HomeMy WebLinkAbout01-0035
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITiAl) \lte ;lblar\~ ~ 10 sep;Jf31ewonJ$
TtI A('.)! ii? T TI ell t< (J L A
s~'A~7'TYT;RG 16'607 I OAT:;~~~_;Zt'(lP I oATE~':HI s--/ 9~ I
:7~;8L;;;;V';G ~~ES N; ";;:;;100; I soc;' ;::Y T~ B I ij-u 6: THIS RETUR~~~;;;~~E~; :;~~:TE WiTH THE
~ 1. Original Retum 0 2. Supplemental Return 0 3. Remainder Return (data of d&<1th ~ict 10 12_13-82)
o 4. Limited Estate 0 4a. Future Interest Compromise (dale of death after 12.12.82) 0 5. Federal Estate Tax Retum Required
o o. Decedent Died Testate (AUar;h CO!lV of Will) 0 7. Decedent Maintained a living Trust (Altacl1 copy of Trust) _ 8. Total Number of Safe Deposit Boxes
o 9. Litigation Proceeds Received 010. Spousal POIIe!ty Credit {da\eo!dea\hbelwean12.~1.91 and \-1-95} 011. Election Iota>: under Sec. 9113(A) (AlladlScn0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLElE MA1UMG "'OORESS
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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FIRM NAME (1IApplicable)
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TELEPHON~.tM~8~ ,,._
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1. Real Estate (Schedule A}
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation,Partnership Of'Sole-Proprietorship (3)
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4. Mortgages & Notes Receivable (Schedule 0)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly OWned Property (Schedule F)
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G Of L)
8. Total Gross Assets. (total Unes 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedef11. Mortgage Liabilities, & Lief1$ (Schedule I)
11. Total Deductions (total Lines 9 & 10)
:;:UjSERj () t I 00 ~::-
!?/CJ BtIlXI}Aw/)p/) ,,-ANd
O/IJ;fJ /I IL-L- I /-111 170//
(1)
(2)
go, /73 Of)
(4)
(5)
If, J./fJ.. "(7
(6)
(7)
(9)
(10)
(8)
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(11)
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12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental BequestslSec 91 t3 Trusts for which an election to tax has not been
14. Net Value Subject to Tax (Line 12 minus Line 13)
15. Amount of line 14 taxable I
at the spousal tax rate
See instructions on reverse re to< aoolicable oercenla<le
16. Amount of line 14 taxable
al6%rate
17. Amount of line 14 taxable
al15%rate
(12)
(13)
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(14)
8'..t.. 5/1
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8),,5/1100 I xl
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01
(15)
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,06
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(17)
(18)
:1-1
,15
1R Tax Due
19. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SlOE ANO RECHECK MATH < <
Under ?ena\\ies ol peTjury, I i1eclare !hat I have examined this return, including accompaf1ying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete. Declara~on of preparer other
than the De1!;onal reoresent:Jlive is ba~ed on all information of which Orl'!rlarer has anlmowledoe.
SIGNATUR 0 ERS RE ONSIS FOR FILING RETURN AD9,RESS
'if 19
(!
ADDRESS
DATE
I J/ 3tl/ t!?;p
DATE
D
d t C
J t Add
ece en s ample e ress:
STREET ADDRESS ~/q BJ2rlJ!< IV()()/J L-I1Ne"
CITY {If} /YJ P ;iXLL I STATE P Ji I ZIP I?/?//
Tax Payments and Credits:
1. Tax Due (Page 1 Line 18)
2. Credits/Payments
A Spousal Poverty Credit
(1)
o
B. Prior Payments
C. Discount
3. InteresUPenaity if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C) (2)
o
TotallnteresUPenalty ( D + E )
4. If line 2 is grealer than line 1 + line 3, enter Ihe difference. This is the OVERPAYMENT,
Check box on Page 1 Line 19 to request a refund
5. If line 1 + line 31s greater than line 2, enter the difference. This Is the TAX DUE,
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + SA This is the BALANCE DUE.
Make Check to: REGISTER OF
(3) 0
(4) 0
(5) 0
(SA) 0
(58) 0
AGENT
THE
BY PLACING AN X IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;........h...................... .......................... 0 ~
b. retain the right to designate who shall use the property transferred or its income;............... 0 00
c. retain a reversionary interest; or ................................ ......................,......... ...u................... 0 ~
d. receive the promise for life of either payments, benefits or care? ................................ ....... 0 ~
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?...............,................ ........................._...... ........................., 0 ~
3. Did decedent own an win trust for" or payable upon death bank account or security
at his or her death? ................................ ................................ ................................ ................ 0 ~
4. Did decedent own an individual retirement account, annuity, or other non-probate property?... 0 t8:l
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
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72 P.S. ~9116 (aJ (1.1) (i) provided for the reduction of the lax rate imposed on the net value of transfers to or for the use of the
surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995.
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 exemot 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 piacing an "x" in the
appropriate space.
Did the decedent create a trust or similar arrangement which is solely for the surviving spouse s benefit for his or her enUre
lifetime? Yes 0 No g;j
If you answered yes to the above question, the tax on the trust or similar arrangement is postponed until the death of the second
spouse, at which time it will be fully taxable at the rate(s) applicable to the remainder beneficiary(ies). Enter the value of the trust on
Schedule J, Part II, in order to remove it from the calculation of the tax due in this estate. You may wish to file Schedule 0 in order to
make the election available under Section 9113. If the election is made, the trust or similar arrangement is taxed in the estate of the
first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero tax rate,
and the remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies). If you choose to make the election, you must
attach Schedule 0 to a timely-filed tax return, along with Schedule(s) K and/or M in order to show the apportionment of the trust or
similar arrangement between the surviving spouse and the remainder beneficiary(ies).
"",."'''''''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
(!IJ~I)L A, -r1l1<e.1/6rrr
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F>
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VALUE AT DATE
OF DEATH
J 3 ~ 2.615,(10
Iff.; 1o? 00
ITEM
NUMBER
1.
DESCRIPTION
'k
TOTAL (Also enteron line 2,Recapitulation) $ 130 J'l'3 . Pt7
(1f more space lS needed, Insert addItIOnal sheets of the same size)
~''''''..''."''\.
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ESTATE OF
(!&f(JL 1/-. if//U!I!J5711"
Include the proceeds of liliga lion and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
3.
q
s:
DESCRIPTION
V/{S !IN A/fI.rTY !I '1- 3'l~8J
(;1J. fjV (f f t IfL rIAl /t# ~ rlH ct (lC(fJ)
/YIrst~LLIIA/;;oRS :5 ~WEL;< Y
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/fs5t1I<.I~ t!..()1714Jr; Y- fJlf/ft!<.EL
VALUE AT DATE
OF DEATH
1#?I/~~'otI
3/ o::rt? 0;
/, CJtif). a
~ttl.oa
:3 t10~~P
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TOTAL (Also enteron line 5. Recapitulation) $/~ ).'';'2.. ()/J
(If more space IS needed, Insert addItIonal sheets of the same size)
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COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
C 1iA.&/...
//...
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Debts of decedent must be reported onSchedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: I ~/??: 00
1. fVJ..the:'E5S:Z"OhlfL ~V~~&:51 rl1rrJ.J. ,.a-S t?"tftl~IJI.!!lfI r
~. C/t5lfFT ~Nb YIlIlJ-r '7 .5:J ~.Oo
3. fJ1r~u:t_/.A"lJ!;:FtJII5 clJ~/ fIr1f};~gr.s "/ ~tJ~
~. P~~b ftND l2p-pp.es;l~tJW7S (JlM~AI(S R;;iS/.) l/r~~.t?tJ
/"
~f I11AM'~ I '2--5'"~ /JZJ
G. /?fl! '5Jf/'flfflff:5 I1Nb rOPb OJt:7MI4J I' /67).00
?, n kJ~S I 2.S: tJiJ
B ADMINISTRATIVE COSTS:
1. Personal Representative s Commissions
Name of Personal Representative (s)
Social Security Number{s} I EIN Number of Personal Representative(s)
SlreetAddres5
City Stale Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent 5 address is not the same as claimant s, attach explanation)
Claimant
SlreetAddress
City ~1:::.le Zip
Relationship 01 Claimant to Decedent
4. Probate Fees
5. Accountant s Fees
6. Tax Return Preparer s Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $/) C!/J Lf; /J/J
,
(If more space IS needed, Insert additional sheets of the same size)
~"''')'~'''''"'II.
COMMONWEALTH OF PENN5Y\'vAN1A
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
f
FILE NUMBER
I).
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trusteo(s) OF ESTATE
NUMBER
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1.
/M 71!t?NY :r: 71I,lC/fprrr
8fC! ~ ~,I}R.Wt1~~ L/JA/Er
~/J/JJjJ Jf at.. J / Ii /7171/
sfJolIS&:"' 1PWf/I/~~J"
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON.TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II . ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent flllllg.
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
1
a-., /?C~
Fee for this certificate, $2.00
Date
Local Registrar
MAY 262000
p
6647882
He\! 2187
No.
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
l.
AGE (laSl Birthday)
NAME Of DECEDENt tf'I;M"I~~- -. - -.---
8lRTHf'LACE (cry "rod
Stale QI f Cfeogtt COOrl(fV}
DECEDENT'S USUAL OCCUPATION
(Gu...1und d work done durll'lg moll
of WOfkang iii.; do not use ,ekted)
. .... Re istered Nurse "b. Nurs in
OECEOENT'S MA.'llNG ADORE-55 (Slleet. CJtyIl'own.~. Zip Code)
819 Briarwood Lane
Camp Hill, PA 17011
UNDER 1 YEAR
Month. Days
54
v..
..
COUNTY OF DfJJH
Olmberland
...
<d.
fArHeR'S NA~E (FlI'st. MK2d1e.last)
_.
METHOD OF OISPOSITtON
IIunaI ~ C'.mal'" 0
01'* (Spec"">
Carol A.
UNDER 1 DAY
Hours Winu*
E.
Ie.
WHite
SURVIVING SPOuSE
lit .we. :;)I"'" maKSet\ name)
'2.
Turchetti
DECEDENT'S
ACTUAL
RESIDENCE
(See InSIfUCbOnS
onoltlef SIde)
Pennsylvania
17.. State
I);d
-
Mine
CUmberland ..........., 11..0 :;.::-='=':::0'
MOTHER"S NAME (Fist Middle. MaJdeo Surname)
-
coly-"
111>. Counly
Joseph Lloyd Jr.
Anthony Turchetti
Marion Barrett
...
INfORMANT'S MAlt.1HG AOOAES~ tSt,eet. CltyfIown. $W... lie> C~
2...B19 Bnarwooa Ln., Camp Hul, PA 17011
PlACE Of OtSPQSlTION. Nwne at CerM\<<H'Y. C'errlatocy lOCRlON . CitylTown. Stat.. l"ip Code
01 Olhef PIK.
~"omSt.f.O
o
2.r!Yaning Cemetery
NAME AND ADDRESS OF FACILITY
2.~aning, PA
ACTING AS SUCH
lICENSE NUMBER
012755-L
Ub.
10 ttw bNl 01 my knowledge, death occurred allhe lime. dale and ptaee slated
<S9na'Uf& and llUe)
....
ItJieOF
t3b. 23c.
WAS CASE REFERRED TO MEOtCAl EXAMINERlCORONfR?
"" 0 No 6!l
'0 DO
>e.
I AppIo.unat.
:=:=:
I
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PART U: Oth<< siQntftcanl concfiCtons ~ '" death. but
not f'8S4Jllingl in the ~caUM given in PART I.
\J(.'-":J,c-~ ~
DUE 10 COR A CONSEOUE NCE Of)'
iJ. u:4-J. L
OUE1O'OR'S'C~Of)'
l't-J.~ 1b '
DUE 10 COR AS . CONSE NCE Of)'
.
WAS AN AU10PSV WERE AUtOPSY F'NOINGS MANNER Of OEATH
PERFORMED? A\WlABlE PRKJR TO ~
COMPLETION OF CAUSE 0
Of oEATK1 _..... HomICide
Accedent 0 PendmQ investtgalion 0
... 0 Nod v.. 0 No 0 SwcKlo 0 Could noli be det.rmlned 0
DATE OF INJURY
(Month. Day. 'fear)
TIME OF INJURY
INJURY 1J WORK? OESCRI8E HOW INJURY OCCURRED.
Voo 0 NoD
3Oa. 3011. M. )Dc. 3Oct.
PLACE OF INJURY. AI home. larm, sa'M', 'ac1ofV.offic. LOCATION (S"8IM. ClttflOwn. swae}
bulbng, .Ie ISpecllv)
a... :lIb. 29. 30e.
CERHflER CCt'eck only onel
.CERllFYlNG PHYSICIAN IPhySIC"'" Celll'Ylng cause cJ death whet" .lnQlher phySl(:.an hdS plO(lounced dealfl afl{) compleled fletn 2Jl
To Ihe beet o. my knowlecfge, death occurred due to'" taUH(I).nd manne,.. ,tatect. .
DAre StGNED (Month. Day. Yeatl
o 31c. .i.", C.(, '" L 31.. iM. 1 1..-".....
NAME AND ADDRESS Of PERSON WHO COMPLETEO CAU DE
(llem27\TypeOlP'int /)12... ~ OSel'N A. Tot1crJu")
;)07 ,..J""se- l'JoJ~.
CAM' J-l.tt JI'A.J70 IJ
;~ft'O
r
.PRONOUNCING AND CERTIFVING PHVSICIAN (Ph~ran ~~ Ol'OllOl.Joe'og oedth dod cendy.ng 10 cause Ol deatfl\
To the Met o. my kno.ledg;~. death. oceuned at 1he Ume. dal.. ~nd place, Ilod due to the cauM(a) .net manner u slilled,.
'MEDICAL fl(AM,NERlCORONER
On the b..i. of ...minaUon andJOt inveslig..lion. in my opinion. death occurred at the time. date, ~nd place, and due to the C8use(a) and
manner .s st.ted. . . . . . . . .. .. .............. . . . . . . . . . . . . . . . . . . . .. ....,... _ > . . . . . . . _ . . . . . , . . . . . . . . . . . . . . . . . . . . . .
'11..
REGISTRAR'S SIGNATU~E ANO NUM8ER
JJ
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESS"ENT OF TAX
/
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
C~TY
ACN
ANTHONY J TURCHETTI
819 BRIARWOOD LANE
CAMP HILL PA 17011
I;
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03-12-2001
TURCHETTI
05-24-2000
21 01-0035
CUMBERLAND
101
Allount Rellitted
*'
REY-1547 EX AFP 112-00)
CAROL
A
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 ~
REV=i5'4j-EY-AFP--n'2':OOY-NOYiCE--OF-YNHEifiTANCE-YAX-APPRAisEMENT-,--AL1-owANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF TURCHETTI CAROL A FILE NO. 21 01-0035 ACN 101 DATE 03-12-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. "ortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/"isc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
( ) CHANGED
ll)
(2)
(3)
(4)
(5)
(6)
(7)
.00
80,173.00
.00
.00
14,242.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/"isc. Expenses (Schedule H)
10. Debts/"ortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
llO)
11,904.00
.00
(11)
ll2)
ll3)
ll4)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this form with your
tax paYllent.
94,415.00
11.904 00
82,511.00
.00
82,511.00
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
PAY"ENT RECEIPT DISCOUNT (+)
DATE NU"BER INTEREST/PEN PAID (-)
82,511.00 X 00 = .00
.00 X 06 = .00
.00 X 00 = .00
.00 X 15 = .00
ll9)= .00
A"OUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ..CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
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