S'pE ENT ADDRESS .f ( ~ ~`~ " ~~+ DATE _ _ ~ Suite 310 Chambersburg Trust Co. Bldg. , ~ Chambersburg, PA -_ _.. _ __ ~ _~~ r q e ' ! 64ct r~~~ ~,f 1 3x+3 pr~~id®s for th® reduetian of th• tax rata: iraspos®d on the net eralua ®f tre~resfiars to or for " bize use of the ~~roas:ae. The rates as proscribed by the atatvt® will bee e ~~/° ~.A~j ~~a°l b~ s~pp9ical;ale f®r estat®s of deeedaests dying on or after eft/9~ artid (before 1/1/9b ~ i% 4.~~j eariii ~~a a;pislicable for estates of d®cadonts dying oc+ or after 7/1/40 ar:d baefare 1/~/9~ m 7% ~.~ij ~-ill lse csp+plicahla for act®tms of dec®denta dying on or after 1/9/g7 and before 7/1/9l~ SpW~~ss~~~ tsafcen~ o~ccurris~g era or aftas ~/'1/411i es~ill °ae ~exarnpt frorre inh®ritsnea t®x. ~'LE~SE ANSV~ER THE ~~Ll,®WINC~ ~UESTI~3N5 ICY E~'L~~9N~ ~ CHECK SARK t~~ IN THE ~1PPR®RRIATE BLQCKS. ~~ i 9 ., .~' 1. Did docec?ert make a transfer and: o, stain thQ use or income of the property tronsferred, ....................................................... I.'. retain the right to designate who shall use the property transferred or its income, ............... r. retain a reversionary interest; or .................................................................................... ci. r~:~sivc the promise for life of either payments, benefits or care$ ....................................... 2. If death occurred on or before December 12, 1 X82, did decedent within two years preceding death transfer property without receiving adequate consideration$ If death occurred after December 12, 19g~?, did decedent transfer property within one year of death without receiving adequate consid~ratiGna ................................................................................................... 3. Qid decedent own an 'in trust for'. honk account at his or her death$ ...................................... h~ Tl~CE ~~S~ER TCz ~,lit`f ®P THE A~®1/E C~UESTi®NS 85 1~ES, ~:'~~?,~ a~~~ST C~~rI~LETE SCHE®ULE ~ AI!!® ~lLE !T A.S P,AI$T ~F THE RETURN. %:9 T ~ ., ' f ~ ~ •~ ~ g 1~, ..k aA~pl'~ 's y .i~Er1 Fri 1 r, ' a~ T..... ~ c; -.v c Vt.4 .,, ?"t,a>dw..<t. _, r..t r} b ~°.a~,a.~- ~ c~ . £.:tsti ts;,, f~; -~.._ __. ~__,......_._ ~_ _ a _ -- ~ _ ~ `'a~ .~'~ ~'~~~i'~ ,+ _ _y _ ___ ~ ~. .~~"~ ... _. ;'~ ~^~ ,. ^L'~. L~ C:C,ff;'+._ .;1~J? dA:Sc'i'l. .Y~r I ., x. ' ... ~ .v s~ r. 7., ~ ' ! l (~ _ ~,-sa;<_~ _ ''uy.~ ?-tom ag~rais~-a b~~ I~nezis :~~. C~ ~.~~:all (ek~~~ ~ &~6,JO ~. _.. ~ n~:EL~ir'+-. ?':~?=c.^epal '_T'.7~'n?e]CS 97.00 .. , ._. , ._....•;~i..^ re£ur„c~ ~f security dega:ait ~ ~ j !~(~ ...`J I . V G _'c~ _ _::~ r?"7S:~~r~l'kc Si~ie1Q o3 oG . ~_ , I-'s t ~-:. , = ~f. ~e:?. `Tsl~~7~re ~.c1-~.~~ny 14 77 . +. i RQfu~ f ~~{ra Insurance r ~ 115. G0 ,.+ ,: ' ~ --_ g i ~ i t 1 ~ f x~ t j ------ ------------- __ ~ i i 1 }}+ -- v r', ;,' ~a _ l ~ .F ,. ~~~I,S. ~~{SA 1~?Yit3i' A!1 tif13 ~„ 4~,aif6..: t""UNti~IQ'*` ------------------'---- i, ,.: , 1 7 s~ _ iS 7 ~ ....._ ,n. ,..1lCT«. l~Yi 3e 6{' ...?C18 if :Yf7~"J }70C[ .u ~ ,.:n...~i { .. ... . ' ~ f ' i r .~ .. 1 ...,.. ~~.: ~t„•K.~.4 S~i~2.~~15..M y'.. ,.~i, i~':t}~a ° '!;r ~ ~ r ~. r ~•, - w ~ ~` 'h:' :. - r~~,. i~4 r _ ;, . .. _ W., ,r arr. ,.9^y~vrq~'xe '~,+~, ~+.~ h~Ax",v.~,, n ~ r .xwar " +~. z S ~ ~, ,r~ ., ... . w ~\ __°' (~!?.~~Gt~JJ ~-r~ Y 4.3~ti31.7iEi~~ C.tiWT"diltAr}r 4JU.~ .x~w'.,s~N.r ~~~a,t?.aJC. 'i% ~11.~~ b~. x'g1.,'+i.&~~T~i ..'M:.~,a.:ti'~5o-a~ _._.` r ~:;~ ('a3 ~r ' ~ r ~t.~F~L'°.C'~, PA, C~1 I..i~' 2, 1 ~~~ « ~ r"r:e~_.e°^;- 'r41hle }~3 with ~r~.tttess & box slating $ 120.00 t~e~~~ .~'-:ltawvr night stG.rd $ 25,00 T~ic;~?:;-`:~.r.tx:~s'~. ~?-cara~,~~t chest of dr~;.wexs 4 {S OQ . °~ X0.00 a~ra~~cn r,'_~~~t~'~ys tree $ 15.0 _'? ~7Y~ l i C~11~ $ 10.00 Platforr! r:acker $ X10.00 ~~:~n fc~istool $ 2.00 ~~ ~T~. ~;~~~, x~nsos.e ~lor ~.~ $ a5.oo :Cat:tery_.,~ ~~>ratea quaxtz clock $ 7. s0 ~`,~ lig3,t *.,n.t~'a flower design {a.s is) $ 2.50 7, i+g~t~c iro' kidney stands ~$ 7.50 $ 15.00 3-Piece maple breakfast set including sma11 drop-leaf table ~ 2 chairs ............................. ......$ 75.00 C'`-.~^,k~`?, t~.hl~=_ light $ 5.00 t~iscellareous bedding & linens $ 25.00 ~zreka ur:~-ight vacuum cleaner (older model; $ 20.00 i:xoc): ~t $ 5.00 "Si scel.laneoezs pots & pans $ 7 . SO ~liscellaneous table flatware & utensils $ 12.00 % Cast-=i nn s;ill.ets @$ 7.50 $ 15.00 lr4n $ 5.00 '1bTI~,L: $ 62~. SS1 t t'~~'z'~~_<, ~. C,otshall, Auctioneer ~" =~-c. ~AIJ-002306-T~ kF .;~ro~ ~ ~~~ ^~~ r~, ~4 ij ~~ s, r. '~:.. ~ ~ r I ~ g AZ~~1Lhr •si 2J M '~ p ' ~ 't,. f i ~ i tf etc ~ F ~dt ; •~YE1fYfA ~ s~~fi`~ ~~~~r.,2}9~S.f,~ ~'~'' ~~[;3 bra i":~ A'2 0". 9 ~ ~ ' L h'. _~~ 'n1 '.'.~` .. -r, __~ tee..-~ =.Y.~____.....__-_.._,..V~~_..._.._.~.._._~...~_~.~._.__.~._......~..._._=--_.1~.'Y d12.:'~~~.;~'G~e~F'«~3 .___. _. ~--~- __ X ~~, n _. _ r j~ ;_ __ __ -._..._..._---T----- -- --- --.-: _~"__._____.` _ I ~~_ AtbD6#E$^a i RELATIOt~5631F'fe.:c &?E+~EQSF~T ,. .+~,. ,. _ ~~a~,zelzr.? f~~>r.sheTJ 11 Brow Street, S~~pensburg PA 17257 daughter i i w. I ~ ' I i ~, j I __.Nr~:T6 t,r_~:;r;^.i r„„>':a ~:"t `i Pt, _'__.____...__--__.__.~_~___~ ---_--_---_-_ I ._.`..__..__._._~_. __'_"-.T.-------~ ~-____ `~%Ui<;~s#:,~ 30 A„ ~ Jt3fh?~ DESCRINTIOAI OF PROAERTY + TOTAL bR.LUi ; t3E~D'S DOLLAR: VALUE Of ~ T"~`~~"T i t I O~ ASSET 19G INT. DE~EDEhT'S INTEREST '' A 1~-~28~80 Chec}cim~ Account #0097350036, ~! ~ I3auphin 1~eeposit Bank 38,913.77 150 r ~ Accrued interest 24 ., 1-9.55.89 i j .~5 150€ 12.13 ~. # n ~,. ~• ,,, ;,. 3~ ~~ ~, ~; ;:: ;r _^_ TOTAL (Alsa enter on line b, RecalSi4ula!icn`-'j S (tf mr_re spcce is naodc:? rnsart oddi4rona! si~ee's of same si.z<~J ^~~ :.. ., r..tn~+~..a~{, z':~"hCt';.,p"!)r~t;,~rjxk" 1~__gu9`n ~,,V '' °:~, ,, .. ~, t:C4'.ra'r ~. ~~.~ tJ t`:i'/i~'id'~'!Fs P; T ( 0. n ~~RR ~roroe~ '9~a3~gY~.'~~-..~f.L y~~"y'i.'".~g'w~,~~r~,~r'±rt"' ~e'~8'.~~~u.>~P.1`+~~~~J.~ ~~~u:~d,~h~:3 .~r6WG8~- ~''l~Ri OP 7y,?E~ C~;ai~ Pr;. ~:0:_~:^~. ;«I~..L.~. Ii,`J:: j~Y'cJi~1~T!d. -----------~----------- ----- -- ~~+pp sp*.y pp,,qq.,RR~tt- a ~.~. S'~~:ITS nr^, :.?. ~ Craves: c~~,::~., I i .... i ,~ii ~43Fi-.. ~_. v`:.'y"3'L .. ..,'f_''s tom: Y ~`nrs,';;,~! ~:~;:~s~ntO"rik'2 Cc,~Ja~,issioros r:~n2 i 5o`.:a ;",_.,;it;: l~~~rw•er e:~ ?~erona! ~.~:~:=~ntotive: _ - _ ''rar f's~rn°-,iss~:rns grid i ... ~-rn.-~,~ . _, - ~. 'U. ~ i1~'t~eC '. ~ rr,~~,;~~r ,_.,_-, -'tics: ' i Cla::r?~J:~? --- Ralatio;~shia .~`,nc'°^s cF Cic:i~-nart at decedent's v~atl9 Ci4~y ____-_-- ~5tate . 'yip Cody -- I I .- r ~., ~ - ,. _ ? -^ ~ ~n uU't7S1't~' R~cJ1S~E'.r 01 '~` L~_.!_S - . :i.~_1r0 ~ I~ ,- ~'~_~ _ ~__._~_..... .. ~• I F':'~i~cdsBic~.:~~33. !~':cra~Ca~r:~s: s i i 2. ~~ i `} ~ ~ ! .'. i ! I i ! r l'. ~ ! I!~ ~ 1 t ~, ' J r;~.~t.3~~~i' ~, ~3G5.30 .r7_.5, 00 175.00 1.00 I f .. -____ ~_,_ !t -_~._________~..____.____..~.~. StTl?~.'» ~111so sent+r on 3iru 4, ~~canit,ti;stio~*) ~,~ ',eraS~%.-•. # s'.^ a*.~u Fs .:~^:, ;7~ dYt as~~'.i4 :2c ~ a ~~ --_~- ..__._____-- r Sf+9h ND 31 ?'±Q,~is~. s+r .^.=:.9~i^~ fi1.4.L9.~ *•itw S °$~5 "^" ^~L~t;iaan~».r,.4r ; ..a".: ~ " ._'z°„".~"g".-,... ,7i i ' ~ ?, 7 ; q ... 4, -. j _ ~~tY ~~br ~. ~t°,~ ~`~ `SilYAa~{`~1~r~h~^4 ~1~V~,"t _(~_~'iFtiN 4A~~~ 4{rh4 ,~~,~ ,Y p 1. °!F'i`. ,~. 1 `' t ._ z w ° ~+~S" :`s.~: ~, 7ti ~ .~ r ~R: a 'ryM'.~ wj" rx4 : +j r~ ~?,~-a'.M j,~ 2'~.y ~'y'~~p ... .~>ls:' i .. '.:i::'. t'~. . f.', `3,: C2iT -n?; r_~!i -------r----- ---- i7a~~ ~ESCR~PTRQ!A! p, y'JiLl.~°'.,1 'a.eie~>t7CI"rE3~ tel@~s'10i+° S2YVICC 14' ~ tC ~S'1 tz oiJ~aGaapQ ~s!s34 ar ~y~Za -- __ _~..----_ `f e~s1~4Z}~?3i' 15.77 13.73 ''~ N ,g t I ~\ . t <4 ~~ t }j 1 II ~; R A' . , i 1 il„ p., ~e ~~ . ~e ~. ~.;; 1~' C-,. F. ~.~ ~~ - ~V. Ih: H~. e'' tl:,C. , ~e.± Pf b'~ ~' ~~~!. _+. „~~:rrr :;ooc, is nfiecsa, rnser; oslditr~naf srsoei; ®3 scm~ asxp.) ~'.~~ i S i e:y;;:~:iM ~': FBLE hBR9PV"es~EC'. ~__ - _. ~~-a.i ~. _ _. '~rnrs - 1 ~ri7.1 rct N~aw~ -' 9Ti:.-~,- ------ g~Y ,,- : RE:B.c~T~~P1~!P'!B~- ~-_:~!~i£331PIT OR `~U~'=".•.t; ~ ie'~Fa3,~ e~.BbR- d~~L'iRESS C)F ~EP.EfBCBhA~i<d i S:•aABt= ~?F ESYAFE ~ f 1 i ~. "J~cx~s~~lir~> fit. ilersF~ey, 1.1 Brow St3°eet, I !i Sh ; Na,:~?~tai.irg, PA 7.7257 daughter i ent:ire estate i f i i i I I i I i i I i -_ y, ~.\ . ;< ~~ f i '~'AR~iE R,BVB7 AB7R39?ESS OF 63ENEFBCBAR~ I r~!'i0tlPddY OBd ~' a~1~1. --E':2 _ i 53~ARE Or ESFATE 8. Cha:itai~~e and Governrantai Bequests: ~- i . ~ nc:il I i i ~? I i ~` ?t~. .. I ~ ~{ ~ ~; I ~ sm, , R-; ~. ~ ~ ~~~ ;. ^*~ i ~: >~. i ~ _'~°•. ~` " .:',Ft;,E AZ?J v0'JE4N1',EN7t1l EEQUB:STS tiAiso ent®r on line 13, Rocaplh>la~ion) ~~' -Y_ ._ (BE dnese~ sgcsn Ia aaeo~od, e~:orP addd'.Bo:~ai sB;oafs ra€ awrre Aisu) ~, ~,.. t~ ~, -, -, ~ ~ - . , . ~. ~ . ',\ ~~ ,. ~ _ r~t~, ~~.~ ..,,, \ 1 s 1 W ~ '~^~ '~ AEN~1167 EY (49~) .~ < 3-+~ w+ r ' _ - . CN ~ A ASSESSMENT AMOUNT RECEIVED FROM: CONTROL NUMBER ~UL?..IR .I©~L R ~ 1 ~ C~A!'BF~'ERffaAdlRt3 TRUST ^.O BLZaGi _ rOl~ rrERE ~` ~__~-~ {eST~iE IivrCR.M~A.TiON t ~ j FILE >`lUMBER S r:Ah1E OS CECECEN'f (IASTj (fIRST) e ~ I ~'.~S~a~T~ Q~`9I ~.. ~ ~C:aTE OF P1YME'MT ~~uC15TMARK DATE ~S''~ i 9 C~`y CATE OF CEATFi ~ 1 C1 /i~Q A~ ftEhtARKS ~.~a ~c:F+l ~. ~~FZ$~Y sc,4~ b,t-€~~~C~` 1~t39 ~. ~£~ISTE~t O~ 9kE~~.~ 1 fOtd HERE -, i e TOTAL AMOUNT PA{C~~' ~ •~`~ RECEIVED 9Y~' ?b,. 1'74Pk i 1/ Y ~~ O R~BYt~T~F3 ~ 6i~JI~_~.E3 ,_. _ ... ~ _ , _ r _ ~' cr~rr:ar~ ~L7~ o u~"=" ~r°-~''~ ?SATYCE t7F IS~NgRITARICE TAH 4 R~t~i r ?! Qa' f~~ M,.S£ ~~ ~LSa€u~ ^' :?aolv'.o.lAt 7A~tf~ APPRAISEMENT, ALLOliADECE ®R DISALLOhANCE DATE ~ mar. 2oc~o1 QF ®EDUCTIQtl:3 AND AgSESSClENT DF TAX 04-03-.5 SdARR1S84AC"'~, 7A :712S~Uh61 - `__,~:~ FILE NO' CUMBERLP+ND > 1.°1')f'+`~'~` €`?.~;=a`-~tSFt~~. COUNTY ~1~..7x; F"3F DFkri°? 10-2l3-44 tSDT~ : ~ ~ I;~eed;RE w !?~MEf: f;REXEZT Ttf YQUR ACCU(32dT, SiiB?]ZT THE RIPPER PDRTID41 OF THIS F6FClI 6PITH YQU9d TA% :'ra;~5_PtT TSB T!!E r"~.%Tr:R Q~ YIILLS. i41wK`_ CHECr. PAYABLE T() "R'Ei,ISTER O~'~~aT ~AY~~N'T "®: REGISTER QF 1rlILLS JOEL R ZULLINCaER CUMBERLAND CO CQURT HOUSE STE X10 CARLISLE, PA 17013 CHAMBERSaUR6 TR CO BL CRAM&ERSn~JRG PA 17201 ~_ . c_~ t] c~ ~ - _ -o ~ t~. CUT 61L 030 T~Ys LY?zE _~ RETAIN-LOt9ER-PORTYON-POR-YOUR RECORD ~~~ -~--°- ~~ t l~~~q 3 NtB~'3C~ OF INt9ERITANCB TAX APPRAI3E14ENT, AL6t0~PlINCE ~R = ~~ ~ - '9 ---=-------- - g~l{ ~ EI! 2 IIISALL06dANCE OF DEDUCTIONS ANE1 ASSE SSMENT OF,~;i.~X GAIL N FILE N0. 21 95-0064 IIAT~ ~;n4-03-95 ACid °18.1 .~ ESTATE OF KQQPdTZ ~_ U.• ~ TAX RETURN NAS: (X) ACCEPTED AS FILED [ ) CNAPFGEDy ~ p REsERVATION COd~CERPEING FUTURE INTEREST -SEE REVERSE {~;P€~t~iiISED 1,+A~nUE +~F RETURN BASED ON: ORIGINAL 00 F',~aal Eslz~:® '.Schec9u2e A) il) __-__- 00 (2) .'~... .:>.4`E; i(:: .^*iRa ~LTfl~$ (:ioitnriule 8) . DO 3. €:lc~y.l;a 4-f°ela€ S.c~~OPartRttrs4oiP Int®rest (Scfscsd~alo C) ($] . 00 k. inFar•tCs:Q~s!`&ctne> tags:®i+:te4sla (Sc4rodallo D) (A) . 87 777 2 5. Crashlfiaa'r.< pFr~g,oci•ka,nliao. P®raonsl Proporty (Schadula E) (5) . , 4b9.02 19 b. .)oinflY (fwno~! Praa+~r'ky (Schesful• F) (6] _ , 00 7. Trztn2Sora (Sci~o+tfulo 6) (7) __ . (a) 22,246.89 3. Tote! E~~saix ,~~a~~a(~u~~~~ ~U~~Rar~~~~~w :w~~~ ~x~aaPTaaN~: 5,~~0.30 9. 'rran~srx:: ~x~±nn~aw/ttatut. CostaOMisc. Exaa~ena®a (Sc:4s~laele ND (9] -- 34 50 !~yt^_,lii3r?:~~n~ l.i~bilitise$/Liens (ScheasiulE9 I? (10] AG . --- 1;0 414 '~ . (11I . - 11. '+ota). 'S;xR,=c;it^+2 (12) ib,332.09 - ?. :~~t VFIu c# Tax Return (13) .00 13. CSinrifablaJaoa:rrmm~tal Bnwsaoata (Sehmc(uls J) 16,332.09 7.4, ~Y~l `.f~Aua O~ ~RtHtA ~jaCt to Tax (la) ~~pe Si0"9'E: ~°' `~ '1~ ~ i P c ~ ~ ~ ~ T B2fS~d•'tOTd~tS. s ~ '4 e~eill ± 8f r IJPn8 ~L.~ P ®4 total ths lud~ ] t~lt~t 1. .~?t[~ °2~l~rfi ~2'. ! :tlSSF.SSlWE3~'" Qu TA~i: , 03= . 00 . 00 ~ '.5. I.e:,us:$ '~. L.irx~ .~'s ~~` sfTOU+sl rule (15) X - 332.09 X.Ob, 16 979.93 75. Pr~r~:Rt ar Liner l~s ''-.'~.:ablo at Linoml/Claaa A rate (16D , .00 X .15~ .00 ~ i'. tla+.ak-e~t oz4 l..;?z 1Ea tnra'zlc tr: Collated x,1/C).~a~a R rtoto (7.7) - X379.93 (1C~] Ai]. Prir.^is>^1 ?ux^.ea '~r'fl ~~u~I~..W. . ' td€CE3!~+ F'flYPlF_MT DISCtlISRIT (+] AST PAID CI„r ~ R4St4SER INTEREST (-) 1 I Oi-2:}°~35 I a1A0e'.2752 49.00 930.93 r^ '+ ZF ?A.IID Ar'TER li4Tc INTSICATEIf, SEE REV_RSE F^^ CdRLCL'! .~aT2F'~ ^F d~I:IT%.°,(«AL INTEPkEST. .. ' r:~ ~l x,. ~~yfi''rL"'~'`~±.a uaaS.`u_%'.'-'~rA'~i d ~~:t~•`~~~~y.g.~h~~ti~ ~`~~~ V y h. TOTA6 TAX CRFDYT 919.93 BA6.ANCE OF TAX DUE .00 IP~TER[&T .00 TOTA+~ ~E .00 ( IF TOTAL DUE IS LESS T]iAA?f dl, ~ P~YtsE~a? ~" RScQUIRE]!. IF TOTAL D7.6E IS R:FLE4:'PED AS A °'CRt;6iIT^ (CRf, Y~J f4AY >gE DRIE A REFUND. SEE QEV9ECcSE SID'e OF T!!IS FORT! r'Dft :ldSTRl,fCTIEYN.4. )