HomeMy WebLinkAbout01-0671
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
1(0 - 2 t-f '-1-- r(
21-01- (01/_
REV- 1500 EX + {6-00}
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128.0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Schoffstall Dennis L.
DATEOF OEATH(MM-OO~YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBeR
209-50-9092
THIS RETURN MUST BE FILEO IN OUPUCATE Wl'TH THE
NUMBER
DATE OF BIRTH (MM-DD-YEAR)
REGISTER OF WILLS
SOCIAL S CURITY NUMBER
X 1. Original Return
4. limited Estate
X 6. Decedent Died Testate
3. (date of death
. Remamder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
(AttaCh copy of Will)
o 9. litigation Proceeds Received
2. Supplemental Return
4a. Future Interest Compromise (date of death after 12~ 12-82)
7. Decedent Maintained a living Trust
(AttaCh copy of Trust)
D 10. SpousalPo\(erty Credit 0 11. Election to tax under Sec. 9113(A)
(date of death between 12~3:1-91 and 1-1-95) (AttaCh Sch 0)
THIS SECTION MUST BE COMPLEfEll. ALL CORRESPOIIllENCE:& CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Ro er B. Irwin Es .
FIRM NAME (If Applicable)
60 West Pomfret Street
West Pomfret Professional Bldg.
Carlisle, PA 17013
IRWIN McKNIGHT & HUGHES
TELEPHONE NUMBER
R
E
C
A
P
I
T
U
L
A
T
I
o
N
1 249-2353
1. Real Estate (Schedule A) (1) None
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, Partnership or (3) None
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule 0) (4) None
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 4,921.28
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) 319.50
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
(Schedule G or L)
B. Total Gross Assets (tota' Lines 1-71 (B)
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 11,175.40
10. Debts 01 Decedent, Mortgage Liabilrt!es, & Uens (Schedule 11 (10) 154,381.64
11. Total Deductions (total Lines 9 & 10) (11)
12. Net Value 01 Estate (Une 8 minus Line 111 (12)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject 10 Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(160,316.26)
OFFICIAL USE ONLY
5,240.78
165,557.04
(160,316.26)
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. !::Hl;l;f<j,ll;lll;.lfY<lV,MIll'\llQl.lES
x o 0 (15) 0.00
(160,316.26) X .045 (16) 0.00
X .12 (17) 0.00
X .15 (lB) 0.00
(19) 0.00
Nil OF AN OVlliRPAVWEIIlT .'
ESTIONS ON REVERSE SIDE AND TO RECHECK MATH < <
Copyright (el 2000 form software only The Lackner GroUp, Inc.
FOfm REV-1500 EX (ReI(. 6~OO)
Decedent's Complete Address:
STREET ADDRESS
561 Meals Road
CITY I STATE I ZIP
Gardners PA 17324
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits ( A + B + C) (Z)
0.00
3. Interest/Penalty jf applicable
O. Interest
E. Penalty
0.00
Total Interest/Penalty ( 0 + E) (3)
4. If line 2 is great&r than line 1 + Line 3. enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than line 2. enter the difference. This is the TAX DUE. (5)
A. Enter the interest cn the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN
1.
{
IN THE APPROPRIATE BLOCKS
No
~X:
XI
X
';,'x'j;
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 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 ather non-probate property
which contains a beneficiary designation?
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Yes
~
o
o
o
IT]
ITl
ITl
Under penalties of perjury, I declare that 1 have eKamined this return, including accompanying scheduJesand statements. and to the best of my knowledge and belief. it is true,
correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knOWledge.
SIGNATUREOF PERSON RESPONSIBLE FOR FlUNG RE;:TURN Anna May Schoffstall
561 Meals Road
. - - - - - - ~ - - - - - - - - - - - - - - - - - - - - - ~ - - - - ~ - - - - - - - - - - - - - - . - - -
Gardners, PA 17324
IRWIN McKNIGHT & HUGHES
60 West Pomfret Street
- - - - - - -. - - -- ~ - - - ~ - - - - - - - - - - - - ~ - ~ - - - - - - - - - - ~ - - --
Carlisle, PA 17013
DATE
7/16/01
DATE
7 (1I~!r/1
For dates of death n or er July 1, 1994 and before January 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% 72 P.S. 9116 (a)(1.1) (i)l.
For dates of death on or after January 1. 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 9116 (al (1.1) (ji)]. The statute does not exempt a transfer to a surviving spouse from lax. and the statutory requirements for disciosure 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 July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one y.ars of age or younger at death to or far the use of a natural
parent. an adoptive parent. or a stepparent of the child is 0% [72 P,S. 9116 (a) (1.2)).
The tax rate imposed on the net value of transfers to or for the u~e of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.$. 9116( 1.2)
[7< P.S. 9116(aXl)j.
The tax rate imposed on the net value of transfers. to or for the use of the decedent's siblings is 12% [72 P.S. 91 16(aX 1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoptIon.
Copyright (c) 2000 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6-00)
AEV.1508 EX +(1.97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE T/J.XRETURN
RESIDENT DECEDENT
ESTATE OF
Dennis L. Schoffstall
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
SSIf 209-50-9092
01/16/2001
FILE NUMBER
21-01-
lndude the proceeds of litigation 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
DESCRIPTION
1988 Ford Pickup Ranger Shortbed - 4 cy1;2.3 Liter; automatic; 2
wheel drive
VALUE AT DATE
OF DEATH
1,600.00
2
1985 Honda ATC 125M
660.00
3
1987 Polaris Cyclone
875.00
4
IRS, 2000 income tax refund
434.00
5
Musselman's - final payroll
1,352.28
TOTAL (Also enter on line 5, Recapitulation) $ 4,921.28
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems. Inc. Form REV-1508 EX (Rev. 1-97)
REV-1509EX ~(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dennis L. Schoffstall
SCHEDULE F
JOINTLY -OWNED PROPERTY
SSfl 209-50-9092
01/16/2001
FILE NUMBER
21-01-
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
A.
SURVIVING JOINT TENANT'S) NAME
Anna May Schoffstall
ADDRESS
561 Meals Road
Gardners, PA 17324
RELATIONSHIP TO DECEDENT
mother
B.
c.
JOINTLY -OWNED PROPERTY,
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank DATE OF DEATH DECD'S VALUE OF
account number or similar Identifying number.
NUMBER TENANT JOINT Attach deed tor jointly- held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1 A 04/01/79 PNC Bank - checking 638.99 50.00% 319.50
TOTAL (Also enter on line 6, Recapitulation) S 319.50
(If more space is needed insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1509 EX (Rev. 1-97)
REV~ 1511 EX ~ (1~97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Dennis L. Schoffstall
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
1.
SS# 209-50-9092
01/16/2001
FILE NUMBER
21-01-
DESCRIPTION
AMOUNT
1
FUNERAL EXPENSES,
Gibson-Hollinger Funeral Home
6,915.40
ADMINISTRATIVE COSTS,
Personal Representative's Commissions
Name of Personal Representative(s}
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
3.
Attorney's Fees IRWIN McKNIGHT & HUGHES
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Anna M. Schoffstall
Street Address 561 Meals Road
City Gardners Stale PA Zip 17324
Relationship of Claimant to Decedent mother
750.00
3,500.00
4. Probate Fees
S. Accountant's Fees
6. Tax Return Pre parer's Fees
7.
1
Other Administrative Costs
Register of Wills - filing fee
10.00
TOTAL (Also enter on line 9, Recapitulation) $ 11,175.40
(If mare space is needed, insert additional sheets of the same si2e)
Copyright (cl 1996 farm software only CPSysterns, Inc. Form REV-1511 EX (Rev. 1 ~97)
REV-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dennis L. Schoffstall
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SS!I 209-50-9092
01/16/2001
FILE NUMBER
21-01-
Include unreimbursed medical expenses.
ITEM
NUMBER
1 Beacon Medical Group
DESCRIPTION
AMOUNT
775.00
2
Bronstien Jeffries PA
530.00
3
Burick Internal Medicine Assoc.
770.00
4
Carlisle Hospital
45.80
5
Farrell Plastic Surgery PC
139.20
6
PA GI Consultants
445.00
7
Pinnacle Health Hospital
150,672.34
8
Pulmonary & Critical Care Medicine Assoc.
505.20
9
Retina & Oculoplastic Consultants
198.00
10
Robert C. Cairns Tax Collector - 2000 personal school tax notice,
221.10
11
Stott & Stott Financial Services
80.00
TOTAL (Also enter on line 10, Recapitulation) S 154,381.64
(If more space IS needed, Insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97)
REV-1513 EX + (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dennis L. Schoffstall
NUMBER
I.
SS/I 209-50-9092
01/16/2001
RELATIONSHIP TO DECEOENT
Do Not List Trustee(s)
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116(aXl.2)]
Anna May Schoffstall
561 Meals Road
Gardners, PA 17324
Mother
FILE NUMBER
21-01-
AMOUNi OR SHARE
OF ESTATE
remainder
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE. ON REV 1500 COVER SHEET
II. NON- TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- 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)
Copyright (c) 2000 form software only The Lackner Group, Inc.
0.00
Form REV-1513 EX (Rev. 9-00)
LAST WILL AND TESTAMENT
I, DENNIS L. SCHOFFSTALL, of South Middleton Township, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
1. I direct my executrix to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
2. I authorize and empower my executrix to sell any realty owned by me at my death,
and not specifically devised herein, at either public or private sale, and to give good and
sufficient deeds therefor, in fee simple, as I could do if living.
3. I devise and bequeath all of my estate of every nature and wherever situate to my
Mother, Anna May Schoffstall.
4. I nominate and appoint Anna May Schoffstall to be the executrix of this my Last Will
and Testament; she is to serve as such without bond. Should she die before my death, renounce
or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and
appoint Beverly A. Wannyn, as substitute executrix, with the same powers as are given herein to
my executrix, and also without the filing of any bond.
5. I hereby suggest that my personal representative retain the services of Irwin,
McKnight & Hughes, as attorneys in the settlement of my estate.
~.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of
December, 2000.
~ft1IVWv L
If~'
Sd,~~
j DENNIS L. SCHOFFSTALL
/W,t1Vk
(SEAL)
Signed, sealed, published and declared by DENNIS L. SCHOFFSTALL, the Testator
above named, as and for his Last Will and Testament, in the presence of us, who at his request, in
his presence and in the presence of each other have subscribed our names as witnesses hereto.
\ a ,pi ~1jjMU
/~'".,~^\ \ ~
/ . -
2
ACKNOWLEDGMENT AND AFFIDAVIT
WE, DENNIS L. SCHOFFSTALL, ANNA M. SCHOFFSTALL and BEVERLY
WANNYN. the testator and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testator signed and executed the instrument as his Last Will, and that he had signed willingly,
and that he executed it as his free and voluntary act for the purpose herein expressed, and that
each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and
that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of
sound mind and under no constraint or undue influence.
l.k-
be"/l"'l~ L Svl, o/(l~e
DENNIS HOFFSTALL
/F !;iH<'t!;'
~:;~~FF~~:: //~ -f-;.L(
---0
'B~~ \}J~
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by, DENNIS L. SCHOFFSTALL,
the testator herein and subscribed and sworn to before me by ANNA M. SCHOFFSTALL and
BEVERLY WANNYN " witnesses, this 14TH day of December, 2000.
(/1r
Notary Public )
3dc,---
Notarial Seal
Roger B. Irwin, Notary PIlbIlc
Carlisle Boro, Cumberiand County
My Commission expires Oct. 3, 2Oll4
Member, PennsylvanlaAssoclallonofNctarfes
~?2-.:ml trl:,?1
0PNCBAN<
Decedent Reporting
Firstside Center
P7-PFSC+F
500. f'ifstAvenue
PittsbW1!f>, PA 15219-3128
Mareh22,2oo1
R.o&er B. Irwin
60 West POlDfret Building
Cariisle> PA 17013.3222
RE: Estate of Dermis L Schoffirtal. Deceased
SSN: 209-50--9092
DOD: 1116/2001
Dear Mr. Irwin:
Please find the date of death balances you have f'lC:qucstod listro below.
CHECKING ACCOUNT
Ml4ll19tl697
DENNIS L SCHOFFSTALL
ANNA M SCHOFFSTALL
DQD Balance: $638.87 + $0-12 acaued interest
IDlerestPaid 1il/2ool-1116/2001 - $0.00
Pag.;! of2
A IJN'mber otThe PNe Rl'lllndl. Sfni('l:l Gn:lwp
PNC B;lnk NA Pilt><burgh Pe"'Ml<l~;a 1S:li5
03/22/01 08:53
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Our offICe cmJy provides date of death balances for IRA'I, CD's,. Checking and
Savbtgs accounts. We do!!Q Ftnandal TransactioDs or Statemeu.t Orden. For
Further iDfonnation plesse ealIl-800-4--BANKER or YOOT loeal PNC Bnmch ad
ask to speak with a Financial Senius Representative.
Sine<<e1y,
GrL1JlJU1h. ~
Rachelle $ciullo
1-800-762-1775
Page 2 of2
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03/22/01 08:53
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you are hereby noMed lI1at any di$QasUTe. copyfng. dfslrtlution or taking of i!I'tJ action )n relianee on the
conlans of this infom1atlon is sIrictIy prohibited. and that the documents should be ret\.lrmld to lhe PiJ'Inadlt
Health System Immodiately. In Ihis regard. W you have receIvod this FAX In error. please notifY Il& by
~te;>hane immed"l3tel:y sO that we can arrange forthe return of the original documents 10 us at nQ eost to ~u.
06/13/01 09:04
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01310I
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020701
Q4C501
0'1..201
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06/13/01
09:04
TX/RX NO.7447
P.002
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~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
ROGER B IRWIN
IRWIN ETAL
60 W POMFRET ST
CARLISLE
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
'COUNTY
ACN
08-27-2001
SCHOFFSTALL
01-16-2001
21 01-0671
CUMBERLAND
101
*'
REV-1547 EX AFP <12-00)
DENNIS
L
Amount Relli Hed
PA 170fJ.'3
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 ..
REY=is'4'-Ex-AFP-ri'2-::o1.r-No'TicE--oF-YNHEifiTANcE-7fA'x-'AppR'AisEMENT-;--ALLOWA.fcE-Cri-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SCHOFFSTALL DENNIS L FILE NO. 21 01-0671 ACN 101 DATE 08-27-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ 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. AlIOUnt of Line 14 at Sibling rate (17)
18. AlIOUnt of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS.
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. Mortgages/Notes Receivable (SchedUle D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (SchedUle F)
7. Transfers (Schedule G)
8 . Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
4,921. 28
319.50
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (SchedUle I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governll8ntal Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
11,175.40
154.381.64
(11)
(12)
(13)
(14)
NOTE:
.00 X
.00 X
.00 X
.00 X
NOTE: To insure proper
credit to your account,
submit the upper portion
of this forll with your
tax paYllent.
5,240.78
165.557 04
160,316.26-
.00
160,316.26-
00 =
045 =
12 =
15 =
.00
.00
.00
.00
.00
(19)=
.
PAYMENT KECt:rPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO'PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THI~ FORM FOR INSTRUCTIONS.)