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PETITION .'OR GRANT ()Ii' LETTERS OF ADMINISTRATION
h~~lale oj -flhka~1 D,111f0dll___
alw k"ow" as ________________
No, ,___,.gI::,__tt!i - 3 J
To:
___ _ /)('('ea,'w(/,
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Social Sct'llrily No, ~ _:; ~____ _L..J_.
Rcgister of Wills for thc
County of ~~_..__ In thc
COl1ll1louwcahh of Pcnnsylvanla
The pClhlon of the undcrsigncd respectfully rcprc.\cnts tllllt:
Your prlltloner(s), who Is/arc 18 ycars of uge or oldcr. appL.L.~__ for leltcrs of admlnlstrallon
---------.------- ---- - ....._ _ on the cstate 01'
(d,h,ll,; rende/lle lite; dtITlIIHC Ub\Cllllll; dllrill1lC l1IitlOrilalC)
the above dccedent.
D~eendent was domiciled III dcath In ___Cfi411b _________________.._ County, Pcnnsylvanla, with " ; J
h u.:l last I'amlly or principal rcsldcncc ut _!:1&_!.>JL<jp.!Y-'!_&L.----21,J;.d"'~L:L, I ? !,;J-r..
111\1 \Ire", nnlllhcr and 111'l11ldpalllY) S'nJA 1?)";'~4.,
Decendenl,lhell ,,1/ ycars of agc, dicd _,-22_,zy_..L~_._, ) 1_'1-2-__, 19__,
at~ old "t.Q,,),., /.~.L_I?~I..?_J_'L'L-_?c._""-_'t~~Z;'" 7iT. '
Decendcntat death owncd propcrty with cstil1latcd valucs us I'olllows:
(II' domlcllcd In Pa,) All pcrsonul propcrty
(II' 1I0t domlcllcd In Pa,) Personul propcrty iu Pcnllsylvalliu
(If not domiciled In Pu,) Persollul property in Coullty
Value of real estatc In PCllnsylvulllu
situated as follows:
$ .5'{j(J (/tl
$
$"
$
Pctltloller_ aftcr a proper scarch ha_asccrtuincd that decedentlcft no wlllllnd was survived by
the following spouse (if any) and heirs:
Namc
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11~A1 ""-
R~tioushlp
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Rcsideflli:
Old U!ln1
~J)d 'Y.'N"M'I
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THEREFORE. petltloucr(s) respectfully rcqucst(s) the graut of Icltel's of administration In thc
appropriate form to the uuderslgned,
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WARNING: It Is IlIogol\o duplicate \hls copy by photostAt (lr photograph.
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'OMMONweALTH OF peNNSYLVANIA. oePARTMellT OP HeALTH' VITAL ReCORDa
CERTIFICATE OF OEATH
(Coroner}
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CERTIFICATION OF NOTICE UNDER RULE 5.6! a I . I
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/;(dctl7 (' II Ir?A/~)" ~ r
Name of Decedent I () I'
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Date of Deathl II}()(J Is /99 ? \:
Will No.
Admin. No. / Cf 91./ - ()() 0 3 (
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To the Registerl
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court ~ules was surved on or mailed to
the following beneficiaries of the above-captioned estate on
I
"
Name Address
i?tJhr"~ T -:Y Jr7lJr;:"!,,-- II Sail 'if.. 'Fort \ (' P , M . ~~'I/Ij )f'l '~fj I
.
/? () hi i'L ,f,. )J? 11(1 01.... y LI,2 ()Id fo t./1) Rei &,'.1I?c!m'",' ,.
, ,
rXCh(,(,(4 J. /).J.d.t! \" h t/I.. old ~/ ()UJ II Ihl C-1r1h rot <;
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except
Datel s-.2(}. 11ft/Ii
j. ,) / ' ! iV/)J/ ;J
.f'.,.{i.,~!~ II Y//n./JA--4'
Signature
Name !?n h <' r t V IV/ ('1 r 5 h
Addr.ess ;J {. 1/~/;~';;'t'I<rI iJ!
(1/ / AJ. /772' ,)
IV !.-r1/Jd?/J'/,I) c~ __1._~
.
~ ; J
't' :(
. 1\:
Telephone!?/?) t!X(, ?i '/<I
CapacitYl, ~ Personal Representative
~,
'.
,. ~)
i~j
Counsel for personal
represen t a to i ve
'.,
II ~i
00
li'I,'
I<~
(.),
,
COMMONWEALTH Of P[N~jSYlVAN;A
DEPARTMENT Of R[VENUE
om 180601
!iARRISI~RO.:. fl" 17128,O~~I_.
OfC!OlNI'!. tll.M( IIAST, mST, MlO MIDO\II~II'I"ll
Iii itl./N.tuk-'iu;".frodll~'I-Ifo-A"O'-DI'iiid '-'IOAiii;; "''', -.
~ _:to_3__-_p-:L:.2.} ~_L_IH~f}._cl.I~.. _ 12' :J.X:.IL ~""'(_~(, ",-/~perI(Y'd_..__.._____
___c_ ~_.~'~:"~'~_C_.."':Oc,,~':."' '"''_'~~~oo~::'''''.''' _ ... 'O""~"U!~~'UM"_'_ _ n _ __ ~~OUN~::::'~'N"'~C"ON"
l!! i><l 1. Original Relurn [-,I 2. Suppl.mnnlol R.'urn LJ 3, R.molndor R.'urn
",:$l;l Ilor dolo. of d.olh prior 10 12.13.821
hlX!fSU LJ ~, liml,.d E.loIO 1140. Fulu" Inlorlll Comproml.o [) 5, F.derol Euol. To, R.,urn R.qulred
Ilor dOl.' of d.olh ollor 12012.82)
U CD [] 6, Deced.nt Died Tellale r ,I 7. Dacodenl Malntalnod a living Trull ..Q. 9, Tolal Number of Safe Depotll BoxlI
IAlloch copy 01 Will) IAlloch copy 0' TrUll)
ALL CORRISI'ONDINCI AND CONFIDENTIAL 'AX INPORMAlION SHOULD BI DIRIClID TO,
t1 ~ HAM! COMPlfIE MAIlIIIO AODR!SS
g;!j! ___ RA&t./i_Lt/.._tlJA/lSJ..____..____ L/(.. 01<1 'I (>,"', Kd
8~ wfPHoNTI1u'i1afR
_______ "~"='?1J..J}i%/~o-J2='/J~.cc7=c=~=o,,..=~_o~=~1c~n_'_'.;J~"0 f /I
II)
12 1 .~__ __ __u_
131 ~m...____.__..._____
14),__ -- "
15 )~fJ.o. < O()
'~/O.OO
A['.'.15oo ll:+ I'J;l41
/1 ~ /SJ.3.' I ~~.
fOR DATIS Of DIATH Anll12/31/91 CHICK HIli
INHERITANCE TAX RETURN _~o~:~fY~W!lITI5.CL~L"!~lIn_____
RESIDENT DECEDENT fill NUMIIR
(TO BE FILED IN DUPLICATE ~21 ''N' ('03/
WITHREGIST_~R <:)~.. WILLS) . cgU_~IV CCJ.DE_____ _ _ VE!oR
DIl.(O(Nl'~ CUMPtUf AODItf~$
1/" Old faw', t.'d
~~~dnt~~ p~ ~/73~~
1. R.ol E,'ol. ISch.dule AI
2, 5'ocl. and Bond. ISchodule B)
3. Ciollly H.ld S'ocl/Porln",hlp Inll"" ISchedulo Cj
4. Morlgaget and Nolot Recolv(lblo ISchodulo Ol
5. Cash, Bonk Deposits & MhcellanllotJl PMlonal Proporly
ISch.dul. EI
6. Jolnlly Owned Proporly ISch.dule FI
7, Tronl'".IS,h.dul. G)ISchedul. L)
8. Total GlOri Allellltololllnll 1,7)
Q, Funeral Ellpenul1, Adminhlrarlvo COlli, MhcllllaneouI
E'pen", ISch.dul. HI
10, D.bll, MOrlgog" lloblllllll, lI.nI IS,h.dul. II 1101 _ u . u. _....______~_____n_.
11. Tolol D.du"'onl (lolol Llnll 9 & 10) 111) _15_1 IJJ~ DO
12. N.I Value of E.lo'. Illne 8 mlnUl lIn. II) 1121 ~_.~..f5.".;lLO..a_____.___
13, Chorltobl. and Gov"nm.nlol D.quIlIl15ch.dul. J) 113) ________
1~, ,Nel Value Subiecllo To, 11Ine 12. mlnul line 13) ...._._..________________....J~.
15, SpoUlol Trani"" I'or dOli. of d.o,h 011" 6,30.9~)
See Intlructlons 'or Applicable Percenlago on RoversD 1I~1
Sid., Ilnclud. volu.. from 5ch.dul. K or Sch.dul. M.)
16. Amount of line 14 100~ab1D 01 6% role
(Includ. volulI 'rom Sch.dul. K or Sch.dulo M.)
17. Amounl of line 14 laKoble 01 15% ra'e
llnclude volulu from Schedule K or Schedule M,I
18, Principal 10' duelAdd 10' from line. 15, 16 and 17.)
19, Credih Spoulol Poverty Credit Prior Paymenll DlIcounl Inleret'
--_....-----_.~ + -. ..--- --.-- +_.~----.-~.-- -..-._--~---
2D, II line 19 h g"ol.r lhon Line 16, enl" Ih. dlll."n" on line 20, Thh I.,h. OVERPAYMENT.
II[J
~
,,~:J~l:~
"",,}~.w
z
C>
~
E
;
z
C>
~
....
f
.
C>
...
S
t.
NUM8ER
,
:""
;,: ~, ,I
I? 31..:L.,
16). .. n ~_ ___....._____._
17)
19 )" 5L~;.L()__9___... _______
,
181.._~OO.O()
116)
----pv
.3"",
. ~-'''f.l''~'''
~L )
~,,15: c
, .
;:
': 1\8)
'. .
,-
_' ,~h)
;g~0)
~ :o:tl
._--ll>~---.---
Ii) ~)
~ ;ii'
-, ..... .-m-~1-:...'-----.-
,,, __ l'~
...C1__..._.__~~-.----
..
...' .
2:J :::.~,
__=' ___ .---j'-______.n _.__
e Q,
--~. _ -.---.-----------..
117) _
(tu,(k IWI(' II VOIl Clll' 'l'C1u(>\1I1I9 II It"une! (l' YOUI oVl'fllllynlt'lIl.
----------m7
.."J -1'7- If V
21. II line 181, A"ol" Ihon Line 19, enlor Ih. dlll."n" on Line 21. Th;. h Ih. TAX DUE.
A. Enler Ih,lnleretl on Ihe balance due on line 21A
B. Enl.. Ih.lo'ol 01 Line 21 ond 21A on Line 21B, Thh I"h. BALANCE DUE.
____.__.._.'oI~~. Check Pavobl._t~I_R.gll~.r o~WI1lI_~.~~~nl ....._____
:-------..- ---.' BI SURI ,~ ANSWIR ML QUISlIONS ON Rive... SIDI AND '0 RICHICK MA'H _ ~ <(
nder pflnollill of perjury, I declare Iholl hov. lKamlned Ihlt relUln, Including accompanying Ichedulu C1nd Ilalemonh, and to the betl of my knowledge and bell.f.
II h Irue, cotrecl and complelfl. I declare Ihol 011 realellate hat been rnporled at IrUD markel voluo, Dlclorallon 01 preparer olher Ihon the personal reptf'tnlallvl h
bafld on olllnformallon 01 which prlporl)r hot any ~nowledge,
';r:Z:lOr1)~~:tOiltij,,' '-Aio~i~i{)1'1 . r c' WI/ Rd--C.~J~d;,-c.-:~~_el:..--}l-j~~ ~"l~-L:~. J~__::
$IONA.1WU 01 rltlPARfA OIlUIt 1t1~H Itrp1I(5fN1A.11VI AiJli~(~~ OA.U
(21)
121AI
1218)
,.
.
Act '48 of 1994 provld.. for the r.ductlon of the talC rat..lmpo..d on the n.t valu. of trantl.r. to or for
the UII of the 'POUII. The rat.. a. pr..crlb.d by the .tatut. will bll
· ~i% (.03) will b. appllcabl. for ..tat.. of d.c.d.nll dvlng on or aft.r 7/1/94 and b.foll 111/96
· 2% (.02) will b. appllcabl. for ..tat.. of dmd.nt. dvlng on or after 1/1/96 and b.for. 111197
. 1% (.01) will b. appllcabl. for ..tat.. of dmd.nt. dvlng on or aft.r 1/1/97 and b.foll 1/1/98
. Spou.al hand.,. occurring on or aft.r 1/1/98 will b. exempt from Inh.rltance talC.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (~) IN THE APPROPRIATE BLOCKS.
1, Old decedent make a tranlfer and:
a. r.taln the uso or Income of the property transferred, "........''''''''''..''...''.....'''''.....,'''....''''
b. retain the right to designate who Ihall use the property transferred or III Income, "".......",,
C. r.taln a reversionary Int.rest; or ."""",,,,,,,,,,.,,,,.......,,..,,,,,,.,,....,,,,..,......,,,,..,.,.............
d. receive the promise for life of ellher paymonll, beneflll or cme' ".""..".""."".............",,,
2. If death occurred on or before December 1 2, 1982, did decedent within two years preceding
death tranlfer property without receiving adequate conllderatlon' If death occurred after
D.c.mber 12, 1982, did decedent transfer property within one year of death without receiving
adequate consideration'".,.,.............,....,..., ...,...., I...'....,.".....,..'..,...........,.....,..,........,......
3, Old decedent own an 'In trult for' bank account at hll or her death"'."........;"""".""""..,,,..
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
...
,
1I~llOIlhIH1l
w
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
PI.a.. Print ar' .
FILE NUMBER
COMMONW!A~H Of ~!NNlnv'N'A
INHIIITA CI TA InUIN
IISID NT OIC DINT
ESTATE OF
-.f2adnw. D JVI,7r~h
(All property 1J.t1y-ownod with tho ll,ht 01 lurvlvollhlp mUll bo dl"l..od on I.hodult PI
ITEM
NUMBER
.
DESCRIPTION
VALUE AT
DATE O' DEATH
'(POO.OO
600
C 1J ~h
"
,,'
I",'
'. ,
'i
. '
,. .
"
'(' '
I "
,.'
'.'
"
, "
" .,\,
..
" ,.
\, 'I"
TOTAL
s
(Allach addllla,aley,. M 11" ,h..lIl! mall ,pa" I, ,..dod,)
,
.
'''''" IX. "II, ...a." SCHEDULE H 1
~_ FUNERAL EXPENSES,
COMMONWIAl;H Of PfNN\ilVANI. ADMINISTRATIVE COSTS AND
-- _ "'~I~:~'!~~EOlf~'fW)\RN ____ .__ _ MISCELLANEOUS E_~PENS~S --.!!..a.. Print or Typ.
mATE Of jIDllUlmr
.jkJlIfI. -JJ--t!llli4_____________________I;)./ ~ " . 0 oj I
ITEM
NUMBER
----._--
A. Fun.ral Exp.ns,"
I. G,cbsorv 'Hol/lh'l~'" I:U/1Hal
'5 of {'I"rtJ.. !3<J/1,mo/"t!.. I'J v~
B,
, 3.
4.
C.
1.
2.
3.
4.
5:
6.
7.
8,
~ ,
DESCRIPTION
AMOUNT
t/tJn,e ,
1'11' #~lly s,rln7 fa
15130,00
1.
Admlnlstratlv. Cas",
. Perlonal Representallve CommlllloRl _
Social Security Number of Porsonal Roprosonlallvol ___
Voar Commllllons paid ____
2,
Attorney Feos
Family Exomptlun
Claimant
"
Relallonshlp
Addrell of Claimant 01 d"edenl's death
Street Addrell
City
State
Zip Co~e
Probate Fees
i'3~,/J~
MI.e.llan.aus Exp.n...,
"
TOTAL (Also enter on line 9, R"apltulallonl $ 51 ~ 0
(If mar. .pact Is n..d.d, In..r! additional .h.... af .am. .1...)
.. .-..
UY,UUU'+I""J
~"l,~
...~
COMMONWIAlltl O' "NNIYlYAtlIA
INNIIIIA,.C' lAIC IUUIN
11I10'NT OIUOINT
SCHEDULE J
BENEFICIARIES
ESTATE Of
PILI NUMBIR
'=
__lid
N~TJ~ER NAME AND ADDRESS OP BENEfiCIARY
RELATIONSHIP
AMOUNT OR
SHARI OF IITATI
A, Taxable BeqV"11:
I. r?db..rt V jVl3rc,A
~, () Id fC)I"H f?J
(j-ardi7e,..~ p~ 173:2.'"
f'iJ1 he~
-
~'O() .0Cl
ITEM
NUMBER
NAME AND ADDRISS OF. BENEPICIARY
. AMOUNTOR
SHARI OF IITATE
Q, Charllable and Governmental Beqv..",
I.
,--
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (All. enter on line 13, Recaplivlatlon) S
II' mar. Ip.ce II n..d.d, In.." oddltlonollh..tl o'lom. II..,
.') ~ -
II / 'f'), /
I I ,.
II R!V-1S47 EX AFP (12-94*
~' COMHONWEAltH OF PENNSYLVANIA
OEPARtHfNt OF REVENUE
ftUREAU OF INDJVIUUAl fAMES
DEPt, 280601
UARRIUUAD, P. 17121.0601
!STATE OF MARSH .- R FILE NO.
DAT! OF DEATH 11-13"93 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAM
PAYHENT TO THE REGISTER OF WILLS. HAKE CHECK PAYABLE TO "REGISTER OF WILLS. AOENT"
REMXT PAYMENT TOI
NOTICE OF INHERITANCE TAM
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
ACN
101
DAT! 04- 03-95
ROBERT U MARSH
46 OLD TOWN RD
GARDNERS
PA 17324
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
(")0
.. ("AIIDun ...tH t l
..~ '
::0
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ....
R iV: i!l47 -ii{' Ai: p""j i 2":94")" NOT i lir "oF" "iNHEiii TAN-CIl -TAX" 'A"PPR'A'iiEHENr;" Ai.lowAN"cll" Dli-" - -"....."""" -..
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
RODNEY D FILE HO. 21 94-0031 ACN. 101
ESlATE OF MARSH
TAX RETURN WAS 1 (X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL
I. Rill E.tltl ISchldul1 Al
2. Stock. Ind Bondi ISchldul1 81
3. Clo,"ly Hlld Stock/Plrtnlrlhlp Intlrl.t ISchldul1 CI
4. Hortglgll/Notl1 Rlcll.lbll ISchldul1 01
S. CI.h/8lnk DIPollt./HI.c. Plr.on.l ProPlrty ISchldul1 EI
6. Jointly O"nod ProPlrly (Schldull FI
7. Tronlflr. (Schldull GI
8. Totol Aluto
, CHANGED ~V ':
~- "
; " DATE '04"03-95
~ I,'
;-'1
-J
III .00
(21 .00
(31 .00
141 ....Q!.
151 600,00
161 ,00
(71 ,00
(8) 600.00
APPROVED DEDUCTIONS AND e~EMPTIONSI
5,162.00
9. Funlrll E.pln.I./Ado. Co.t./HI.c. E'Pln.o. (Schldull HI (91
10. Dlbh/Hcrtglgl Llobllltl../Llon. ISchldull II 1101 .00
11. Totol Olduotlcn. (11 I
12. Nit Vllul of TI. Rlturn 1121
U. Chorltlbll/Gov.rnolntol 81~u..h ISchldull JI 1131
14. Nit VIlul of Eohh Subjlct tc Tox 114 I
NOTEI If an a.....m.nt was i..u.d previou.ly, lin.. 14, IS .nd/~r 16, 17 and 18 will
r.fl.ct figur.. that includ. th. total of B11 r.turn. a......d tc dat..
ASSESSMENT OF TAXI
IS. A.cunt of Llno 14 .1 Spcu.II r.11 (151
16. Aoount of Llno 14 h..blo .t Llnl.l/CI... A r.to 1161
17. Anaunt of Llnl 14 tl.lbll .t Ccll.t.r.l/Cl... 8 r.l. (171
18. Prlnclp.l T.. Duo
TAX CREDITS I
PAYHENT
DATE
~ , I & z...n.n..
4,562.00-
.00
4,562.00"
.00
.00
.00
X .00.
X .06.
X .15.
1181
.00
.00
.00
.00
RECEIPT
NUH8ER
DISCOUNT (t I
INTEREST (- I
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
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" ICR), YOU HAY IE DUE
A REfUND. SEE REVERSE SIDE Of THIS fOR" fOR INSTRUCTIONS.I
AESEAVATIONI E.t.t.. of dlcld'nt. dvlnl an or blforl D,c.-b.r 12, 1982 ~~ if any future Int.r..t In the ..t.t, t. trln.f.rr'd
In pa.....lon or '"JoV'lnt to Ch.. I (coUlt.rIU b.ntf1al.rt.. of th" <<Mc.ant eft,r the expiration of any ..tet. for
11ft or for v..r., the COl.onwIIlth hlr'by Ixpr".lv r"lrVI. tht right to tppr.t.1 .nd ...... tran.f,r InherltlnGl 'lxi'
It thl lawful Ch.. I (calllttr.ll r.t. on .nv .uch future Intsr..t.
PURPOSE Of
HOrlCEI To fulfill thl rlqulrl.ent. of Section 2140 of the Inhftrltance and E,tftt, ,.x Act, Act 22 of 1991. 72 P.S.
SecUon 2UO.
PAVHf:HTI Ottlch the top pcrtlon of thlt HoUc. Ind .ubIIlt with your plv.ent to the R,gltter of NUll prlntlo on thl rever.. .Ide.
..Mlk. ch.ck or .on.v order ".'Wabl. tal REGISTER OF MILLO, ADENT
All p.y..nt. rec.lved .h.ll first b. appll.d to any Inter..t Mhlch IIY b. dUe with any r...lnct.r appllld to the tlx.
Rf.FUHD (CA)1 A rtfund of . hx credit, whJch 'III not "qu..ted on the Tax R.turn, "V b. requlltsd bv cOlIP1.t1nll en "Applle.tJan
for R.fund of PIM,wlvtnl. Inherltane. Ind E.t.t. Taxh IREY-13UL Appllc.Uonl .r. Iv.Ulblt .t thl Offlc.
of thl R.gl.t.r of Willi, any of the 23 Rtv.nUl Ol.trlct O'flce" or by o.lllng t~ ''''01.1 24.hour
anlllflrlng ..rvlet noMtr. for for.. arwrlnlll In Ptnn,wlvllnll l'aOO-36~.2050, outllde "enn.vlvlnl. tnd
WU"I" 10c.1 Harrhburu .r.. (717) 787.a094, TOD. (717) 772-22SZ HIt.dng Ilptlred Only).
OIJECTIOHSI Any p.rtv In Inter'lt not ..tl.fled with the .""r.I....nt, 1110Nlne. or dl..lloNtnt. of d.duotlonl, or ...~...tnt
of tlx (Jn~ludlnll dl.eount or Intlr.,tl a, .hONn on thl. ~otlc. .u.t obj.ct within .Ixtv (60) d.y. of r.e.lpt of
thll HoUr.. bYI
--wrltt.n prot..t to th. PA D'Plrt.lnt of R.vlnul, IOlrd of App..h, D.pt. 281021, HlrrJllburg, PA l71l1-I021, OR
--.l.ctlon to have the ~.tter det.r.ln.d at audit of thl ICCOunt of thl p.r.onll r.pre..ntltlv., OR
"1"p..1 to thl Orphan,l Court.
IIlIUN
1S1AATlYE
CORRECTIONS,
F.ctu,1 error. dlteev.rld on thlt a.......nt .hould bl addr...td In wrltl",. tal PA tI."trt..nt of R.l/lout,
lurllu of Indlvldull Tax.., ATTNI Po.t A.......nt Review Unit, DI"\. za06DI, H.rrltburg, PA 17Ua'0601
Phont (717) 717-650S, S.. P'," 3 of the bookl.t "In.tructlon. for Inhlritencl Tlx R.turn for. R..ldtnt
Otcfdtnt" (REY-lSOU fer In 'ICPltnlUor of tdlllnhtretlv.tv correct.bl. .rrort.
IN1ERnl,
If any tlX dul I. p.ld wlthJn thr.. (3) clllnd,r ~onthl Iftlr the d'eldtnt'. d.ath, . flv. p.relnt (S~l dl.count of
the tllC plld il tlloM.d.
Intlrl.t It chlrttd blglnnlng with flrlt dlY of d.llnquency, or nln. (" lonth. and ant (1) d.y frO' the dlt. of
dI.th, to thl d.t. ef Ply...,t. T.x.. which b.c... d.lInquent b.fer" JlnUary 1, 19'2 bltr Inter..t It thl r.t. of
.Ix (6:'0 p.rclnt per lMUlI c.leul.t.d It . dlUy ret. of ,000164, All tlX" which bloMl Hltnquent on Ind Ift.r
JlnUtry 1, 1912 will bur Inter..t It Ira" Mhleh wUl vlry fro. <:.hndtr v..r to c.linMr Yllr wlth thlt rete
Innounced by thl PA D.p,rt..nt of RIV.nul. Tht applleabl. lnt.r..t rlt,1 far 1"2 through 1915 .r'l
DISCOUNT I
!!!!: Inter..t Rlt. Dllh Inter..t F.otor ~ Inter..t Rltt DIllY Inter..t Flotor
1.11 lOX .0001'1 1967 'X ,eem7
1.11 16X .oeml 1'11'1991 m ,000161
1'1, llX ,000101 1"1 'X ,Oem7
1.11 lSX ,000116 I"S'I~ 7X ,000191
1.16 lOX ,DOOm 1"1 'X ,Oem7
"Intlr..t It cllcullt.d .. fallOM.1
IHfERElf . IALANCE OF TAX UNPAID X NUHIER OF DAYS DELINQUENT X DAILY IHTERElf FACTDR
."Any Notlc. '..utd .fter thl tlX becOM' delinquent will refllClt an Int.r..t Clloul.Uon to flft"" 01' dlY'
btVond' the d.t. of the .......ent. If Plv.ent I. .Id. Ifter thl lnt.r..t coeput,tlan dlt. .hown on the
Hotlo., Iddltlonll Inter'lt IN.t be CII~ulltld.
It '.
r!.-
STATUS REPORT UNDER RULE 6.12
Name of Decedent 1 r?,r!h f'( 0
Date of Death! 1/ - I j- 9~
W ill No.. J / - ~J 1 - -3 (
/\1Nr,~J?
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate!
1. State whether administratiDn of the estate is complete!
Yes X No
r ........
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete 1
3. If the answer to No. I 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 anYl for
the personal representative's account iSI
c. Did the personal representative state an
account informally to the parties in interest? Yes 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 attached to this report.
l) " I I')' (' -" 1
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Signature
f? 0 be I-"t V /VI (u-S~
Name (Please type or pr nt)
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Address
Date 1..L.2 ','). / - C] :;
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J.J.ill )f Y, fa - 3 17 t/ I/-
Tel. No.
Capacity, ~personal Representative
Counsel for personal
representative
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