HomeMy WebLinkAbout95-0372
This is to certify that the certificate hereunto attached is a true and accurate copy of i:he 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.
Auc i s 200
Date
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F'ERMANEMT
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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
036891
NAME OF OECEDENTIT'er. MidAe. leap 9EK SOCIAL 3ECURRY NUMBER DATE OF DERH(MpIIh, DeK
195
28
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+• John W. McGowan
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_3 ,. Apr.
2. Male ,. 189 - 09 - 487
ADE M1•r BlydldeYl uNDER,YEM UNDER, DAY DREaFBwrH elRrrwLACE ~2yrb PIACEOF DERN(duck aNyaro-rIIluYUC2orle ae aetw sldN
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1-13-1911 ,Harrisbur , Pa
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tYS ^ Yyee, ep•dIY Cuben. (SPA
II Cumberland Carlisle 250 Glendale St. ~•^~~•^^~•~ White
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DECEDENT'S USUALOCCUPRION KIND OF BUSINESSIINDUSTRY Yws DECEDEM EYEAN DECEDEM'S EOUCRWN MARI81l s,RUB•MrIW suRVmND SPOUSE
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FRNER'S NAME(Fer. Midds Lrr NOT/ER'S NAME IPer. MitlM, MrMn Sturlrnq
+~ John W. McGowan tY Alice Miller
wFDRMANr'B NAME (Typwr:dl YifT3RMA1(T'9 MAaINB ADDRESS (SIeeL L51YIT ~. SV4, $ Cad.)
Virginia L. McGowan 50 Glendale St. Carlisle Pa 17013
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arlisle Pa 17013
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NYI6 AN AUTOPSY WERE AUTOPSY FlNDINDS MANNER OF DERV DRE OFINJURV TIME OFINJURV INJURYRWORK? DESCRIBE NOWINJINiYOCCURRED.
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CdTTIFIFA (ChackoNyane) SIDNRURE AND TRLE OF CERTEIER
'CFlIT1FT'INB PMY]ICIAN (Pltysidan csr4lyiny cause d deeC~ v.,wi Modes plryacian Its pranoonced deem Md cwnpleted Item 23)
Te/M ter a my IaeenledY•~ eeeth eeeuned dw b rM eetwe(e) end mrwras eYted..........
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-MONOUNCINO AND CEITTN'TYID PHYSICIAN LICENSE NINABER DATE M. Y. Neer)
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NAME AND ADDRESS OF PERSON WHOCOMPLETED CAUSE OERH
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32.
R OISTRAR'S SKiNATVREA NUMBER DATE FKED(MOnIh. Dey. Neer)
b V ~ ~ ~ b ~ ~ ~~ ~ ~ RE ~ DENT DECEDENT ~a~ POVERTY CREDIT IS CLAIMED ^
coMMOrtwe~ ~~ ~T E FILED IN DUPLICATE FILE 2 MBER 95 0372
DEPARTMENT Of REVENUE ~{
M1RRI3WERG~_ 0~0610712R.0601 1 ]5 ~ ITH REGiStE~t OF~fIIiLLS~ _
rn~ ~urv Anne ve a e
' DECEDENT'S NAME (LAST, fIRST, MIDOIEJNI U DECEDENT'S COM-tEtE ADDRESS
MCGOWAN, John W. ~, 250 Glendale Street
W SOCIAL SECURITYNUM6lR DATE OFDEATN OFSIRTH Carlisle, Pennsylvania 17013
189-09-4873 4/28/95 1/13/11 ~
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Pf AIKKJUlE1 SUllvrvnvo sroutt'i NAME BAST, flafT AND MiOpt! INITIAy SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
McGowan, Virginia L. 201-18-6025
~++ ®1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
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^ 4. limited Estate (for dates of death prior to 12.13-8:
^ 4a. Future interest Compromi:• ^ S. Federal Estate Taz Return Re
uired
~
¢ m q
(for dates of death after 12-12-82)
~ ^ 6. Dendent Died Testate
(Attach copy of Will) ^ 7. Deadsnt Maintained a living Trust _ 8. Total Number of Soh De osit Boxel
(Attach wpy of Trus P
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFO ON SHOULD BE DIRECTED TOz ~ . !' ;
..: ..
.
a Z
mZ NAME
Roger M. Morgenthal, Esquire ,
TE MAILING AOORlSS
11 East High Street
~~ TEIEPNON[NUMRER Carlisle,.. Pennsylvania 17013
717 243-5513
1. Real Estate (Schedule A) (1) ----
2. Stocks and Bond: (Sdtedule B) (2) 579.24
3. Closely Held StodJPortnenhip Interest (Schedule ~ (3) ----
4. Mortgages and Notes Recehrabie (Schedule 0) (4) ----
• . S. Gosh, Bank Deposit: ~ Misallaneous Penonol Property (S) 23 , 994.18
(Scheduh ~
----
6. Joimly Owned Property (Schedule F) (6)
~ 7. Tronshn (Schedule G) (Schedub l) (7) -°-
d ~ 8. Total Gross Assets (total lines 1.7) (8) Z 4 , 5 7 3.4 2
9. Funeral Expenses, Admini:trotive Costs, Miscellaneous (9 )
8,342.40
Expenses (Schedule H)
10. Debts, Mortgage liabilities, liens (Schedule I) (10) 551.49
11. Total Deductions (total Lines 9 b 10) (11) 8,893.89
12. Net Value of Estate (Line 8 minus Line ill (12) 15,679.53
13. Charitable and GovemmerMa) Bequests (Schedule J) (lg) -'--
14. Net Value Sub)ect to Tax (line 12 minus line T3) (14) 15 , 679.53
1!S. Spousal Tronshn (for dotes of death after 6.30-q4)
7 , $39.77
See Instructions for plicoble Peroentoge on Rewne (15)
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e va
ues
rom Schedule K or Schedule M
)
.
16. Amount of line 14 taxable at 696 rah (16) 7 , 839.77 pb = _
x 470.39
(Indude values from Schedule K ar Schedule M.) ,
17. Amount of Line 14 taxable at 1596 rate (17) x
is =
z (Indude values from Schedule K or Schedule M
) .
c .
18. Principal tax due (Add tax from lines 1S, 16 and 17.) (ig) 470.39
~ 19. Gsdits Spousal Poverty Gediz Prior Pa menu Discount Interest
~ + 1, 20.00 • 63.16 _ (t9) 1, 263.16
~ 20. If lt
ne
19 is greater thou Line 18, enter the dRFerence a~ Line 20. This is the OVERPAYMENT. (20) 792 ' 77
~
~~
21. If Line 18 is gnater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21)
A. Enter the interest on the balance dw on Line 21A. (21A)
B. Enter the total of Line 21 and 21A on line 218. This is the BALANCE DUE. (216)
Meke Cheek Payable tes Register of Wails. Aaesst
> > BE SURE TO ANSWER ALL QUESTIONS ONlREVERSE.SlDEA~ TO RECHECK MATH t ~
penalt~ss of peryury, I dedan that I have exammsd thl: rewrn, Indudmgg accompang~ng schedb'Ye as n`d statement:, and to the best of my knowledge and belief,
e, correct and complete. I dedan that aU real estate has been nported~t~triTi marrkket value. Dedaration of preporsr other than rtes penonal representative is
on all informs ' n of p has any knowledge.
IRE OF PERS RESP NQ RETURN ADDRESS DATE
TNER THAN REPRESENTATIVE ADDRESS _ DATE ' 4
tl
Act X48 of 1994 provides for the eduction of the tax rotes imposed on the net value of fronsfers to or for
the use of the spouse. The rates as prescribed by the statute will bes
• 3°i6 (.03j will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2°/6 (.02j will be applicable for estates of deeederrts dying on or after 1/1/96 and before 1/1/97
• 196 (.Olj will be applicable for estates of decedents dying on or after t/1/97 and before 1/1/98
• Spousal tronsf~rs occurring on or after 1/1/98 wiq be exempt from inheritance tax.
BY PLACING AS CHECK IV ARK ~ r~ IN ~ AP ROPR A~ BLOCKS.
1. Did decedent make a transfer and:
a. rotain the use or income of the property transferred, ...................................
....................
b. rotain the right to designate who shall use the property transferred or its income . ...............
c. rotain a reversionary interest; or ...................................................................................
d. receive the promise for life of either payments, benefits or caref .......................................
2. If death occurred on or before December i2, 1982, did decedent within two years preceding
death tronsfer property without receiving adequate considerotionf If death oaurrod after
December 12, 1982, did decedent transfer property within one year of death without receiving
adequate considsration$ ...................................................................................................
3. Did decedent own an 'in trust for'. bank account at his oc her death ......................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr
YOU MUST C07VIPL-ETE SCHEDULE G AND FILE 1T AS PART OF THE RETURN.
SI, spl E t X30 S
REV•`I502 EX~at (12.851
' ,~ ~'~ SCHEDULE A
~`~~"" REAL ESTATE
COMMOHERiTANCE TTAXERETURNANIA
FILE
ESTATE OF
MC(30WAN, John W. 21-95-0372
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) Ali 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 willing seller, neither being compelled
to buy or sell, both having reasonable knowledge of the relevant facts.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
~• ~ None-jointly held with .spouse
TOTAL (Also enter on line 1, Recapitulation) ~ 5
(If more space is needed, insert additional sheets of same size.)
Ktv-i~u:f tx+ la.aol /w~
c
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS AND BONDS
MCGOWAN, John W. 2195-0372
(All eroaerty jointly-owned with Right of Survivorship must be disclosed on Schedule F.)
(lf more spoce is needed, insert additional sheep of same size.)
REV-3504 EXt~ (7-83)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE "C"
INHERITANCE TAX RETURN CLOSELY HELD STOCK,
RESIDENT DECEDENT PARTNERSHIP AND PROPRIETORSHIP
ESTATE OF FILE NUMBER
MCGOWAN, John W. 21-95-0372
(Schetluls "C-1" or "C•2" must be attachetl for each bustnese Interest of the deeetlent, other than a proprletorshlp.)
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 3, Recapitulation) ~ $ ~
(If more space is needed insert additional sheets of same size)
REV-1507 EX+ (7.831
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE "D"
MORTGAGES AND NOTES
RECEIVABLE
ESTATE OF FILE NUMBER
MCGOWAN, John W. 21-y5~0372
(AIl property jointly-owned with Right of Survivorship must be disclosed on Schedule "F")
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER
1.
TOTAL (Also enter on line 4, Recapitulation) I $ ~
(If more space is needed insert additional sheets of same size)
REv 1508 EXA !2.87)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
MCGOWAN, John W.
(All property jointly-owned with the Right of Survivorship must be disclosed en Schedule F)
ITEM DESCRIPTION
NUMBER
Please Print or
NUMBER
21-95-0372
VALUE AT
DATE OF DEATH
1. Certificate of Deposit -, Farmers Trust Company 11,132.90
cert if icat_e:~ numbQf~ 69035
2. Certificate of Deposit -Farmers Trust Company .8,248.11 /
certificate number 90030
3. Account -York Federal Savings and Loan Association 1.563.17
account number 010-184347 /
i rr
4. 1988 Oldsmobile Snation Wagon-serial number 1G3AJ8139JG312 68 3,050.00
(appraisal attached)
TOTAL (Also enter on line 5, Recapitulation) ~ $ 23 , 994.18
(AMach additional 8'/:" x 11" sheets if moro space is needed.)
kRv~sov ex+ jtt•eal
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
MCGOWAN, John W. 2195-0372
Joint tenant(s):
NAME ADDRESS RELATIONSHIP TO DECEDENT
A.
B.
C.
Jointly-owned property:
ITEM
NUMBE Lr~ORR
JOINT
TENANT DATE
MADE
JOINT
DESCRIPTION OF PROPERTY TOTAL VALUE
OF ASSET DECD'S
% INT. DOLLAR VALUE OF
DECEDENT'S INTEREST
1.
TOTAL (Also enter on line 6, Recapitulotion) I $
(If more space is needed insert additional sheets of some size)
REV-1510 EX~ (2-871
. ~~ SCHEDULE G
COMMONWEALTH OF VENNSYlVAN1A TRANSFERS
'ATE OF
MCGOWAN, John W.
PLEASE PRINT OR TYPE
21-95T0372.
THIS SCH EDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OFTHE QUESTION S ON THE REVERS E SIDE OF T HE COVER SHEET 15 YES.
ITEM
NUMBER DESCRIPTION OF PROPERTY
Include name of the transferee, their relationshi to decedent, date of transfer.
P
EXCLUSION TOTAL VALUE
OF ASSET DKD.
°x'
INT. OOIIAR VALUE
OF DECEDENT'S
INTEREST
TOTAL (Also enter online 7, Rempitulalion) I $
(If more space is needed, insert additional sheep of same size.)
REK1J11 EXr h.aa~ SCHEDULE H
°-'~~ FUNERAL EXPENSES,
~,~~r«
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
INHERITANCE tAX RETURN MISCELLANEOUS EXPENSES please Print or Type
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MCGOWAN, John W. 21-950372
ITEM DESCRIPTION AMOUNT
NUMBER
A. Funeral Expenses:
1. Hoffman -Roth Funeral Home 4,139.00
Westminster Cemetary - endgwment fund 115.20
Carlisle Memorial -marker, engraving and foundation 466.7L
B. Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees Flower, Morgenthal, Flower & Lindsay
3. Family Exemption
Claimant Virginia L. McGowan Relationship sP.9l~Ge
Address of Claimant at decedent's death
Street Address
City State Zip Code _
4. Probate Fees Register of Wills
C. Miscellaneous Expenses:
i• Frederick & Fair -car appraisal •
2• The Sentinel -advertising
3• Cumberland Law Journal
4• Clerk of Court, Charlotte County, Florida
5• Register of Wills - file inheritance return
6. Reserve for miscellaneous settlement expenses
7.
8.
1,250.00
2,000.00
i
74.00
25.00
65.48
40.00
2,00
^15.00
150.00
TOTAL (Also enter on line 9, Recapitulation) 8,342.40
.~. ~ '~
(If more space is needed, insert additional sheets of same size.)
REV 1512 EX• p.eB~
~~ SCHEDULE 1
MONWEALTH OP PENNSYLVANIA DEBTS OF DECEDENT
COM
INXERITANCE TAX RETURN P
MORTGAGE LIABLITIES AND LIENS
RESIDENT DECEDENT Pleaso Print or Type
ESTATE OF FILE NUMBER
MCGOWAN John W. 21-95-0372
ITEM
NUMBER DESCRIPTION AMOUNT
1• Laboratory Corp.
67.00
2. Dr. 0. Sambandam ~ 5.50
3. Dr. A.L. Gabarda 125.00
4. Radiation Therapy Center X02.99
5. Masland Associates 10.00
6. SWFRMC Out Reach Laboratory Services 41.00
i
TOTAL (Also enter on line 10, Recapitulation) S 551.49
(If more space is needed, insert additional sheets of some size.)
aevisu Ex. ~2.en +
COMMONWEAITN OF -ENNSYLVANIA
INNRtiTANCE TAX RETURN
RRSIDlNT DKEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
MCGOWAN, John W. 21-95-0372
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests.
~• Ronald L. McGowan son 50%
2. Virginia L. McGowan wife 50%
ITEM NAME AND ADDRESS OF BENEFICIARY AMOUNT OR
NUMBER SHARE OF ESTATE
B. Charitable and Governmental Bequests:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation] I $
(If more space is needed, insert additional slseets of same size]
,~`
~:'"
REV-1607 EX AFP (12-95)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX
STATEMENT OF ACCOUNT
ACN 101
DATE 04-29-96
C,IATE o~ MCGOWAN JOHN W FILE N0. 21 95-0372
DATE OF DEATH 04-28-95 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMI7 THE UPPER PORTION OF THIS FORM WITH YOUR TAX
PAYMENT TO THE ADDRESS SHOWN. MAKE CHECK PAYABLE AND REMIT PAYMENT T0: ,
ROGER M MORGENTHAL ESQ
11 E HIGH ST
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Amount Remitted
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR FILES ~
----------------------------------------------------------------------------------------------------------------
REV-1607 EX AFP (12-951 ~*x INHERITANCE TAX STATEMENT OF ACCOUNT ~~~
ESTATE OF MCGOWAN JOHN W FILE N0. 21 95-0372 ACN 101 DATE 04-29-96
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: 03-25-96
PRINCIPAL TAX DUE:.......
PAYMENTS (TAX CREDITS):
_ ..................... 4 2 5.38
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST (-) AMOUNT PAID
07-05-95 AA047960 21.27 1,200.00
04-09-96 REFUND .00 795.89-
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
* IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN S1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 1
425.38
.00
.00
.00
NOTICE OF INHERITANCE TAX ACN 101 ~'
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
HARRISBURG, PA 1712a oeo OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 04-01-96
ESTATE OF CGO N J HN FILE N0. 2 9 -
DATE OF DEATH 04-28-95 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, AGENT"
REMIT PAYMENT TO:
REV-1547 EX AFP (12-95)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
1
ROGER M MORGENTHAL ESQ REGISTER OF WILLS
11 E HIGH ST CUMBERLAND CO COURT HOUSE
CARLISLE PA 17013 CARLISLE, PA 17013
Anount Remitted
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS t
----------------------------------------------------------------------------------------------------------------
REV-1547 EX AFP (12-95) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MCGOWAN JOHN W FILE N0. 21 95-0372 ACN 101 DATE 04-01-96
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)
2. Stocks and Bonds (Schedule 8)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schsdul• D)
5. Cash/bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schsdul• F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adn. Costs/Misc. Expenses (Schsdul• H)
10. Debts/Mortgage Liabilities/Lions (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governnsntal Bequests (Schedule J)
14. Not Value of Estato Subject to Tax
(1) .00
(2) 579.24
(3) .00
(4) .00
(5) 23,994.18
(6) .00
(7) .00
(g) 24, 573.42
(9) 9,842.40
(10) 551.49
(11) 10.393.89
(12) 14,179.53
(13) . 00
(14) 14,179.53
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:
)
7, 089.76
X . 00=
. 00
15. Amount of Line 14 at Spousal rat' (15
16. Amount of Line 14 taxabl• at Lineal/Class A rat' (16) 7, 089 .76 X . 06. 425.38
17. Anount of Line 14 taxabl• at Collateral/Class 8 rat' (17) .00 X .1 5. .00
18 Principal Tax Due (lg) 425.38
.
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) p~~ ppID
DATE NUMBER INTEREST (-)
07-05-95 AA047960 21.27 1,200.00
TOTAL TAX CREDIT 1,221.27
BALANCE OF TAX DUE 795.89CR
INTEREST .00
TOTAL DUE 795.89CR
* 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" (CRI, YOU MAY BE DUE
~•
REV~1470 EX 16881
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 2 8-060 1
DECEDENT'S NAME
SCHEDULE ITEM
NO.
_, ,,
INHERITANCE TAX
EXPLANATION
OF CHANGES
FILE NUMBER
21•`;-~37~'
ACN
I i"t 'l
EXPLANATION OF CHANGES
_ ~-~ _,.Cty E~:c:C'_Ct3.7c ,_c31ii'tF31"~j ~'~y 1•;t~iy L:'E f 3i"~7.Zj'
tL'P 11' y ~Df3 .wt~5 c~ ,lE"blr.'ii'.l 1i1CrEE351T1 111E 2;:iOl Rt Of I: ?C' C.l.il,. L iS?i ~ ~'~ y ~)r!1~'
TAX EXAMINER: "arc i.; ,:~i1 r>rrla:;
PAGE