HomeMy WebLinkAbout95-0107
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This is to certify that the certificate hereunto attached is a true and accurate copy of the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is
subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital
Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed
and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L.
304.
AUG 16 2001 ? •
Date Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
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NAME.OF DECEDENT (F'eY, A•Otl1e. Lash SEX SOCUL SECINUTY NIIIABER ~ DQE OF OERH P/oten, OaY•Yw)
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128 Big Spring Ave. R~10B/CE ~+
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NArEANDADDRESS pF PERSON wNO COMPLETED CAUSE aPDEevN
IIEDICAt EXAWNER/CORONER
YPe or Print
itemz>fT Michael L. Norris, Coroner
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405 Fairway Drive
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a:. Mechanicsburg, Pa. 17055
REOISTRM
3 SIGNATURE MBER
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~, ~* ~ FOR DATES OF DEATH AFTER 12131191 CHECK HERE
INHERITANCE TAX RETURN p
TU
~
~~ OVER
CREDIT IS CLAIMED ^
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTME FILE NUMBER. ~~~-0~
(TO BE FILED IN DUPLICATE
NT OF REVENUE
DEPT.2B0601
HARRISBURG
PA t7128
o
t 21 95 0107
WITH REGISTER OF WILLS)
,
•
60 COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MI DL IN ITIAL) DECEDENT'S COMPLETE ADDRESS
Derr Enoch A. 128 Big Spring Avenue
W
L° SOCIAL SECURITY NUMBER
204-30-6096 DATE OF DEATH DATE OF BIRTH Newville PA 17241
1-8-95
F
PP 10-16-14
count Cumberland (Newville Borou h)
O (I
A
lICA6lEl SURVIVING SPOUSE'S NA7tE (LAST, FIRSr AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED ISEE INSTRUCTIONSI
N/A
N/A N/A
'+'
a ®1. Original Return ^ 2. Supplemental Return
^ 3
Remainder Return
y
Y
ur''id~ ^ 4. Limited Estate .
^ 4a. future Interest Com romise (for dotes of death prior to 12-13-82)
P ^ 5
F
d
l E
T
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e
era
state
ax Return Required
(for dates of death after 12-12-82)
a ®b. Decedent Died Testate
(Attach copy of Will) ^ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes
A
(
ttach copy of Trust) PNC Bank, N.A. , Newville
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: '
y' =
°p NAME
Hamilton C. Davis,
Esquire COMPLETE MAILING ADDRESS
75 East Kin
St
vd
TELEPHONE NUMBER g
reet
P O BOX 375
717 532-5713 Shippensburg PA 17257-0375
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1. Real Estate (Schedule A) (1) $54, 000.00
2. Stocks and Bonds (Schedule B) (2) 130.00
3. Closely Held Stock/Partnership Interest (Schedule C) (3) None
4. Mortgages and Notes Receivable (Schedule D) (4) None
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) 10, 109 • 28
(Schedule E)
b. Jointly Owned Property (Schedule F) (b) None
7. Transfers (Schedule G) (Schedule L) (7) None
8. Total Gross Assets (total Lines 1-7)
9. funeral Expenses, Administrative Costs, Miscellaneous (9) 8, 911 • 83
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 385.08
1 1. Total Deductions (total Lines 9 8, 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
15. Spousal Transfers (for dates of death. after b-30-94)
See Instructions for Applicable Percentage on Reverse (15)
Side. (Include values from Schedule K or Schedule M.)
16. Amount of Line 14 taxable at b% rate (16) 54, 942.37
(Include values from Schedule K or Schedule M.)
17. Amount of Line 14 taxable at 15% rate (17)
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tax From Lines 15, 16 and 17.)
19. Credits Spousal Poverty Credit Prior Pa ments Discount Interest
+ 2,80.00 + 142.50
!0. If Line 19 is greater than line 18, enter the difference on L ine 20. This is the OVERPAYMENT
.
!1. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE.
A. Enter the interest on the balance due on Line 21A.
B. Enter the total of Line 21 and 21A on Line 21B. This i s the BALANCE DUE.
Make Check Payable to: Register of Wills, Agent
(B) $64,239.28
(11) 9, 296.91
(t2) $54, 942, 37
(13) None
(ta) _$54,942.37
x._- N/A
x .06 = 3, 296.54
x .15 = N/A
(t8) 3, 296 4
(lq) 2, 992.50
(20) N/A
(2t) 304.04
(21A) N/A
(2 t B) $ 304.04
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ~ ~
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
it is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the pe
based on all information of which preparer has any knowledge.
SIGNATWIE OF PERSONLRESPOtJSIRtF rno cuwr_ oc.~~o.~ ...,...~.._
' D xecutor 128 Bi S tin Avenue, NeTaville PA 17241
SIGNAT Of PREPAR ER TMgN REP ENTAUVE ADDRESS
Ha lton is ~''-~ P 0 Box 375, Shippensburg PA 17257-0375
representative
UAIt:
'~ ys-
DATE
~/zs 7J~
Act #48 of 1994 p-ovides for the reduction of the tax rotes imposed on the net value of transfers to or for
the use of the spouse. The rates as prescribed by the statute will be:
• 39k (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1197
• 1 % (.O1) will be applicable for estates of decedents dying on or after 1 /1 /97 and before 1 /1 /98
• Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (r) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transfer and:
X
a. retain the use or income of the property transferred, .......................................................
X
b. retain the right to designate who shall use the property transferred or its income, ...............
X
c. retain a reversionary interest; or ...................................................................................
.......................................
d. receive the promise for life of either payments, benefits or cared X
2. If death occurred on or before December 12, 1982, did decedent within two years preceding X
death transfer property without receiving adequate considerations tf death occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving x
adequate consideration$ ...................................................................................................
3. Did decedent own an 'in trust for'. bank account at his or her death ...................................... X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
._ _. ~ P
REV-1502 EX+ (12-851
` SCHEDULE A
COMMONWEALTH Of PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER 1995-000107
Enoch A. Derr 21 95 0107
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value
which is defined as the price at which property would be exchanged between a willing buyer and a wiliieg seller, neither being compelled
to buy or sell, both having reasonable knowledge of the relevant facts.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
Of DEATH
~• Single family dwelling house located in the Borough of Newville
Cumberland County, Pennsylvania, known and numbered as 128 Big
Spring Avenue, Newvillle, PA. 17241, conveyed to the deceased
and his late wife by Paul E. Loy, by daed d~;ted August 26, 1969
and recorded August 26, 1969 in Cumberland County Y.ecorder of
Deeds Office,. Deed Book "I", Volume 23, Page 943.
(see attached letter of opinion for appraised value) $54,000.00
~'° .
TOTAL (Also enter on line 1 Recapitulation) ~ $ 54, 000.00
REV-1503 EX+ (0.86) ,
SC~IEDULE B
STOCKS AND BONDS
FILE NUMBER 1995-000107
Enoch A. Derr 21 95 0107
(All property iointly-owned with Right of Survivorship must be disclosed on Schedule F.)
ITEM
NUMBER DESCRIPTION VALUE AT DATE
Of DEATH
1• Cumberland Valley Cooperative Association
Common Stock-certificate #2274 (1 share/$10.00 share) $10.00
(see attached confirmation) interest none
2. Cumberland Valley Cooperative Association
Preferred Stock-certificate 44840 (9 Shares/$10.00 share) $90.00
(se.e attached confirmation) interest none
-certificate 416733 (3 Shares/$10.00 share) $30.00
(see attached confirmation) interest none
~'',,
TOTAL (Also enter on line 2. Recaoitulatinnl S i ~n nn
iV-IS01 FX+ (9.01)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Enoch A. Derr
FILE NUMBER 1995-00010
21 95 0107
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
nryna yr aurvworsnip muK b~ di~CloNd on
DESCRIPTION
Checking Account 4r` 51-404100418, PNC Bank, N.A., Newville
(see attached confirmation) rinci al
P p $6,356.00
1980 Ford Truck sold at private, arms length sale acc int 0.00
to unrelated party: Brian L. Barrack (see attached money orders $ 500.00
Tangible Personal Property/Contents of home
(see attached appraisal by William Rowe of Linden Hall Antiques $1,251.00
Insurance Refund-United Security Assurance (4126332)
(see attached check for confirmation) $ 158.67
Insurance Refund-United Security Assurance (4128785)
$ 214
(see attached check for confirmation) .24
Insurance Refund-United Security Assurance
( s (4136136)
354
$1
37
ee attached check for confirmation) ,
.
Capital Blue Cross/Pennsylvania Blue Shield-refund-death benefit
(se $ 127
20
e attached receipt-Agreement 41204306096) .
Insurance Refund-United Security Assurance (4432614)
$ 4
(see attached check for confirmation) 8'85
Insurance Refund-United Security Assurance
(se (4136136)-overpayment
$ 38
87
e attached receipt for confirmation) '
Insurance Refund-United American Insurance Company-Medicare
claim refund (Control 41505131648260A) $ 60.08
.-''-
TOTAL (Also enter on line 5. Recao~r~~ia,~.,.,i
Ilf more •p~c~ b nNdw ~nwrt ~dditiond shNts of Mme •Isd
SCHEDULE "E"
CASH AND MISCELLANEOUS
PERSONAL PROPERTY
$ 1
VALUE AT
DATE OF DEATH
RED-~5~~ Ex+ I~~BB~ SCt1EDULE H
~'~•~+~
•M ~ FUNERAL EXPENSES,
COMMONWEALTH Of PENNSYLVANIA ADMINISTRATIVE COSTS AND
IN RESIDENTEDKEDENTRN MISCELLANEOUS EXPENSES P{ease Print or Type
ESTATE OF FILE NUMBER 1995-000107
Enoch A. Derr 21 95 0107
ITEM
NUMBER DESCRIPTION AMOUNT
A. Funeral Expense::
~• Egger Funeral Home, Newville PA 17241 $5,005.00
2. Eby Granite Works (inscription) $ 65.00
TOTAL $5,070.00
B. Administrative Costs:
1. Personal Representative Commissions -WAIVED-
_ _
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees to Hamilton C. Davis, Esquire $3,000.00
3. Family Exemption -N/A-
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State Zip Code
4. Probate Fees Cumberland County Register of Wills
($115.00 probate, $24.00 short certs, JPC $5.00, extra pgs $9.00
C. Miscellaneous Expenses: TOTAL $ 153.00
~• Zullinger/Davis PC, reimbursement for Legal Ad, Cumberland
County Law Journal $ 40
00
2• PNC Bank, N.A., of Newville, PA (safe deposit box inventory) .
$ 25.00
3• Orrstown Bank, Shippensburg, PA (check book charges/check order $ 6.63
4• The Sentinel-Legal Ad $ 72.20
5• Linden Hall Antiques (appraisal charge) $ 45.00
b• Reserve for contingencies and expenses of closing $ 500.00
7.
8.
TOTAL (Also enter on line 9, Recapitulation) $ 8, 911.83
(If more space is needed, insert additional sheets of some size.)
aEKlsla Ex+ p-vat ~
COMMONWEALTH OF PENNSYLVANIA
INME RIiANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
OF
Enoch A. Derr
ITEM
NUMBER
2.
3.
4.
5.
6.
Please Print or Type
IMBER 1995- 000107
21 95 0107
DESCRIPTION
Newville Water and Sewer Authority (10/1/94-12/31/95 billing)
P P & L (electric bill 12/14-DOD).
Agway (heating oil delivery)
United of Pennsylvania (phone bill)
Carlisle Hospital (medical expenses)
RWC Emergency Physicians (medical expenses)
AMOUNT
$ 90.82
$ 66.48
$107.39
$ 20.39
$ 69.37
$ 30.63
~~.
TOTAL (Also enter on line 10 Recapitulation) S 385 O8
(If more space Ts needed, insert odd~tTOnal sheets of same size.)
RE V~1513 EX+ ~2~R7~
COMMON WEAITM Of PfNNSYlVAN1A
INHERITANCE TA% RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
Enoch A. Derr
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
1. William Edward Derr
128 Big Spring Avenue
Newville PA 17241
2. Mary Barrick
12 Weist Road
Newville PA 17241
3. Alta Grace Dunkleberger
1279 Boiling Springs Road
Boiling Springs PA 17007
FILE NUMBER 1995-000107
21 95 0107
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
son
daughter
daughter
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
1.
1/3 (one-third
residue)
1/3 (one-third
residue)
1/3 (one-third
residue)
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNAIENTAL BEQUESTS (Also enter on line 13, P,ecapitulation) $
(If more :pac• is needed, iesert oddifional :heetR of same size)
I ~l ~i5 - Ooo ~o~
al q~ oio~
LAST WILL AND TESTAMENT
I, ENOCH A. DERR, of the Borough of Newville, Cumberland County, Pennsyl-
vania, declare this to be my Last Will and Testament and revoke any will or
codicil previously made by me.
ITEM I: I direct that all my just debts and funeral expenses, including
my gravemarker and all expenses of my last illness, shall be paid from my
residuary estate as soon as practicable after my decease as a part of the
administration of my estate.
ITLM II: I devise and bequeath all of my estate of every nature and where
ever situate to my wife, EDITH M. DERR, providing she shall survive me by
(thirty days.
ITEM III: Should my wife, EDITH M. DERR, predecease me or die on or
before the thirtieth day following my death, I grant to my son, WILLIAM EDWARD
DERR, the option to purchase my home residence (including all furnishings)
presently owned by me at 128 Big Spring Avenue, Newville, Cumberland County,
Pennsylvania, such residence to be valued for purposes of such option at the
(J fair market value of such residence as determined by appraisal by my executor
as of the time of my death. Such option must be exercised by written notice
thereof to my executor within three 3 months
( ) following my death. Should my
t°
son, WILLIAM EDWARD DERK, fail to exercise such option, or should he notify my
executor in writing of Iris release of suctl option prior to its expiration, I
devise such residence as a part of my residuary estate.
ITEM IV: Should my wife, EDITH M. DEKR, predecease me or die on or before]
amilton C. Davi
~~~ the thirtieth day following my death, I devise and bequeath all of tl'ie residue
ATTORNEYS AT LAW
NEWVILLC 6 SNIPPCNSNUNG of my estate of every nature and wherever situate to my issue, per stirpes, ~
PENNA.
living on the thirty-first day following my death.
ITEM V: I direct that all taxes that may be assessed in consequence of
my death, of whatever nature and by whatever jurisdiction imposed, shall be
paid from my residuary estate as part of the expenses of the administration of
my estate.
ITEM VI: I appoint my wife, EDITH M. DERR, executrix of this my
last will. Should she fail to qualify or cease to act as executrix, I appoint
i
'my son, WILLIAM EDWA1tD DERR, executor of this my last will. Should both my
wife and my son fail to qualify or cease to act as executors, I appoint my
(daughters, MARY BARRICK and ALTA GRACE DUNKLEBERGER, executrices of this my
(last will.
ITEM VII: I appoint THE FIRST NATIONAL BANK OF NEWVILLE, PENNSYLVANIA,
guardian of any property which passes outright either under this will or
otherwise to a minor and with respect to which I am authorized to appoint
a guardian and have not otherwise specifically done so, provided that this
appointment of a guardian shall not supersede the right of any fiduciary in
its discretion to distribute a share where possible to the minor or to
another for the minor's benefit. Such guardian shall have the power to use
principal as well as income from time to time for the minor's support and
education (including college education, both graduate and undergraduate)
without regard to his or her parent's ability to provide for such support
and education, or to make payment for these purposes, without further I
responsibility to the minor or to the minor's parent or to any person taking
Hamilton C. Davi care of the minor.
K1~04ifltx6c~e~tXGbk
ATTORNEYS ~r LAw ITEM VIII: I direct that my executrix or guardian or their successors
NLWVILL[ 6 SMIPPENSBNRG I
PENNA,
shall not be required to give bond for the faithful performance of their duties)
- 2 - I
I
in any ,jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will
and Testament, written on four (4) sheets of paper, dated this ~ day of
1981.
~12 ~ Q, ice, r-. • ( SEAL )
Enoch A. Derr
Ttie preceding instrument, consisting of this and three (3) other typewrit-
ten pages, each identified by the signature of the testator, was on the day and
date thereof signed, published and declared by the testator therein named,
as and for his Last Will, in the presence of us, who, at his request, in his
presence, and in the presence of each other have subscribed our names as
witnesses hereto.
residing at
1
~ ~ i
~-~~ residing at
Imilton C. Davi
xticu~cx~accraxxr~x
ATTORNEYS AT lAW
N EWVILIE 6 6NIPPENSRURG
PENNA.
i
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, ENOCH A. DERR, the testator whose name is signed to the
attached instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I
signed it willingly; and that I signed it as my free and voluntary act for the
purposes therein expressed.
C~~ 4` K5[.Q/~h.~ ( SEAL )
Enoch A. Derr
milton C. Davi;
6[o[~CA~cfdlkYdfi
ATTORNLYS AT LAW
NEWVIELE 6 SHIPPFNSBURG
PLNNA.
Sworn or affirmed to and ac owledged
before me, by ~n o Gti /¢ . ~a r ~ ,
the estator, this y-/E day of
O~ ~ ~ 1981.
~~/ '-(ACC c_) sus~;i~! i.:..:~i ._.. ~;. ,., ~r; ~I' .
Nota P lic N~;~~i~l~, :. .;I !...i .._ ..
My Comu~i:.si~n ixpn~s ~:a, i. G, , ),'~
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
We, ~~~a-~1 ~, ~ ~~ and JCL 11~ a 1 ~ the witnesses
whose names are signed to the attached instrument, being duly qualified accord-
ing to law, do depose and say that we were present and saw the testator sign
and execute the instrument as hls Last Will; that he signed willingly and that
he executed it as his free and voluntary act for the purposes therein expressed
that each of us in the hearing and sight of the testator signed the Will as
witnesses; and that to the best of our knowledge the testator was at that time
eighteen (18) or more years of age and of sound mind and under no co raint or
undue influence.
~.
Sworn or affirmed to an subscribed
before me by !~ ~ (', , S
and ' ~ witnesses,
this 9~/, day of ~-,
1981. '
~ ~/
Notary ub~ c N,'•'''' ~' .,
rYly 1~~,., ~, , ., . I .. .
- 4 -
NOV - 6 rr~nr,
REV-1547 EX AFP (12-94)
COINIDNUEAITH OF PENNSYLVANIA ACN 101
DEPARTlENT OF REVENUE NOTICE OF INHERITANCE TAX
suREAU of INDIVIDUAL 7Axes APPRAISEMENT, ALLOMANCE OR DISALLOFIANCE
DEPT. tso6oi OF DEDUCTIONS AND ASSESSMENT OF TAX
NARRISlUR6, PA 17128-0601 DATE 11-06-95
CSIAIC Yr LCRK ~nu~.n A FILE NO. cl 77-ului
DATE OF DEATH 01-08-95 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM MITH YOUR TAX
PAYMENT TO THE REGISTER OF HILLS. MAKE CHECK PAYABLE TO °REGISTER OF FALLS, AGENT^
REMIT PAYMENT TO:
HAMILTON C DAVIS ESp REGISTER OF WILLS
75 E KING ST CUMBERLAND CO COURT HOUSE
PO BOX 375 CARLISLE, PA 17013
SHIPPENSBURG PA 17257
Aaount Re~itted
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
-----------------------------------------------------------------------------------------------
RE'~f~3S4-7 EX AFP C12-94) NOTICE OF INHERITANCE TAX APPRAISENeNT, ALLOwANi;e GEC
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DERR ENOCH A FILE N0. 21 95-0107 ACN 101 DATE 11-06-95
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rul Estat• (Schedule Al (1) 54.000.00
2. Stocks and Bonds (Schedule B) (2) 130.00
3. Closely Held Stock/Partr»rship Interest (ScMdule C) (3) .00
4. Mortpayes/Notes Receivable (Schedule D) (4) .00
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 10.1 09.28
6. Jointly Owned Property (Schedule F) (6l .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (e) 64,239.28
APPROVED DEDUCTIONS AND EXEMPTIONS:
9.
Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule Hl
(9) 8,911.83
10. Debts/Mortya0e Liabilities/Liens (Schedule Il (10) 385.08
11. Total Deductions (11) 9 .296 _ 91
12. Net value of Tax Return (12) 54,942.37
13. Charitable/Governaental Begwsts (Schedule Jl (13) .00
14. Net Valw of Estate Subject to Tax (14) 54,942.37
NOTE: if an assessment was issued previously, lines 14, 15 and/or 16, i7 and 18 will
reflect ~Pigures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) • 00 X . 00_ . 00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 54, 942.37 X . 06. 3, 296.54
17. Aswunt of Line 14 taxable at Collateral/Class 8 rate ll7) •00 X .1 5. .00
18. Principal Tax Due (lg) 3,296.54
TAX CREDITS:
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (~)
INTEREST (-) AMOUNT PAID
03-10-95 AA022929 150.00 2,850.00
08-08-95 AA048084 .00 304.04
TOTAL TAX CREDIT 3,304.04
BALANCE OF TAX DUE 7.50CR
INTEREST .00
TOTAL DUE 7.50CR
^ IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN •1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT^ (CR), VOU MAY BE DUE