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Home My WebLink About06-12-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT{}F REVENt1E BUREAU OF INDIVIDUAL TAXES DEPT.2$O6d1 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FRaM: INHERITANCE AND ESTATE TAX . 4FFICIAL RECEIPT Nt�. CD 0� 7�3� BYERS ELMA C 219 THREE SQUARE HOL�OW R�,1Aa NEWBURG, PA 1724Q ACN AS�ESSMENT AM�UNT CONTROL NUMBER -------- �� ------____ ___..---- 1�3 3�541 � $13.53 ESTATE INFORMATipN: Sstv: 12132539 1 $2�.49 FILE NUMBER: 2113-Q473 1�13253$ ( $1 t�.14 DECEDENT NAME: BENDER MARTHA R 12132544 ( $18.05 DATE OF PAYMENT: 06/12j2013 12132542 � $2`7.53 POSTMARK DATE: Q6/11/2013 � CoUtvTY: CUMBERLAND � DATE OF DEATH: t�5f 1 1�2012 � � TOTA� AMOUNT PAID: $95.74 REMARKS: �HECK# fi874 INITlALS: DB1 SEAL RECEIVED BY. GLENDA FARNER �TRASBAUGH REGISTER C�F WIL�S REGfSTER OF WILLS �e ■I�� A�Ill�l�rr�� Jun 03 2C113 13: 59 �ULI...II`IGER - DRVIS, P. C. t 814-260-9CI37 p. 5 PENNSYLVANIA INHERITANGE TAX suR�tu a� r�zvrntia� T,�cES INF�RMATION NOTICE FxI.E �io. 2i �"' ��' �7'� PO 3x07C 280601 enns �Y�til�l A�� AChI 121�2541 : w►Rtttsautc Pa i�iza-osaz p�pARTMEN�aFaEU�u� TAXFAYER RESPO�+lSE t�ATE t�5-22-2012 REY-754!EX 11FP t03-il) TYPE 4F ACCC1UwT EST. bF MARTHA R BENDER � savt►�ss SSN ❑ c��cxtN� � DATE t!F DEATH 05-Z 1-2012 ❑ TRUST � �, ,� �C COUNTY CUMHERLAND � CERTIF. t�,.. � --� � � � R�MIT PAYMENT AND Ft�RMS T0: E�II��, '� C BY�t3� REGISTER OF WILLS 2�.9 "`I"HR� S�If�E�OL�OVtit 1 COt�RTHt�USE SpUARE N��W�RG a.. � �' r$A 172�+0-9213 CARL ISLE PA, 17013 ' � � �: �. � � � � �.a..9 �.a.! Y--� ._..! "'� �3C � G'7 ;� � � � : � � m MEKBERS �V'�U ""'� prov'ded the department rr�th the infarmatian b�1ov. which was used in calculatin� the inheri�anee tax due. Records ind t hat the deat�f e e�ove-named decedant. you were a �aint ownerJbeneftciary of this account. 1f you are the spausa of the deceased � i�y a�t other t zero is ref7ected below un the Potential Tax Due line. note no tax may be due. but you nust n��ify th e�tartm�p of your re tionship 'ta the deceased by checking Box C in PART 1 belox and wt�tting '�spouse" in PART 2. If you belie•re he in oTniatton is incnrrect plense obtain Nrftten carrectiw► fron the ffnancial institution, attach a �opy to this fora and return it to the above addreSS. Please ca11 ?17-7�7-8327 with questions. COMPIETE PART 1 SELt}W �* SEE�REVERSE SIDE Fdl� FILIN� AN� PAYMENT INSTRUCTIt'�NS Aecaunt No. 18',1'840-43 Dat+a Cl5-12-��05 7o ensura� prodar credit to the accaunt, twa Establishad coaies of this notic� •ust acco�anr paympnt to tha Regis�ter af W311s. Make check A�ccoutnt HaI$noe $ 6{��..5�. Qavabl� to "Re�ister af Mta21s, Et�Qn't". Percent Taxable X 5Q.OOD NOTEs If tax pay�ents are Aade within th�ee All�otttlt Sub3ect to TaX �; 3(1k}.7�ti aanths of the dac�da�nt's date of death, - 7ax Rato X .0��'j deduct a 5 porcaot discount an tha tut dua. Anv inhsrftanme ta�c due will bQCOwa doli�qv�nt . Rot+�ttt�ill TiX Dus +,,� �.�.53 n5nar Aanths aft�c the data of death. �� TA�CPAY�R RESPDNSE 1 _ A. The above inforaatfan and tax duQ lt carract. Renit pay�,ant ta the Register of Wi�Ys N�#I1 tM0 copies of this notioe ta obtein CHEC� a discaunt a� svo3d intarost, ar rafiur� this notica ta the Re�ister of Irfills and �N E �n official aasessne�t will bs issued bv #hs PA Depertwent of Ravonua. BLOCK B. � TFe abare asset has been or vill tie reQOrted end tQUC paid wittt the Penr�s3r2vanaa intee�itenca tax r�etum ONL Y filad by the estate represant�,tiva. C, � The abave infa�3an is fncarr� ancVar debts and deducticsns w�tw aaid. Complete PART 2 and/or PART 3 below. PART =f 3ndia�ting s diff�r�ont tax rate. pleas4 st�ta 1�1 rel�tio'nship tc dec4dent: � TAx RETURN - CALCULATION DF TAX ON JOINT/TRUST ACCOIIHTS I.INE 1. D�te Established 1 2, pocaunt Ha1�ncQ 2 � 3. Farc�nt Taxatale 3 x 4. Au��unt Sub�dct to Tax 4 $ 5. Dob#s and Daduetions � 6. Atnourtt Tsr�cmbi� 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ PART DEB�TS AND DEDUCTI�MS CLAIMED a � DATE PAED PAYEE DESCRIPTXDN AM01JtrIT PALD 70TAL iEntar on Lins 5 0�' Tax Cowputation) ♦ Under penalti�s of per3ury, I daclare that ths faats I rQpart�d abave +are tr�a, correct and comp eta ta t � best ct' m�t khowl�edg� and beli.�f. ME1ME {F'��'� }�;y�`�� raRK c � �- -j � TAX �N j� E TELEPHOFtE NUMSER DATE Jun 03 2013 13; 56 ZULLINGER - DRVIS, P. G. t 814-�gp-gp3? �� 1 � PENNSYLYA�IA INNERITANCE TAX INFORMATZtIN NOTICE FxLE wo. ZZ�"�,�`"��„� .F INDIY2DUll� ?AXES �'��'�D1 �ryn��anj� A'N� ACN 12132539 �BU�c �A �7�z8-aso� D�,PARTMENTOFREVEMUE TAXPAYER RESPONSE DAT� 05-22-2oi2 REY-354b EIC�FF(�S•11) TYPE UF ACCOUNT - EST. OF MARTHA R BENDER � sAVINGS SSN' �] cwEC�ct►�� DAT'E O� DEATH o5•i 1-2012 ❑ zRUSr COUNTY CUMHERLAN� � CERTEF. REMIT PAYMENT AND FdRMS T0: Et.!'!A C SYERS REGISTER �F' WILL� 219 TNREE SQU/0.RE Nt�LLC1W 1 COURTHOUSE SQUARE NEWSURG PA l�'240-9�13 CARLISLE PA 17013 M..17 C� � '� � II.. � � � � . t� • "�'"� � C,� MEMBERS ls�--�U � "" � � p provided the de�rartmen, with the infiorRa.ion belaw. which was used in calculdtinQ �he lnheritanCe tax due. Recards Snd1C�t�t �#ret atpChe dcath�tl�abo�e-named decedent, yau were a joint ohnertbenefieiary of thts account. I? you tlre the Sp8U5G 01' the deceas�d snB�n�amaunt oth''� ;!�at�zera is re�'lec�ed belo�t on the P�tential Tax Due line. note na tax a�ay be due, but y�u a�ust noti fy the ��,.t�xmen�qf y� ��1adCl onshi p to the detensed by cheCki ng Bax C i n PART 1 be1 ow and wri ti n9 "spouse" 1 n PART 2. I!yau belteve�- fi ntar�n�iian�1 rr t ple9se a6tain written correcCion firor� the tinancSai insti�utiarr, attach a copy to this i4rm and return it to the ahol�ela�e�s.,�-�qleas�a�1�7$T-83?7 wtth questions. CQMPL �jPA� 1 �$ � I�N� 5EE'�EYERSE SIDE ECIR FIL.IN6 AN]'� PAYMENT IMSTRUCTIONS Accau� I�. OS3-1� � D�te 05-2`9-1984 To 4nsurs P1'oP�r eraciit ta tha �eccount. #wo W � � � Estaat�lished ccaies of this no#iea� e�ust aeco�a�er�y Aocaut� Ba Ian DaYMent to the lteqistcr of Wills. Makw chedc � y 1�1?�.3�F payabl• to "Repis�ar of Wills, Asent". PQrcQnt T�xa�hlo X Sp�qpq 5$8.67 �Q7E: If taac Qav�n4nts ere aade w3tt►3n tbr�� Asount Subject to Te�x ,$ bonths af the dQCadoht's data of dQath, : '1"�x Rit+p x' �Q(`15 deduct a 5 p�rcent discount on th�r tex dus. AnSr inhe�ritance ta�c dua wflZ b�co�o delinauant Potontial Ts�x Du� $ �6.�'"+9 nin� rronths eftgr th�t data of dQath. P�T TAXPAYER RESPONSE 1 � : A. Th• above infar�ation and t� due is corract. Ra�it payrent to !he Rar�iater of wills �rith two eocs3es afi this notice to o6tsin C H E C K a discount or avnid interest, or r�turn this notic• to Rho Re9ister of W111s and GN E an officirl ass�ssme,nt will bQ issuNd Dy tha PA DeRartAent of Revenue. �E-D�K $. � The above aastt has b�an or r�ri11 be r��orted and #ajc v�►id re9th t6e Perrnsylvania inharat�nc�► tax reture ONLY �Filad bv the astata� r�prasqntstive. C. �The ebove 3nfo � ian i� inaarr ct aadlor debts and dac�etions wa�re p�id. Caapleta PART � snQlo�PART � b�e2aw. paR� If indicatin� a difrterent tax rata• pl�ase state (�1 r$lationsbip to d+�c+�d�ntt U TAX RETURN - CALCtILATIDN QF TAlC OH JOINTITRUST ACCOUhITS �INE 1. Date Established 1 2. Account Bmlanca 2 � 3. Percent Taxabla 3 X 4. Atsount Subject to Tax 4 � 5. Debts �nd Dsduc�ians 5 6. A�wount T�xable� 6 � 7. Tsx Rata 7 � 8. Tax Due 8 � PART DEHTS AND AEDUGT�ONS C�AXMED : � . . QATE PA�D PAYEE nESCRIPTION AMCiUNT PAID TOTAI {Enter an �ino 5 oP Tax Cat�putatlon} ! Under p+�nalkies o1' porju�y, I deel�are thf�t ths f�cts I rsported abowa are tru+�, ocrract and c p eto to tho st of any kn�wl4d�e an4 baliel'. HOME C�� ,��3��'� . W�RK C ? �'�� f_�._. . A P G T TELEPH+f3NE NUMBER DATE III��I �� Jun 03 2013 13: 56 ZULLINGER - DRVI�, P. C. ( 814-260-903? p. z PENNSYL.VAN IA I WHEl2I TANCE TAX 2 TNFORMAT�Ol�1 Ni�TICE FxtE r�o, 21 �`�-�7 7"� BIiCtEAU dF IKDIVIDUAL TAXES - Pv Bax �ar6oi pennsylvania AN� I�CM 12132538 W#RRISHURG PA 17I28�OS01 pEPI1RTMENTOFRE4ENUE TAXPAYEFi RESP[1NSE DATE 05-22-2�112 NEY-1547 E%A�P tOB'II1 � TYPE OF ACCOUNT EST. C►F MARTNA Ft HENDER � SAVINGS SStY ❑ CHECKINO DATE CIF DEATH [15-11-�012 ❑ =RUSY CUUNTY CIIMBERLAhiD Q CEtZTIF. ' REMIT P/IYMENT AND FORMS T0: ELMA C BYERS REGISTER OF WIL�S : 219 THRE� SqUARE Ht7�LOW 1 COURTHQUSE SqUARE NEWBURG PA 1724D-92I3 CARLISLE PA 17L113 Ci� � La- � t3.. Q � �~ . 1�.� ..�,� � � C� � ,,.""" c� � MEMHERS 1 �I.I � provided the department Nith the infornation below. which was used in calculatin� the inheritance tax due. Records indi�c,�te hat a��he de�h�"' h� ebave-nened decedent, ,�au Nere a �aint aNnerlbene#i�iary af this sccaunt. 11 you are '�he 5p0U5� af the deceased ar��--a�ano�ln'C ot(a�r a�zero 1 s reflec�ed be1 ow on the Potenti�►1 Tax Due 1 fi ne, note n� tax �ay be due, but you nust noti�y the � ment of y��le�lonship ta the deceased by checking Box C yn PART 1 de7orr and writing "spouse•� in PA,R1' 2. If yau bsttev h�.�i�n�o��ton��`s� ��,$ct please aDt6ltt wrttten �arrectlon fr an the ftnanc101 instttltian, attech a copy to this form Bnd return it to the ab�a ess. leas'�'"ak� �7�7-8327 with questioas. � . C�MPLt��'PA 1 �E�!Q * SEE REYERSE S IDE FOR FI L IN6 AI�D �PAYMENT I NSTRUCTIONS Accau Mp�. �D 63-0� � Dato D 1-04-199 2 =o �nsur� Rroo�� cra�dit #o the accounX, two G.� � � Estahlished copies of this natica wust eeconpany �"�' � aavA�rnt ta the Repiator af V1311s. Msk• ehsck Aecou��ana`�; $ tI150.�� p�ysb2e to '•Re�fster of Wills, Agant". Po rca�t 7axabio d � 5 0.0 0 D Mount Sut��ect ta Tax �,► 2i25.24 NOTEx Tf tau payments are aade within three �nanths of the decedent's date of daath. � Tax 12ats � . 04"'jrj de�duct a 5 peresnt diseaunt on tha tax due. kr�r inheritanc�a tax dua kili bseawe drtlinquant Pot�ntial 7�x Duo $ L0. 1�1 nino wanths aftor �he d�te of dasth. �A�� TAXPAYER. RESP�NSE � A. Th� above infot�twation and taac du� is carrect. Resit DaYS4nt to the R�pister of Wi11s Mith tuo coDies vf th3s notics to obtain �H�� a discount ar aro3d inte�ext, or retu�n this notice to th� Rapis#er of Ylills snd aNE an affici.al assessAQnt will 6e isssued by #hs PA Ilapsrt�nt of Revenue. �LCICK H. � Tha� abore ass�t has 6esn or +uill be reporterd end tax paid witl� the Pennsvlv�nia inheritanca te�c return Q N L`� filad bY thQ a�ta#e repcexanta#ive. . C. � The abave infars� ion is ir►correat andlar dobts ond d+aductians rtere paid. . Co�r►plate PART 2� endPor PART � belo�t. PART If Sndicat3n�I a different tax rate, plaase �tet+� n rw2ationship to doaadent: }_,� TAX RETURN - CALCULATIOh! �F TAX oN JOINT/TRUST ACGOUNTS LINE 1, Aste Extablish�d 1 2. Account Bs2snce 2 � 3. Paresnt Taxabla 3 � 4. Maunt Sub�act ta T`ax 4 � r 5. Aebts snd Tfeduct3ons 5 "' 6. ancunt Taxabla 8 $ 7. T�x Rate 7 � 8. Tex Due 8 $ : QaRT DEBTS AND DEDUGTIIJNS CLAIMED' � • : DATE PAID PAYEE DESCR�PTION AMOUN7 PAID TOTAI. CEnt+�r on Lina 5 a4 Tax Ca�putation� � Under ponalties of pa��ury, I decld�� that the facts � raported sbeve �r+s true, corra�c# anci - comp ste to tfi� be� of �y knowiedqo and balief. HDME �� "�(� '��r: woaK c � �?�.�'�"�L TAX A I TE�EPNONE NUMBER �DATE n��.�� Jun �3 2013 13: 5? ZULLIhIGER - DAUI�, P. C. [ 914-260-903? p. 3 PENNSY�YANIA INHERITANCE TAX INF�RMATION h1�TICE F�� No. 21'"!�`7T� ltUREAU OF INDIYIDUAL TAXE� , Po sox zeacoi �ennsytvama �N� ACN 12I32540 NlU2RISBURG PA ��a��e�-oao� pppAp�ENTOFqEVENUE TAXPAYER RESPOlrtSE DATE o5-22-2012 qEV-isS3 dc+►FP ces-�1� TYPE OF ACC4UNT EST. t}F MARTHA R BENDER � SAVINGS SSN ❑ cHEC�it�� DATE 0� DEATH 05-11•2012 � TRUST COUNTY CUMSERLAND ❑ ��t��. �„�„ � � REMIT PAYMEKT AND FORMS TO: EC,M�C' � C 9YER�"' . REGISTER OF WIL�S 219��'l�REE r.�lUARE �;,.LOW 2 CDURTHOl1SE SQUARE NEW�1�� ,� ��1724d-9213 CARLISIE PA 17013 �..� ' � � c.� r� �.�� = � . -� ct� '�` � �.: �t � �`=' �y,I � �# t.?.� ''� r—i .J ""� tL' � ��.. _ #lEMHERS 15T y 1� ;� � �provided the department Mfth the infornat�on belou, which was ased in caleulatinfl the inheritance tax due, Retords indicat ha�-at t#�'Jdeath of e ove-nan�ed decedenk, you bere e �oint ownerlbenei`tctary of tFris accaunt. If you are the Spo415@ af the deceasetl �nd t�oun�C"4ther t o 1 s refl ected b�1 aW an the Pt�ten'�1 a1 Tax Due 1 i ne. nate no tex may be due, but you Aust notify the de t�nt ot your re t ship to tf�e deceased by cfiecking Box C in PAR7 1 below and wrltfng "spouse" in PART 2. If you believe � �arvna�� is int4rre�please obtain Nritten carreCtion trnn the flnarrC�d1 tnstltution, attach a copy to thts fprn and return tt to the abave dr s. ase call 717- 7-832? with questl�ns. r•...,j GQMPI.ETE PART 1 BEI.C}W �rt SEE REYERSE SIDE FDR FII.ING AND PAYM�NT INISTRt1C'i"It1NS Account Na. I83E340-0� Date 05-03-1999 Ta ansurt RroPar credit to the �ccaunt. twa� EstablisF+ed copies ot this notic+� aust accompeny AcCOUht B�1lence $d�i.35 PaSlre�t to the Roqister of Wills. Maka eheok $ aavable to °Reqiste� of Wflls, A��nt". Porcont taxabia �( 50.000 A�aunt Subjact to Tax � 401 18 NDTE� If ta7c paynants are wado rrithin thraQ • months of the decedant's data of dvsth. Tax Rat� �( .045 d�duct e 5 peFC�nt dis+count on tha taac due. Amr �nharitance te�c duar urill becus� delfn�iu�nt Pot4C►ti�l i"ax Due � 1B•�'�r' nine eanths a4ter thQ data of death. PART TA�PAYER RESPONSE U A. Tha abova infr�rwation and tax eiva ia corraet. R�wii pevsent to thw Re�istar vf Wxlls �rith txa caPies of this natiee ta ob#ain C��C� a discount or avaid intarest, or return this notic� to the Rogistor of Wiils end �N E an afficial assess�nt will b�r tssued by thQ PA D�vartwsnt cf Revenu�. BL�1�K B, �Th+� abave asset his be�n ar will bQ reaortBd and ta�c aaid with the Pannm�rlvenia inh�rMtance tax r�turn I��ILY filad !�y tha estata �op�esentative. C. � Th� abav$ infor ion ia incorrect and/ot' debts �nd daductians xore paid. C�t�late PART � �ndlor RlIRT � beloit. ' PART Lt indics�ting a� dififsrent tax rst�, plaasa sEat� Qrelatironship ta dscedent: TAX RETURN - CALGUl..ATIOlV t�F TAX ON JO�INT/TRUST ACCOIINTS tIHE 1. Dat� Eatablish�d 1 2. Ac�oUnt Balance 2 $ 3. Perc!�nt Texable 3 � 4. A�+�unt Subjeat ta Tax �€ -�. - - , `. . . � . 5. p�bts mntl D�ductions 5 ' . 6. Awaunt Tax�ble 6 � 7. Tsx Rata 7 � 8. Tax Due e $ : pq�T DEBTS ANO DEDUCTIDNS C�AIMEL! a � DATE PAID PAYEE DESCRIPTIDN AMC�UNT PAID TOTAt, tEntar an Line 5 of T�x Co�putation] # Undar penslt3as af per3ury, i d�clars that the �acts I roported abave �re true, corraot end oornplst• ta the bes of a�y knawledga �►nd beli�f. ��f� HC1ME Cf��] ) �� ...� !r�(� � _�.�,.� g t�_ WGRK C ) .� TAXPA TELEPNONE N1IMBER DATE � �...�.�.,�. Jun 03 �013 13: 58 �ULLINGER — LIRVIS, P. C. [ 81�4-260-9037 �. 4 PENNSYLVANIA INHERITANCE TAX � �r �� IN�`ORMATION NOTICE F=�E Na� Zi. J st��au aF �xD�vmua�. T�c�s PO BDX aaasoi pennsyLvania AND ACN 12�,32542 HARR25BUR�a PA ��a�-o 6ax D5FAR7MENT CrF REVENI�E TA�CPAYE R RE 5 P 0 NS E I�ATE o�-22-�oa.2 REY-ib4S EY AFP CIS-l37 � TYPE {�E ACCOUNT EST. OF MARTHA R BENDER ❑ sAVLN�s $$iN � CHECK=ht6 BATE C�F DEATH 05-�.1-2012 ❑ TRUS7 CQCTNTY CUMSERLAND � CERTIF. REMIT PAYMENT AN3� FClEtMS T0: E�MA C BYERS REGISTER OF WILLS 219 THREF�SQUARE H LLC.}W 1 CDURTHDUSE SqUARE . NE�BU�G �,� I�t 17240-9213 CARLISLE PA 17D13 C3 � � � „ C? � � � �.� s.".# t„r°�... �.s� ��a� � � � � �:c�. "a�- i�.' � . � M'Eh{�ER� lS'C�Ft'� [!) ,,,� prcvided the deP�rtment �ith the infa�mat�on be]o�, whtch was used ict calculatinp the inheritante tax due« Records lnditzt�t nt�q dea�o he bove-named decedent, yau were a �aint ownerlbeneficiary of this accaunt. If yau tt1"e th@ spouae Of the dezeased end �`�t�mau�tf'"ath rt ro 1 s retl ected be1 ow nn the Potenti al Tax Clue 11 ne. note no tex maY be due. but you �aust natify ttre d�� ent'rb"�yo��r a r�ship to the deceasad by checking 8ox G 1r� PART l hel�rt and wrlting ��spouse" in PART 2. If you believe' e�'i form n i n r please obtsin written carrection f ron the financtai institutian, attach a copy to this ibrm a�d �eturn it to the abo��q�d�ss. 8��ease cAl Si�.7g7-832T with questions. CdMPL �P"AR't'�1 BEl�QW� SEE REVERSE S�DE FflR FII.IhI� AND PAYMEHT ZNSTRUCTII�NS Accoun�q� 1 84Q-45 U Dat� D6-20-2Q05 To aasure Droper cradit to the account, trro ^ EStablished cogi.es af thia natice �aust accoipanY AaaC��lr�t $�lanC� $� 1 i22�a35 D�Qnt to thw Re�ister of Wills. Mak�► chack omrah2a tn "Registtir nfi Mtills. A�Qr�t". pa�aant Taxable X 50.000 NOT�� If tex paYaarnts are �nede wfthin #hrea An�ount Sub3ect to TaX y� ��.�..68 �onths of the decadant's deta of desth, Tax Rate �( ,0�5 deduct a 5 D�ra�nt disaaunt on the tax due. PotantiaL Tax Du� $ Z?��►3 �ny fnheritence teor duQ will bacor�e d�1S�aua�t nina Konths after tho date af d�ath. FART TAXPA►YER RESPflNSE a A, The BibOYii infor�atian and tax due i►s correct. lteeit pavwent to ths Ra9i�ske� af Wi11s M�'tN tM0 cov�.�s of this notiee to obta�n �KECK � disccunt or avaid interest. or raturn this notic� to the Rapist�+r af Wills and en offacial assess�ent wi1L ba issuad by tho PA Depertwant of RevenuQ. UNE aL�C� B_ � Yhe a6ove asse# has been or uill ba rs�arted and tauc taaid kith th�r P�rmssriv�nis fnhe�itenc� t�c return ONLY tiied by the estato revr+�sentativ�. C. � Tha above info aan is incarr�c endlar dabts and dQductians w�re va�id. Co�plete PAR7 �.end/or PART � belo�r. PAR7 Lf indicatin9 a diPterent tax ratw, ploas�r st�te Qr�2s�tionshfp to dgcesiant: TAX RETIiRN - CALCl11ATI0N O� TAX pN JOINT/TRUST ACCOUhITS LINE 1. �atc Established 1 2. Account Hmianc• 2 $ 3. Perca�nt Taxablo 3 X i 4. Jlnovat 5ub�ect to T�x 4 � 5. DoDts and Daduct�ons 5 - b. Ar�QUnt Tsxable 6 � 7. Tax Rwta � � 8. TaX Ilu� g � PAR7 DEBTS AND DEbUCTIQNS CLAIMED L� t}ATE PAID PAYEE �ESCRIPTION ANl�UNT PAID TOTA� tEnter on �ine 5 of Tax Ccaputation� S Und�r pahalties ot per�ury► I declare th�t th�► facts I repe�te�d above �re truo cerrect and taa l�te to th ba t of my knawl+�dge and b�lief. H�KE �� ,��-�-�C r�� woRK c � - /� TA AY ATU TELEPHCINE NUMBER DATE l: . �' '� C ••• t.:? ►_. 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