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95-0207
2~ _q5` azo 7 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. Date AUG 18 200T _ ~ ~ Fran eropoli, t Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH 014442 N,DS.+w7 RSa. 2fS7 TrPEwRrrr x1 PERrANENr raac wK i ~~ _~ W W U w 0 0 f 2 NAMEaPOEDEDENr6n MWa.. ta.p SEx SODIAL SECUWTV NUMBEN D DP IMerwn. D.y.'A+.r) ' ,. Fredrika S. Bohl Lfemale L zo6 - 32 - 1735 - AAE(Lr+EYSId.N INi061, YEAR UNDFA,DAf DRE aF MITI SIR1NPlACE PC.Y.Ad PIACEOP DERNICIUdraN,m.-e..Nludionmcllul eid•1 1' M.r.lb D•Y• Hou. MMtw ~.1my~,q.~•~- SW.a Fa.q~Cawyl ~ _ Sy = ~ CTi. 10, 1110 ^ ERIG IW+l CJ DDM ^ ^ ^ 5 d b~ ~ ~ ~ ug R.iOYin ( 0. M1 I vr. -r% L COUNTYOF 060N CrtY,SD110.iW-OF OERII FACLIfY NAMEIIIMfrAMar. V+'•lM.ntl+uni0r) OP/IIBPAMCORIGIMt RACE-AnYllnrI YAYR SYd4 W1i1.. ac. ae C] IIV...w.~r ... White Cumberland Carlisle arch Todd Home 1000 W. South St. N• ~. MYtlra4 P.rb RtarL.Ie. DECEDENr'aueLHlloccurwlDn waaP~RY vwEDecE EVERM oECEDEnrsEtwcJEIDN MARraLSmus-M.rrYA sLlRnvwsPDLmE ~+nlydnruinN N M wb W IM Wa ... n.bd, .. . P Icly.Yna awkmr~~.s u.S ARMED PoRCES7 '~f°~ +Y. ^ R. ~4 ~+r n~ I wido"+P.+» !S'Si'#~~'1` r it 11 1L 1L 4 10. DEeEDENrarAawADDREasta..~caww-•.slr.zac.ex ~~N*'9 ,T..eYb Pa. Dw ,r..O n..a...e.,.,.eY ~P. RESDENCE ~+ y Carlisle 1000 W. South St.Car11s1e,Pa. ~' Mb.a~PT ~~ ~ ~ ,TaCJ u ,m FATNFA'S RAMS (F..I, AiAUw LseS MOTHER'S NAME 6.at MiAA.. M.ibn9arln.r) /~ Nornlan F . Swords ,L Martha Taylor ~PQ~FI'ic~iaeohl 500 P`~`ark Av~e~21exCumberland, Pa. METlIOOOP OFDdiPOSITION RACE OF pSPOSILION•NrlbaC.rrrbry, CrwrlYer, LOCJD,DN •CA)Yban.9bY,2d G.d. °~ ""^°~"r°""Y"~ b°~`~ 1 rrisb r Ce eter p~ Harrisbur Dau hin Co Pa ~~ p , 995 e g y u m a p g, . . r. sta. :,.. ~~~ sm. 0f8 L ~se].m~an F~'u~neral Home Inc,324Hummel Ave.Lemoyne, Il.w tl.ead,.RwoWM,Yq 1e AYU.Ma bnWdp., A.WIOmnW adb AnY. da• Wc• LICENSE NIRAEER DWESIDNED ~' Yna...IYM..tYMaA.WIb ewul,erb.dd.Wt ,~ / /f/ 71.. A..r 2aZS bYN G.•eniPI11•d EY ME OF DATE .Dry. y1.tl IMSCASE REFERRED W MEDICAL E%AI.MNERICORDNEM gyp. / VN ^ MoIO wllopanwm..AMYI M M. M A. M11Tk EnbrM.Arw..iA+Y•a mnOMOMar WYdl VI. A.W. DO n.l.r.r dM I dgiq, .udlr Yna.aMrJ+a lR.rl YYUr.. IAppr•.Y.Ib FART A: OIIW.grM..N Wr10YuI.•YM.Ar9bd.W1.W ~Y..rY.IMaM1 na l.WYpbtlM ntlYlyYgcrwy.YIY RVIT I. LYlea, m.eYw•...dIM. I.rR.1.r10 d.W1 EM®IATECAUMIFnY + cer,Aacn fay \~ !'t ~.w, A hf~ rwtr~w. ~ r'~'`~~ n A.Wq-. •. r.YiErp DL~E W coR As A coaEDUeNCE OFl: S•OIIN.iWI'+V GerldWP1t b OUEWIOR ASACONSEWENCE OFk I E.wA WAIgb...il.dl.b or.. Eir.rIEOMLIIME , ~ QMp[(DiarranA+y c h1 Y1fI1eA ay.M. DUE W (DRAB A CDNSEOUENCE OF} I r..WYpnd.NglAfT a MYUfAN M/IDPSY AUIDP6Y FllOM1G3 MANNER GP DERV DRE OF INJURY TWE OFINJlIR1' AWRY IPNORK7 OESCRISE IIOW INJIIRI'OCCURRED. PERFORMED9 A4YLAELEPIIIDRW IMarwr. DS.'Mr) IONOFCAl16E COCOI~T ,p~ NWra ~ MomKitl. ^ N yY. ^ No ^ Aetid.nl ^ P.Msp Myarq.HOn ^ M. Nb ^ N•~ M. ^ N• ^ 2M. Slicia ^ Coad not G dY.rmYIaA ^ ' 29. PLACE OF INJURY ~ N II.IN, Yrrn, an.L Ydx,t oMa LOCATION f5a•a. CdyJfown, SYb) WiiK.b. ISV•cM 70.. 3or. ~„~„~Iyd, ay,yW SKiNRU OF CERTNIER 'CERTMTNID PNYSMJMI (P+rY•o.^.arM+SC•uas d AMN Mien anoVw dM•~cYn M paiWncW Oea.i arw camp4lW l+em 231 To El. bwtdeq bwwlWE.,d.Wre~vn.d AwblM.wW.,aNr.rarra.aaM ..................................................... ~ P1n• 1,-. +. . `N.rl N ED I Nailh.Ory LICENSE NUMBER DRE Sg •-RDNaINewDANDCOIr+PYwD PNrsIC1AN(PnynanEWi PrNUAbnfl AeWianA c.rMyrq bc.ue.dAeaMl ~ .bW a A d A b tl q rr `` ~~ jj la 1~0 a tb ~t L't t C 7,G T0~7• "ZJ. t Q .......................... b e.u..l•I.r rn.nn.ra. ui. TaIM UM d.ry bl...bdE•. dn1A exwrW a tlb S.r•. AN•, an Wc•..n NAME ANDADORESSOF PERSON YAIO COMPLEfEDCAUSE OF L1E/PI/ R ' ~ plemr2~ Typ. a Print P 3 fLW w. ~Rr. mo iWIOr Irw.sllyWUn. ~n my opinbn. M.N occurt.A a IAe LMN. A.L...rM Pbn. and Au. Le M! e.u•N•) uM liwrln.I ~1~ O.W d . .............. ~ n ...a1w b F Oe+~e. P~ `b 1 ' ~1 9 C~ .. ................................................................................. rn. n« ~,.. . C t~w. 1~ . '>• , 7:. 85D W2~.n~+cc REGIBT 'S SIGNATURE AND NUMBE DATE FSED /Mwah. Day. year) ~ ~. ys >.. 0 ~nn~~n2n ~~/ REV-1500 EX+iJ-94) r INHERITANCE TAX RETURN rVKYq~iJVrvcM.nwr.in...w...................~~ IF A SPOUSAL ^ +~ POVERTY CREDIT IS CLAIMED RESIDENT DECEDENT FILE NUMBER COMMONWEALTH OF PENNSYLVANIA E (TO BE FILED IN DUPLICATE _ ///777 ~~_ C%~ ~~ ~% / ( ` DEPART MPTT28060EVENU WITH REGISTER OF WILLS) YEAR NUMBER D HARRISBURG, PA t7128.060t COUNTY CODE DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS G i.F r_ (= F2 t~ '~,tru cf<,~- S Icc: C :.~ :t's r S;. U r-u ~ r R air z S OCIAL SECURITY NUMBER DATE OF DEATH ~ DATE F BIRTH ~f~ C'.:kRL ~ $ Liz ~ ~ A ~ Z ~ i 3 U 2V~ ~ ~ d~ 4~~J ~ 23 ~45 ~O f fQ Counf G ~.1 N~1.5 ii. ift ~. ~}-YJ~ p I IF AVPUCABLE( SURVNING BPOUBE'S NAME (LAST, FIRST AND MIDDLE INIiIALI -~~ SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) ~ Q 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (for dates of death prior to 12-13-82) Y a H co ^ 4. Limited Estate ^ 40. future Interest Compromise ^ 5. Federal Estate Tax Return Required = (for dates of death after 12-12-82) ~ a m ~ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach copy of Trust) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHCtULR BE DIRECTIED TO: ~ NAME COMPLETE MAILING ADDRES!S~ »" • C l~ Via. l X'+ C• L ~o ~, M~cu,~-~'~ 3crfi . S-z~c C~r~RL< A-v+~~~.~ 0o ~a TELEPHONE NUMBER _ Nei..: C~~3~ct~,w-,~a ~A t?ti"'tc (~,i{-c~~ct, r'it'7 1 z 0 ~- a z 0 a 0 x a f- ~ ~ 1. Real Estate (Schedule A) (1) _._.. ~-- z ` - .. ~ _ 'Jt 2. Stocks and Bonds (Schedule B) (2 ) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) s ,. ~- ~Nc ~ ~ 4. Mortgages and Notes Receivable (Schedule D) (4) a _ 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) ~ ' "' ~ , _.-. . - -`~ - - ' 6. (Schedule E) Jointly Owned Property (Schedule F) _ __-_ _ .. L. C {j~ ` (6) ~ ~t ~~ ~ 7 ~ ` ~ ~~~ ~~~ - ~ ~ 7. Transfers (Schedule G) (Schedule L) (7) - _, - ~ ~ ~ ~ _ .,,,, ~~ ~ 8 Total Gross Assets (total Lines 1-7) (B) ~ '~` ~' See Instructions for Applicable Percentage on Reverse (15) x•-= Side. (Include values from Schedule K or Schedule M.) '~ ~~, _ 16. Amount of Line 14 taxable at 6% rate (16) y--~f-f~,-~~ x .06 = -~'' - (Indude values from Schedule K or Schedule M.) -> .~ ', ,., 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) ~~, ~~L J Expenses (Schedule H) _ 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 1 1. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 1 1) ~- 'l' j ~: , ; ~~: 13. Choritable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) °' `" ~ ~ `' 15. Spousal Transfers (for dates of death after 6-30-94) 17. Amount of Line 14 taxable at 15% rate (17) x (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 Payments Discount Interest + + - 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. ~^ 21. 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 21 A. B. Enter the total of Line 21 and 21A on Line 218. This is the BALANCE DUE. Make Check Payable to: Register of Wills, Agent BE SURE TO ANSWER ALL GlUESTIONS 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 knowledge and belief, it is true, correct and complete. I declare that all real estate has been reported of true market value. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 51 ATURE OF P SO ES NSI E OR FILING RETURN ADDRESS DATE \ ~ _,~. ~GG~'~2w< /t+1f,-ski ~~4: l.ti,».t~r~tL,t-Nl~ 1~l :~c`tt, 3~'~6~~t~ ei ti~oc nc ooconoco nTUCO THAN RFRRFCFNTATIVF AnnRFGS DATE I ~ ' , ~' (11) J (121 `~ (13) 15 = (19) . (20) (21 A) Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use of the spouse. The rates as prescribed by the statute will be: • 3% (.03j 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 1/1/97 • 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. BY PLACING AS CHECK MARK ~~0, IN TH APPROPR ATE BLOCKS. 1. Did decedent make a transfer and: a. retain the use or income of the property transferred, .................. ..................................... b. retain the right to designate who shall use the- property transferred or its income, ............... c. retain a reversionary interest; or ........................................... ........................................ d. receive the promise for life of either payments, benefits or care? .................. . ..................... 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................... 3. Did decedent own an 'in trust for'. bank account at his or her death? ...................................... IF THE .ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ,. ~ REV-1508 EX+ (2-871 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTArrTE OF '~ (All property jointly-owned with tht Righf of Survivorship must be diseios~d on Sea~dul~ f) ITEM DESCRIPTION NUMBER l 1~~1~ ~-tL (Z ~ 3 SSW i i~ ~ S ~1~. ~-~-tc vJ~ii ~`~ /~ :~ ~r ai~(~~jSr2f~e.~ l~ TT %Z fZ i 5 f 3 ~i-(Z- t. 1 /T ~ e,~ ~ ~"1 -~~~~3i3b.1 Please Print or ILE NUMBER ~~t `~ 5--d C? 2-Q ~l l+r~-r~. fz c~ S ~-~ f ,~ c~s 3~ t< L~ ~ G~f-la-_t3-7~'~y 'P~: S,~ c~~-~~~~ 3~~,~ ~~~ i I i jA~.,~.,~ p ff;; pG --7 ~, ['furl'. yCin?4. /I ~~'KWI ~ LE.`~:~"1.-10 `~~ f.. VALUE AT DATE OF DEATH ~f-l ~ C~e~ ~ z~n-- . ~, b~ Uc~d_`~,~ iii ~~ ~, `~`~ i TOTAL (Also enter on line 5, Recapitulatio (Attach additional 8Y:" x 11" sheets if more space is needed.) ~__,._ -, .~, P _ . x - r RFV-1509 EX~ (7-83) COMMONWEAITM OF !ENNSYlVAN1A INNERITArJCE TAX RETURN RESIDENT DECEDENT SCHEDULE "F" JOINTLY-OW~V~D PROPERTY Joint t~nant(,s): NAME ~ ~ ADDRESS RELATIONSHIP TO DECEDENT B c. Jointly-ownstd property: ITEM NUMBE I LETTER FOR JOINT TENANT DATE MADE JOINT , DESCRIPTION OF PROPERTY _ TOTAL VALUE OF ASSET DECD'S 96 INT. DOLLAR VALUE OF DECEDENT'S INTEREST ~" 1-` ' j Y` ~ --- -r. ~} C / /'~ u~ ~~C/ <~ B E' /~'C- fly t~ ~:~3L-' /L ~~/72~ i TOTAL (Also •ntatr on ling 6, Rscapitulotion) I $_ ~~~ ~'`~5~ ~dC~--- ((l mars space is n..d~d ins~ri odditionof sh~•rs o/ same size) J ~I ~- C (-" t j ~.. ~~...) REV-1511 EX+ 17-88) SCHEDULE H FUNERAL EXPENSES, COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND INHERITANCE TAX RETURN _ RESIDENT DECEDENT MISCELLANEOUS EXPENSES Please Print or Type ESTATE OF FILE NUMBER r2~~~a2ieK.~ S, 4~a.i~ tct5 -~~~o~ ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: 1. ~C.~S 5.%4 :1.~}-+~ `S FGi.r~ d'iLoF-~- ~'~o ~4 Z 1 ~ ~1 to ~~ 7 ~ O G j] ~ ~ / $(~t,.~Zk (T'Yt(C-Q..t ~ (~:~ttq""~.`~ ~ ~ ~%X=~. ~u~ ~ ~~ ~-` ~- 3 r ~J p ~'~'~-~ i1 i ~S ~ R-tY 1C ~ ~+c ti~ ~ ( a ~ ~ 4 i 1 11 ~~ < ~ d ~ ~ B. Administrative Costs: 1. Personal Representative Commissions I ~+ -3 ~ l - Socia Security Number of Personal Representative: Year Commissions paid ~~~'~ 2. Attorney Fees 3. Family Exemption ,. Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate Fees f'c.t+`.o r3 ~r~ f^rz~ ~ 7~ ~U -~.. ~ l}K~tarT3-/<.k ~ ~tx- ~l ~-t NS t: ~fZ.~, ( ~t(? l~ C. Miscellaneous Expenses: ~~~ ~~ ~_. ~:- ~ w~_3 ~C~ r-p-~- 2. `~'r~`/~'. d~ c`~Tizi~ ~C?i~!2 4. 5. 6. 7. 8. TOTAL (Also enter on line 9, Recapitulation) $ ~/~ c7 `7~~ ~ l (If more space is needed, insert additional sheets of same size.) i " _ ~' f _~ I REV-1513 EX+ (2-87) _, ' ~ ~`. SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~(2rz~>taiCicra, S. ~~i}L FILE NUMBER Cc~q,~-_Ge.2~7 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: ~i~lre i3Krc.r S~ G~.+~~ w-a ~~ fa8+32. t ~fW .t ~ 1'vl , e t~z ~c. i~{-~- - ~ [l~ ~. Ik rcu~~ ~~•~~ ~ o ,J ~~~ S it-~-(tom ` ' ~/TR.~~ ~ rv K lam! ~.: ~L J u ~j w ` ~ t A ^I t ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: AMOUNT OR SHARE OF ESTATE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation} I $ (If more apace is needed, insert additional sheets of same size) .~ t~ ~: C .~, ~~~ ~~ .,- r 1~ REY-1547 EX AFP (1Z-941 COMlIONMEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPT. 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX HARRISBURG, PA 17128-0601 ACN 101 DATE 06-06-95 DATE~OF DEATH~~~02-23-95 rKCiJK1KA s FILE N0. - 000NTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO ''REGISTER OF WILLS, AGENT^ REMIT PAYMENT TO: DAVID M BOHL 500 PARK AVE NEW CUMBERLAND PA 17070 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Amount Reaitted CUT ALONG THIS LINE - RETA_IN LONER PORTION FOR YOUR RECORDS -~ REV-1547 EX AFP (12-941 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR --------------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BOHL FREDRIKA S FILE N0. 21 95-0207 ACN 101 DATE 06-06-95 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estat• (Schedul• A) 2. Stocks and Bonds (Schedul• B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. MortyaGes/Notes Receivable (Schedul• D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedul• E) 6. Jointly Owned Property (Schedul• F) 7..Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ads. Costs/Misc. Expenses (Schedul• H) 10. Debts/Mort9aGe Liabilities/Liens (Schedul• I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governwental Begwats (Schedul• J) 14. Net Value of Estate Subject to Tax NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17 and reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rat' 17. Aaount of Line 14 taxable at Collateral/Class 8 rate 18. Principal Tax Dw TAX CREDITS: PAYMENT ~ RECEIPT DATE NUMBER DISCOUNT (+) INTEREST (-l (1) .00 (2) .00 (3) .00 (4) .00 (5) 27.000.00 (6) 11.894.99 (7) .00 (8) 38,894.99 (9) 11,874.87 (io) 00 (11) 11 .874 87 (12) 27, 020.12 (13) .00 (14) 27,020.12 AMOUNT PAID 18 will (15) .00 X .03= . 00 (16) 27, 020.12 x . 06. 1, 621.20 (17) . 00 X .15= . 00 (18) 1, 621 .20 TOTAL TAX CREDIT 2,415.25 BALANCE OF TAX DUE 794.05CR INTEREST .00 TOTAL DUE 794.05CR * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN il, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE Rcv-1470 EX )6-88) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME Fredrika S. Bohl SCHEDULE STEM FIL 2195-0207 101 NO. EXPLANATION OF CHANGES ~ 3 ~3S bPt~n rF..lr~nn.1 ... _.___ ,.s, Arcessia Byrd TAX EXAMINER: INHERITANCE TAX EXPLANATION OF CHANGES PAGE lrn; P REY•1500 EX+ ('-94 t ~ c~ ~ ~ (;~ w~ - I CF '_ INHERITANCE TAX RETURN IFORDATESOFDEATNAFTER1~f~ll91CHECKHERE IF A SPOUSAL RESIDENT DECEDENT POVERTY CREDIT IS CLAIMED ^ ~ COMMONWEALTH OF PENNSYLVANIA FILE NUMBER DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE DEPT, 280601 . n HARRISlURC, PA 17148.0601 WITH REGISTER OF WILLS) ~'~~ "I S - ~o~~ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIALI COUNTY CODE YEAR NUMBER d L r DKEDENT'S COMPLETE~AwDDRESS = 11' 2~s7'L_LKd- ~ S'ii•a.~•Lf ~• t COO W SOCIAL SECURI NUMtER DATE Of DEATH ~ ~FM - f'~d Fti ~ ~ ~Uj DATED BIR fOGO 1A~• v b -310- - l't$ Sa4rH Sr• W S ~ 2 3 9 S L O ~r g•~ r a ~,~~; s« ,PA r ~, l 3 O (1F AffLIGARLI~ SURVIVING SPOUSE'S NAME (LAST, fIRSr ANO MIDDLE INR1A4 SOCIAL SECURITY NUMlER COUn C ~ ~'l a tiR `~ a, AMOUNT RECEIVED (SEE INSTRUCTIONS) ~ ^ 1. Original Return Y t y ~ 2. Supplemental Return ^ 3. Remainder Return =oo ^ 4• Limited Estate (for dates of death prior to 12-13-82) ~ ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Re "gym (for dates of deoth-aftsr 12-12-82) quired ~ ^ b• (AAA~e copy ofTWill) e ^ 7. Decedent Maintained a Living Trust (Attach copy of Trust) -8. Total Number of Safe Deposit Boxes ~o = NAME W 'ice o COMPLETE MAILING ADDRESS ¢z `/Aul;~ /~~cs.,ulrL ~6~ ~ 7c,W~D Mcc~tet•E'~ LJ6N~. v ~ TELEPHONE NUMBER _ Z i 'Z ~ '~ y - C'7 e (o ~ o b r~ft-R K ~ v~ ~-~w ~KH~sQ2L_.4.~.L~ PA t~Q~a 1. Real Estate (Schedule A) (1 ) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3 ) 4. Mortgages and Notes Receivable (Schedule D ) - -- ~- -- 1 (4 - ~ -°' S. Cash, Bank Deposits $ Miscellaneous Personal Pro ert ~ o (Schedule EJ P Y (5) `~ ~ ~.~f 4'7 _~~'~! • } b ~ >s,..~--~ g ~ f~je c~+~-e-. -___ -- 1- 6. Jointly Owned Property (Schedule F) (b) (( ~ ~g' ~9 ~X !~ d • ~,...-~ /y g 7. Transfers (Schedule G) (Schedule L) 7 - - ~,--~•~'- ~ r~ ~ ~ ' ( ) -__ ~. d 8. Total Gross Assets (total Lines 1-7) _ ~ 3 .~~ ! _ ~ 9. Funeral Expenses, Administrative Costs, Miscellaneous 9 r ( Expenses (Schedule H) ( ) ~' ~Ly L ~ ~ ~ %)~' - _._.__,~.._.__- ~ I I q ~.._.__ 10. Debts, Mortgage Liobilitiss, liens (Schedule IJ (10) ,~......- T., 11. Total Dedudiens (total Lines 9 $ 10) l '~ ~ , ~ '~ ` ~ ~, - `-- 12. Net Value of, Estate (Line 8 minus Line 11) (11) f A ~i ~ 4 y ~~ 8~~ _ _..- r ,, _ 13. Charitable and Governmental Bequests (Schedule J) (12) ~~--,~~- ,~~~ --~ 14. Net Value Subject to Tox (Line 12 minus Line 13) (13) - 15. Spousal Transfers (for dates of death offer 6-30-94) , . / _ _` See Instructions for Applicabb-Psresnfogs on Reverse (15) ~~` "~ .r., "~ ~ }~ "~ __ Side. (Include values. from Schedule K or Schedule M.) x•-= - __. 16. Amount of Lins 14 taxable at b% rats (Ib) ~~-~,_ (Include values from Schedule K or Schedule M.) x .Ob = -:--~-tT1~~ ~; "• _ 17. Amount of Lins 14 taxable at 15% rate ~ ` ~ U - of (Include values from Schedule K or Schedule M.) (1~ x .15 = c 18. Principal tax due (Add tax from Lines 15, 16 and 17. e. 19. Credits Spousal Poverty Credit Prior Payments Discount _ ~ + S3 34, lq Interest ~ ~ r 16- - _ " 20. If Line 19 is greater than Lins 18, enter the difference on Lins 20. This is the OVERPAYMENT. (20) ~U ~ , (, 21. If Line 18 is groatsr than Line 19, enter the difference on Line 21. This is the TAX DUE. - A. Enter the interost on the balance due on Lins 21A. B. Enter the total of Line 21 and 21A on tins 216. This is the BALANCE DUE. - Make Chedl Payable ro: Register of Wills,. ARenf : - = ~ - , >, > aE'suRE to ANSw~ ~-u~QU~tagrs oN ~~sroE ANI It sdtrueecorrect and complste.el Ideclahetthatall ~eol estate hlas been reported at true maarkle9volus. Dsclan ~sed on all information of which preparer has any knowledge - ayctNATURE OF PERSON RESPONSIg~E FpQ fILING RETURN i~1 , L /'1 n f~ /'1 A .. ADDRESS (21) _ (21A) - -(216) _ statements, and to t!s ion of preparer other ~~ • ., _ of my knowledge and belief, the personal representative is DATE a c3 97 DATE 6d0 fhQrt ~~~ N~L~I:t,.Brc+.awo PA 1'7o'1O ADDRESS T0: PA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 FROM: DAVID MICHAEL BOHL, EXECUTOR 500 PARK AVENUE NEW CUMBERLAND, PA 17070 717-774-0706 RE: ESTATE OF FREDRIKA S. BOHL FILE NUMBER 21 95-0207 DATE OF DEATH 2-23-95 SOCIAL SECURITY NUMBER 206-32-1735 THE FOLLOWING FACTUAL ERRORS HAVE BEEN MADE ON THE ORIGINAL TAX RETURN OF THE ABOVE DECEDENT: 1. ITEM 5 SCHEDULE E, ITEM 3 REDUCED TO ZERO DUE TO BEING A JOINT ACCOUNT. 2. ITEM 5 PREPAID EXCESS ON 2 CD'S. ACTUAL VALUE X26,997.22. 3. ITEM 6 CSCHEDULE F1 END OF MONTH BALANCE USED INSTEAD OF CORRECT BALANCE, 2/23/95. 023,737.90) 4. ITEM 9 SEVERAL ERRORS DUE TO TRANSPOSITION AND NOT LISTED. SCHEDULE H REPORTED VALUE ITEM A2 X1467.33 TRANSP C 1 . 2370 .0 7 ~~ C3 19.22 ~~ CS ADDITIONAL EXP. CPA INCOME TAX) ACTUAL 1467.63 2372.07 28.83 78.00 TOTAL ~ .30 2.00 9.61 78.00 X89.91 STATUS REPORT UNDER RULE 6.12 Name of Decedent: ~2~'~~ Date of Death: a, ~,~ f will No._o?/'- ~'~" a0' Pursuant to Rule Court Rules, I report the the administration of the Z ~ k~ S. 30~+~. Admin. No. 6.12 of the Supreme Court Orphans' following with respect to completion of above--captioned estate: 1. State whether administration of the estate is complete: Yes No t~~ 2• If the answer is No, state when the personal representative re sonably believes that the administration will be complete:- /~p~ ~` (~~r-.~ 3• If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: account informally tDodtheepartiesainrinterestatiyeSState an No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be.filed with the Cerk of the Orphans' Court and may be aL-tached to this report. Date: Signature ? ' ~. /~'t'~HA6 ~ 1-~o t~ L. Name (Plre~ase type or print) SUO 1 ~}'21~G ~cJu ~Ju,t N~£tJ Cct'.~~R+.~f/~JPi$ Address i"7o'tc L~?(?) ~ "7~- 070 Tel. No. (MAH:rmf/AM3) Capacity: ~ Personal Representative Counsel for personal representative SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS ~--- PERSONAL PROPERTY Please Print or T e ESTATE OF FIIE NUMBER r2~~oa,r,.~,~ ~3oi+~ 1445- oo~d-t {Attach additionol 814" x il" sheets if more space is needed.) ~ , t REVe1509 EX+ (12.881 . COMMONWEALTH Of PENNSYLVANIA INHERITANCE iAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY F2~r~cz~el<~ `J.i` Joinf tenant(s): NAME B. C. Jointly-owned property: ITEM LFORR DATE UMBE JOINT MADE TENANT JOINT 1. FILE NUMBER I44~ o,~21~~ ADDRESS RELATIONSHIP TO DECEDENT Sbo rnA 21< /~~:~ N~ w C u,,..Q l= 2 ~,~,, ,~ , P~ S o ~s c"lo~o DESCRIPTION OF PROPERTY TOTAL VALUE DECD'S DOLLAR VALUE OF OF ASSET % INT. DECEDENT'S INTEREST ~-SA-~.~P µ~ ~ 1~Tz'Pas ~r 3/f*>hc ~-3,~3~.9 O 5'O~~ ~ _. ~o fox 2~` j ~ ~ ~~s3,9~ ~~4-Q.R~SD 4R~ ~ t~/E f~ 16~ 2cr6 ~ C ~CK~a)(p ~CCT~ I~'tiZQgO?-$ TOTAL (Also enter on line 6 Recapitulation) $ (If more space is needed insert additional sheets of same size) REKUII fX. p.pl - COMAIfONWEAITH OF PENNSYLVANIA INHERIUNCE TAX RETURN SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ~2r?~2tlc,~} ~. 1J01-~L ITEM NUMBER DESCRIPTION A• Funero) Expenses: t' /'~'t (•~ S S ~'Lrh R~J`S ru,v,?,2 2 ~~RR~s~t~2 G e~~~trrr~2y ~~ S S ,5 St' ey k N-o cap ~ B• Administrative Costs: 1. Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid 14q T tit - 32 - 2g~2 2. Attorney Fees 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address Clty State Zip Code 4. Probate. Fees ~2 0 4~r~ FCC" Z~+aeas~2y F.~c~+6 F~F C• Miscellaneous Expinsis ~c~ T't~` ~"c w~ ~'F~ t . s ~ 2~ ~ To~~ I-1-a r-~ ~ 3' C A-2 ~~ s c. ~ ~,k ,ti.G I .J L 4. 3f[..U~17E2 ~ I~'~ tt"J 1 c FFt ~ p (~ Q, 5. {~ A. ~ ,eP dF R^vrN4~ 6. 7.. y 8. (If more space is needed, insert odditional sheets of same size.) 5`~~1. 60 t `t ~ ~ ~ (~ 3 .~ . ~ D t4(..R~" fey ,yjc ~3~,pL, ~ Z. o p c o . 00 is. ao 2 3 -t 2. o ~ ~, ,~„ o 5G 3.43 28'.53 q.bl ~-c3•Q1 ,i.ql ~ ~~ o o TOTAL (Also enter on line 9, Recapitulation) I $ I (, 4 Please Print or Type NUMBER ~4S- Ga 201 AMOUNT NOTICE OF INHERITANCE TAX ACN 1 O1 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 06-06-95 ESTATE OF FILE N0. - DATE OF DEATH 02-23-95 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, ACENT^ REMIT PAYMENT TO: DAVID M BOHL REGISTER OF WILLS 500 PARK AVE CUMBERLAND CO COURT HOUSE NEW CUMBERLAND PA 17070 CARLISLE, PA 17013 Amowt Rewitted CUT ALOHC TFIbS i--INc w RETATN LOWER PQR.TION FOR YOUR RECOP?aS a -------------------------------------------------------------------------------------------- REV-1547 EX AFP (12-94) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE -------------------- OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BOHL FREDRIKA S FILE N0. 21 95-0207 ACN 101 DATE 06-06-95 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( Xl CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 2. Stocks and Bonds (Schedule B) (2) .00 , 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 4. Mortgages/Notes Receivable (Schedule D) t4) .00 2 7 8~-~~•~" C~~~ ~- "~ ~ '- 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ~ -y--r , (5l ~ 6. Jointly ONned Property (Schedule F) (6l_ ~11-~-64~i-:-9~ ~ ,/ ~'(~~ % `y 7. Transfers (Schedule G) (7) .00 l 8. Total Assets (g) _ ~-38;894:-•9~9 ~l~ ~~~ ~`~ `~~~~ '~`''") APPROVED DEDUCTIONS AND EXEMPTIONS: •' 11$7~F.-B~- 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (g) 10. Debts/Mortgage Liabilities/Liens (Schedule I) ( 10)_ . 00 ~ ~, ~~~~ • /,~' 11. Total Deductions tll) 31 ~~=~---- 12. Net Valw of Tax Return ~~=~C~~1~"I 3~' (12) '27,020:1-2` 13. Charitable/Governmental Bequests (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax ~ ~ j'iG ~ ~? (14) _„2Z, 020.1k2 NOTE: if an assesstaent was issued previously, lines 14, 15 andior 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate , ~+~, C~ -~C' 3c (15) _t • OD X . 03_ ~ ' ~ . 00 16. Amount of Line 14 taxable at Lineal/Class ~ rate t16) i1~: 3 i X • 06= '-~~ ~ o- -1, 621.•2-0 17. Aew~t of Line 14 taxable at Collateral/Class B rate (17) . 00 X . 15. . 00 18. Principal Tax Dw (lg) 1-,621 r~$' TAX CREDITS: ' ~., ~ ~ ) ~, RF6•=1.. i7 EX AFP (12-94) COMRIO~IHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE SUREA~3 OF INDIVIDUAL TAXES 4EPT. 280601 HARRISBURG PA 17128-0601 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST (-) ~O~ pAID 03-20-95 AA022941 81.06 2,334.19 TOTAL TAX CREDIT 2,415.25 BALANCE OF TAX DUE 794.05GR INTEREST .00 TOTAL DUE 794.05CR * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REWIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT° (CR), YOU MAY BE DUE • wG G~I.1.• !GC OG•I!s!c wTwC w~ T..T! lwsY rww T•.wTw..wTTw•... • COMMONWEALTH OF PENNSYLVANIA ' DEP~iRTMEN` OF REVENUE BU?EAU OF INDIVIDUAL TAXES DEPT. 280t~01 HARRISBURG, PA 17128-0601 DF.CEDFNT'j NAME Fredrika S. Bohl SCHEDULE ITEM NO. E 3 INHERITANCE TAX EXPLANATION OF CHANGES N 2195-0207 101 EXPLANATION OF CHANGES Has been reduced_ to zero. This is a jointly account which was reported on Schedule F. ----------- TAX EXAMINER: Arcessia Byrd PAGE *' COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION oeaT. 2aowl APPRAISEMENT, ALLOWANCE OR DISALLOWANCE HARRISBURG, pA 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX acv-i5a~ ex AFV cos-s» DATE 03-2 -97 ESTATE OF BOHL FREDRIKA S DATE OF DEAT 0 - 3-95 FILE NUMBER 1 95-0207 COUNTY CUMBERLAND DAVID MICHAEL BOHL ACN 101 500 PARK AVE Anount Remitted NEW CUMBERLAND PA 17070 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 ___~______________________ -- -------------------------- --------------------------- -1547 EX AFP (03-97) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR REV DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX BOHL ESTATE OF FREDRIKA S FILE N0. 21 95-0207 ACN 101 DATE 03-24-97 . TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) (1) .00 2. Stooks and Bonds (Schedule 8) (2) .00 3. Closely Held Stock/Partnership Interest (Schedule C) (3l .00 4. Mortgages/Notes Receivable (Schedule D) (4) .00 5. Cash/Hank Deposits/Misc. Personal Property (Schedule E) (5) .00 6. Jointly Owned Property (Schedule F) (6) .00 G) d l (7) .00 7. u e Transfers (Sche 8. Total Assets ($) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests (Schedule J) 14. Net Velue of Estate Subject to Tax NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 00 (9) 78.00 (lo) - .00 (11) 78 _ 00 (12) 78.00- . (13) .00 (14) 26,942.12 NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: .0 0 X .00= .00 15. Anount of Lins 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (161 26,942.12 X .06. 1,616.52 17. Amount of Lins 14 taxable at Collateral/Class 8 rate (17) .00 X .1 5. .00 (lg) 1 , 616.52 18. Principal Tax Due TAV PD C*1TTC• . PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER .INTEREST/PEN PAID (-) 03-20-95 AA022941 80.83 2,334.19 02-21-97 REFUND .00 794.05- TOTAL TAX CREDIT 1,620.97 BALANCE OF TAX DUE 4.45CR INTEREST AND PEN. .00 TOTAL DUE 4.45CR * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS .LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A ''CREDIT'' (CR), YOU MAY BE DUE TAX EXA NEfi: ~~~~''d'"-f'~"'~ _ PAGE /"' - COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION INHERITANCE TAX DEPT. 280601 HARRISBURG, PA 171za-oboe STATEMENT O F AC C O U N T REV-lip? ER AFF (pS-97) D M BOHL 500 PARK AVE NEW CUMBERLAND PA 17070 DATE 02-02-98 ESTATE OF BOHL FREDRIKA S DATE OF DEATH 02-23-95 FILE NUMBER 21 95-0207 COUNTY CUMBERLAND ACN 95115847 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS __~ REV-1607 EX AFP ( 03-97 ) ~~(~ --°°-°°--°---°'--°°----- INHERITANCE TAX STATEMENT OF ACCOUNT ~*~ --"----"-------- ESTATE OF BOHL FREDRIKA S FILE N0. 21 95-0207 ACN 95115847 DATE 02-02-98 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-22-97 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 00 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 02-13-97 AA185174 .00 712.14 01-16-98 REFUND .00 712.14- * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 91, NO PAYMENT IS RE@UIRED. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISIDN DEPT. 280601 HARRISBURG, PA 17128-0601 DAVID MICHAEL BOHL 500 PARK AVE NEW CUMBERLAND PA 17070 DATE 07-15-1998 ESTATE OF BOHL FREDRIKA S DATE OF DEATH 02-23-1995 FILE NUMBER 21 95-0207 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this fora with CUT ALONG THIS LINE - RETAIN LOWER_ PO_R__T_I_ON FOR YOUR RECORDS .,~ yO1r tax payment. -------------- REV-1543 EX AFP (09-97) ~- ---'°"""'° ___ *~ INHERITANCE T --"" AX RECORD ADJUSTMENT ~~ ~-""""" ESTATE OF BOHL FREDRIKA S FILE N0. 21 95-0207 ACN 101 DATE 07-15-1998 ADJUSTMENT BASED ON: OARD OF APPEA S REFUND VALUE OF ESTATE: 1 R eel Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) .00 3. Closely Held Stock/Partnership Interest (Schedule C) (2) .00 4. Mortgages/Notes Receivable (Schedule D) (3) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) .00 6. Jointly Owned Property (Schedule F) (5) 26.997.22 7. Transfers (Schedule G) (6) 11,868 95 $. Total Assets (~) .00 DEDUCTIONS AND EXEMPTIONS: (B) 38,866.17 9. Funeral Expenses/Administrative Costs/ Miscellaneous Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (9) 11,964.7$ 11. Total Deductions (10) •00 12. Net Value of Tax Return (11) 11 , 964 78 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (12) 26,901 39 14. Net Value of Estate Subject to Tax (13) •00 TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 taxable at Collateral/Class B rate 18. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DATE NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) 03-20-1995 AA022941 02-21-1997 REFUND COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT REV-1593 EX AFP (p9-97) 80.70 .00 (14) 26,901 39 cls) . 00 x.00 = (16)_ 26.901 39 x.06 = • 00 (17) 1,614 08 . 00 x.15 = . 00 (1B) 1 614.08 AMOUNT PAID 2,334.19 794.05- AL TAX CREDIT i * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. REST AND PEN. 6.76CR TOTAL DUE •00 6.76CR ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL_DUE IS REFLECTED_AS A ••CREDIT" (CR), YOU MAY BE DUE REV-1600 EX.(i-97) ~;~ '~ "`~ ~' .~ ~•~ r ~,~~ ~.~~~~ REV-1500 COMMONWEALTH FPENNSYLVANIA INHERITANCE TAX RETURN DEPARTMENT OF REVENUE DEPT. 280601 RESIDENT DECEDENT HARRISBURG PA 17128-0601 DECEDENTS NAME (LAST FlRST Z W W W D 30 t o ~' ?~- ( ~ 3 S v ~./~ 3~1 q 9 S (IF APPLICABLE) SURVMNG SPOUSES NAME (LAST, FlRST, AND MIDDLE INmALj SOCIAL SECURnY NUMBER i O N MUST BE FILED IN DUPLICA' REGISTER OF WILLS ~ ^ 1.Original Retum v d Y ^ 4. Limited Estate =off' ~ ~ m ^ 6. Decedent Died Testate (Aaacn copy or Wiq a ^ 9. Litigation Proceeds Received ~ THIS SECTION MUST t3E CO EI W NAME 0 z ~. a /~^ ~ C kf,~ ,t^ L~ G~ L W FIRM NAME (IfApp6cable) p TELEPHONE NUMBER V 1 t7 ) ~ ~ ~ _. 07 ~~ 2 0 f- a V W 2 O xxQ Q~ H~ a O V ^ 3. Remainder Retum (date ddeafh pri0rtp tz-t3-szj ^ 5. Federal Estate Tau Retum Required - 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Anacn scn of MIITION SHOULD BE Dfi2ECTED TO: S1oo Q~~ t< ~ur` 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) ~ a , 3. Closely Held Corporation,Partnership orSole-Proprietorship (3) > > 4. Mortgages & Notes Receivable (Schedule D) q O ~ } `~ {~T- g ~~ ~ ca 5. Cash, Bank De posits & Miscellaneous Personal Property ' ' ~' ~ - Tt rr *~ ,..; ^~ (Schedule E) (5) ~ ~ , (~ ~ ~ q --~ ~ • l m ~..~ ~ . 6. Jointly Owned Property (Schedule F) 7 Inter-Vivo T f (6) G ~ f ` } o . r" ~ ~ • I-\VN . s rans ers & Miscellaneous Non-Probate Property (Schedule G or L) (7) 'p ,~„ 8. Total Gross Assets (total Lines 1-7) ~ a -, la • • ~:._ ~`~ r~ - 9. Funeral Expenses 8 Administrative Costs (Schedule H) (g) ~ q (8) ,, ~'~ ~ , ~ fog ~ ( `1 ,o , ~ 4 ~ Y • , . Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental BequesLs/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 15. Amountofline 14 taxable at the spousal tax rate , ~ X .( See instructions on reverse side for applicable percentage 16. Amountofline 14 taxable c at 6°k rate , a (. , l C~ X 3 9 x 17. Amount of line 14 taxable at 15°~ rate , ~ x 18. Tax Due ,9. n ~~, penalties of perjury, I declare that I have examined tonal reor~entative is based m all iMorm 4TURE OF PERy~ON RESPONSIBLE FOR AND MIDDLE INITIAL) use a Npxrc tAoek b separate was (11)~~ ~ R ~D4 •`7 C i~a (13) ~ ~ (14) , ~ (o t ~ ~ ~ 3 9 (15) , 7 • .06 (16) r ~ f I!o 1 15 (17) i e f ~ :. ~*~+ waac nnv rtcVntC:K tiNATli < < relum, including accompanying schedules and statements, and to the nest of m kno which r has anv knordedne. Y wledge and belief, it is true, correct and complete. Declaration of preparer other ING RETURN ennooee _. 0 0 0 5 8 9~~0'~ FILE NUMBER d2 I ~ S-•~ c; .2 0 ~ rroiurv rune .,r... - TE OF &RTH (o/cg/[9 2. Supplemental Retum 4a. Future Interest Compromise (daze oraeazn after t2•tz-9zj ^ 7. Decedent Maintained a Living Trust (Anacn copy orrrosq ^ 10. Spousal Poverty Credit (date ordeazn nMween tz-3t•st and t-t-ss) V r~ ~vv DATE ~b~ ARK ~~,~ ti1~I~ ~~-^Ba~~~~~ P~ t'lo'7d ~~~ ~- dU SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE Decedent's Complet STREET ADDRESS JAaaN i c t ac~o CITY ~ /~ R `. Address: ~c3 c.i^i'H S'T' Tax Payments and Credits: 1, Tax Due (Page 1 Line 18) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments (~ (`'~ • ~ C, Discount Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D, Interest E, Penalty Total InteresUPenalty (D + E ) 4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Llne 19 to request a refund 5. If line 1 + line 3 is greater than line 2, enter the difference, This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF (3) (4) (5) (5A) (56) ,AGENT ___ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: a. retain the use or income of the property transferred : ...................... .. ........ b. retain the right to designate who shall use the property transferred pr its income : ................ ^ (~- ...................................................................... ^ 0 c. retain a reversionary interest; or ....................... d. receive the promise for life of either payments, benefits or care? ......................................... ^ Q 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..................... . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ...................................................................................................................... ^ 4. Did decedent own an individual retirement account, annuity, or other non-probate property?.... ^ 0- IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN 72 P.S. §9116 (a) (1.1) (i) provided for the reduction of the tax rate imposed on the net value of transfers to or from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995. use of the survwing spouse 72 P.S. §9116 (a) (1.1) (ii) provided for the reduction of the rate imposed on the net value of transfers to or for the use of the surviving spouse from 3% to 0% for dates of death on or after January 1, 1995. The statute-does not exempt 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 is the only beneficiary. FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995 - Please answer the following question by placing an "x" in the appropriate space. Did the decedent create a trust or si 'lar arrangement which is solely for the surviving spouse's benefit for his or her ent re lifetime? Yes ^ No If you answered yes to the above question, the tax on the tru i cab~emo the rema rider benefiiary(es) Enteetheavaluetof the~ust on spouse, at which time it will be fully taxable at the rate(s) app Schedule J, Part II, vaiolab a under~Sectiofn 9113e1f the ele'cti n is made, the trust or samilar arrangement is taxed~n he eOstate tithe make the election a first decedent spouse, the portion of the trust/ cable to therrema rider beneflc ary(ies)hlf you choo a to makethe a ecthonZyoutmust e and the remainder is taxed at the rate(s) app attach Schedule O to atimely-filed tax return, along with Schedule(s) Kand/or M in order to show the apportionment of the trust or similar arrangement between the surviving spouse and the remainder beneficiary(ies). I ZIP (~O( ...... ......... . ~~ -~% I SCHEDULE E, PART 1 COMMONWEALTH of PENNSnVANw MISC. PERSONAL PROPERTY INhIER1TANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF --~ rQ~fli11 -ca ~. 1JCHL Part 1 must include all MdrgiWe personal ProPertY having ifs sides with the ' ht of survivorship must be disclosed on Schedule F. C ITEM NUMBER 1. FILE NUMBER ? i -9SC~2G~ hrania. Examples of tangible Personal property are jewelry, tumidue, Paintings. etc. Ap property JoindY-~ 'art 2 on roverse side ONLY when the rtionabe nretfrod of tax computation is ebcted. DESCRIPTION VALUE AT DATE OF DEATH ~-A22~5~3u,z~ P~ 02 ~ l4~rZ e r S Sze u r ~+G S 4~A~%;t ~'~ ~ ay -tz - i3l ~~w PARTITOTAL s PART 2 TOTAL P-opationate Method Only from reverse side $ TOTAL (Also enter on line 5, Recapitulation) S (If more space is needed, insert additional sheets of the same size) LS~g, g~ 19,gg8.3~ r RE~1509 EX+ ps-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~R~~ Rc K,q S. ~ Ja Joint tenant(s): NAME B. c. Jointly-owned property: JOINTLY OWNED PROPERTY ADDRESS ~~~ C~~+S~'a~w~~~~- ~~a ITEM LETTER JMBE DATE JOINT MADE DESCRIPTION OF PROPERTY TENANT JOINT t. ~R~a C ~ECK,aG ~CLOU „1; 4 P l-1, ~ ~ ,er P6S (T 3 9-n~ K ~` (i~24~oaz~ E NUMBER ~P - `~562G--7 RELATIONSHIP TO DECEDENT sv n TOTAL VALUE OF ASSET DECD'S DOLLAR VALUE OF % INT. DECEDENT'S INTEREST ~3 ~3~ r .go s~ TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed insert addifional sheefs of same size) ` ~LtZ'C r'~~w~1~t S 1~ A-`~`~ Q T V A' L 4R Jk~Tft c'r 1 0 '~A X ~-ra~ o~E~ L l~~ ~ N S~ k ~LJ1'-j~- E F~~~ ~ 2 ~ -4'02 0"] 2c~9a1.~9 L I i~ , t~ $ ~ y ~Z.41 w ~- -0 Et .,. ~ji --' ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN NOWRESIDENTDECEDENT ESTATE OF r2F~ , K~ s ~3 SC~IEDULE H use schedule H, Part2, orrlLYfor FUNERAL EXPENSES 8 method of tax computation. Pr'oPortionate ADMINISTRATIVE COSTS `I<_'~?c Debts of decedent muri be reported on Schedule L ITEM NUMBER A• FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. .Z. ~ 4 5 5 ~~ ~K ~ r c• .~ ~a v.>,~ 6Fe c~. r• SG •? ~t 7, O C: (-~T ~ 2t2 l,$' l3 taQ L C rlr+•r T- C2 t /I'{ (r ~ , (s ,~ 3' ~+ R Y},J D T ~S G ~~'a S g` S ST~a4{t_Ke4 stt Ioy,~{(o B• ADMINISTRATIVE COSTS: t . personal des Name d Personal R (s) ~ /''t •Z ~ aQ~ 'r3 0 ~ Soc'~I SecrRKp Number(s) / EIN Number d Personal ^~'e(s) _ 1 ~ t -3 Z -?>P4 t saeetAedrss sro P,t,~K ~~~ Cily ~T'~: e u rr.,~..~ ~ Q - - State ~ 1'7 010 Year(s) Canrnpsion Paid: i44 f 2. AtDorrrey Fees ~ 3 ~ C . O 3. Probate Fees ?ave. F~f Tr~e~TvR-i t=t a,~.,~ f=~~ ~'T, a c:V 4. AaoormfeM'sFees ~•r ~tta~r...,cc Tity~ F,~~.~I, ~E~ ) o . o U tS~G© 5. Tax Rebrm Preparers Fees 6. SA 2A u ?~UT, a7 i~a ,.. ~, ~ 312 • ~ 1 C''~'2R ~ PoT-H~e.~a~ ~.r ~~4Qt_.SK T..~+cr~vi. 5C3• `~3 ~$•~3 lip. ~~~~aE ~FDIC.~ ~oQ ~- y3~41 . ~~ ~at~T, OF ~~vCaw~ 1$.0~ TOTAL (Also enter on line 9, Recapitulation) s (If more space is needed, insert additional sheets of the same size) ~ ~ ~ ~ '~ ~/' (aefl tat COMApNWEALTH OF PENNSYLVANIA IrNiERITANCE TAX RETURN ~^ t2 (' NUMBER I. 1. ~. 1 SCHEDULE J BENEFICIARIES gat rate method is elected list the benefidaries of the Penns vania NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (indude outright spousal distributions) ~i~ ic, 3 ~~r s; 3 C~ o ~1'~ 21r A. u r- N ~C... ~K vim. a `^ ~oruonate memos is elected,- RELATIONSHIP TO DECEC Do Not List Trustee(s) saw Jcs~{ i ~~b zo-~ ~eficlanes. AMOUNT OR SHARE OF ESTATE SO ~~ SO °.~o ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV 1737ICOVER SHEET OR THE PROPORTII HATE MET ON THE REVERSE SIDE OF REV-1737 COVER SHEET, AS APPROPRIATE. HOD WORKSHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF ppRT Ij. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1737 COVER SHEET S (If more space is needed, insert additional sheets of me same size) HN•1737 7 IX • (49~ IPC) SCHEDULEI DEBTS OF DECEDENT, ® COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS .~ . Use Schedule I, Part 2, ONLY for proportionate method of tax computation. ' ESTATE OF Part 1 must indude mortgage liabilities, liens and taxes against the Pennsylvania realty that were due and owing as of the date ~ decedent's death. Complete oats metl-od of tax computatlon is elected. Part 2 ONLY when the proportio PART 1.OWi atlone ainst Penn ~ AMOUNT ITEM NUMBER 1. DESCRIPTION TOTAL PART 1 ~ S PART 2. All over debts of ITEM NUMBER 1. DESCRIPTION :, ~ ~,,. 2 TOTAL (Also enter on tine 10, Recapftulation) E Ct1P.P-1'C (lf 1'I1P. CATP. C17?~ AMOUNT Ilf more space is ~' needed insert pennsyLvania DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14) INHERIT%tdtf�IV" F' STATEMENT OF ACCOUNT Lj NDFFICE 0 PO BOX HARRISBURGPA& WILLS DATE 02-09-2015 117EB 17 F111 1 19 ESTATE OF BOHL FREDRIKA S DATE OF DEATH 02-23-1995 FILE NUMBER 21 95-0207 C;O'j COUNTY CUMBERLAND DAVLD M ACN 101 i �= iZM SAVE Amount Remitted NEW CUMBERLAND PA 17070 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS I COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS +- -E-X-Wl�* -(12-71747) *;; -fkHikffA7NH TAX STATEMENT bViCC70;Pf - -X;*- - - - - - - - - - - - - - - ESTATE OF:BOHL FREDRIKA S FILE NO. : 21 95-0207 ACN: 101 DATE: 02-09-2015 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-10-2000 PRINCIPAL TAX DUE: 1,614.08 PAYMENTS (TAX CREDITS) : PAYMENT RECEIPT DISCOUNT AMOUNT PAID DATE NUMBER INTEREST/PEN PAID 03-20-1995 AA022941 80.70 2,334.19 02-21-1997 REFUND .00 794.05- 07-20-1998 REFUND .00 6.76- TOTAL TAX PAYMENT 1,614.08 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.