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PETITION I<'OR PROBATE and GRANT OF LETTERS
Estate of .J1Lm~-,-t{\ (l~ { No, a;J I-"I.~-.!t..
also known as To:
- Register of Wills for the
Deceased. Counlyof CUMBERLAND in the
Social Security No. <? 0 q - 1.2,--:1lL/ ~. (./ Commonweailh of Pennsylvania
The petillon of the undersigned respectfully represents that:
Your petltioner(s), who Islare 18 years of age or older an the execut'" ,
In the last will of the above decedent, dated
and eodlcll(s) dated
named
,19~
(Slate rCICYlllI1 clrclIJ1\stances, e.g, renunciatIon, death of c,<cculor. etc,)
r 1 \' 0u(Vd;)hla.ncl
Decendent was d?mlclled at death in Y III \~: TTj . Co\!nty, Pennsylvania, with
h , last family or principal residence at-.:2J"-l_l-!.t.:d J1'1(( I ~+
":::lfll'pptl\~hl!.i!i...:'I1L"--_ __
U (lIst weel, number illld mllnciplllity)
~0~?Cr.Ye~Ofage'dlebl!(~il ~C\nU(l'~ _, 19Cf~ ,
al nl: , .-- h.l~ ( '__ ,
Except as follows, e 'edent did not marry, was not orced and did not have a child born or adopted
after execution of the II ffered for prohn(e; was nolthe victim of a killing and was never adjudicated
Incompetent:
Decendent at death owned property with estimated values liS follows:
(If domiciled In Pa.) All personal property
(If not domiciled In Pa.) Personal property in Pennsylvania
(If not domiciled In Pa.) Personal property In County
Value of real estate In Pennsylvania
situated as follows:
Ci J S-u ()
$
$
$
$-
WHEREFORE, petltloner(s) respectfully request!s) the J)robale of the last will and codlcll(s)
presented herewith and Ihe grant of lellers TEST AMEN I AR Y .
theron.
IlcIIRm'l\lnry: RdmllllSlrQllOn c.I.a.: .dmlnl.tralion d.b,n,c.t..,)
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OA TH OF PERSONAL REPRESENT A TIVE
COMMONWEALTH 0).' PENNSnVANlA }' I:lS
COUNTY 0)<' CUMBERLAND
The petltloner(s) above-named swcar(s) or afflrm(s) that the statemellls in the foregoing petition are
lrue and correct to the best of the knowledge and belief or pctllioner(s) and that as personal represen.
tallve(s) of lhe above decedent petitloncr(s) will well jld truly admlnlsler the estate according to law,
Sworn to or afrlrmed aud subscribed {' ' 'k. ~ ill/nUl a {JIL,J)..I.UL11 ~
before me this 14TH day of I
~ ~ /~ 19~
!..-J :/ t ./ /-'?'. .
M RY LEWIS ' ~ Ref,/sler ~
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N 21 - 94 - 54
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Estate of -Al.MA G. KINFR ,Deceased
DECREE 01<' PROBATE AND GRANT OF LETTERS
JANUARY 26. 94 . .
AND NOW 19__, In ~onslderallon of the petition on
the reverse side hereof, satisfactory pruof having been presented heCore me,
IT IS DECREED that the Inslrumenl(s) dated 1981
described therein be admllled tll probate and riled of record os the last will of
ALMA G, KINER
Rnd Lellers ____--TESTAMENTARy
. Rre hereby grantcd to KATHERINE ~NN SWARTZ
FEES
Probate, Lellers, Etc, ...,...., $
Short Certlflcates( 1) . , , , . ,. , ., $
. ~nelallon ................ $
- $
TOTAL _ $ 4~.OD.
Filed ...... JM(~~RY..~Q. ..1.~ 9L .. .. .. ,
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3.00
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ATIORNBY (Sup. Cl, 1.0. No,)
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ADDRBSS
--'
PHONB
Mailed letters. and order to Executrix on 1.2Q-94.
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WARNING: It Is Illegal to dupllcalo Ihl8 copy by photostat or photograph.
2080341
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COMMONWIALTHS, p!NHlnIllHIA' DIPA~TMIHT Of' HULTH' VITAL ~'CORDI
CERTIFICATE OF DEATH
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21 - 94 . 54
REGISTER OF WILLS OF CUMBERlAND COUNTY
OA TH OF SUBSCRIBING WITNESS
td~~(!1[lvj.,.,{.
, codicil ()
(each) a subscribing witness 10 Ihe will presenlcd herewith, (each) being duly qualified according to
law, depose(s) and say(s Ihat i7 ::.L / j ){J .., present and saw
, ,
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the testatl .. 1 , sign the same and that T signed as n witness Rtthe
request of testalLi...lL. In hU._ presence IInd (In Ihe presence of eRch other) (In Ihe presence of the
other subscribing wltncss(cs)). ) _ . \ (i
Sworn to or affirmed and subscribed before "-1, (1/ h ~ Ji 4Jl.l' (( ~J f (1 ~"1
me Ihls _. 14TH _ day of (), (~Rme{J '
. ~ NUA Y 19~) "l3~:LI;.'O(/(fJJlfi'-t.dj1J"rrJ".1 iJ.,.,1.71' Pi+- .
:. '(.(.rl..~ UIAddrcss) U
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IMARY C, LEWIS
(Name)
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REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON.SUBSCRIBING WITNESS
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I
(each) a subscriber hereto, (cae
hJJ IS
being duly qualified acco ng1Jaw, depos~(s) a" say(s) Ihat
familiar with the slgnalure of . mil. (" k I 1'1.4 ( ,
,'6lliell-
subscribing witnesses (0) the will
leslall..l.L of (one of the
presented herewllh and
codicil
believes Ihe signature on Ihe will Is In the handwriting of
-I
_lllmL-G. II LMr
10 the best of _~ knowledge and bcllef.
Sworn 10 or Rffirmed and subscribed before
me tbls 14 T~ day of
NUA Y 19.......M...
that
0W/H't.j ~ ~W'lt'~J;'
(/
_, (Name
;}.Jilli"elldt'^, 'oad S'hi ppe'JStlltyJ PI1
(Address)
,r
ReI/Isler
(Name)
(Address)
t
r
,
CEIlTIFICATION OF NOTICE UNDEIl RULE 5.6 ( a)
Name 0 f Deceden t I_..ill (\~ t.i. n, ~ (lQ(
Date of Deathl I .- L\j.. (I~I
Will NO.-.::.! \_C/Lj.-5~ Admin. No.
To the Registerl
I certify that notice of beneficial interest required by
Rule 5.6 (a) of the Orphans' Court Rules was served on or mailed to
the !OlloW/ing beneficiaries of the above-captioned estate on
,'fIII.(IY I
Name
~J.Lk i' e \/\)0 112
~J1w SW(,lh.
c::: c
-('-)hll((,/) eJfu, 11 ~L
QoctLStQ/l\ e \/ V-J () I h
. 0 (
Notice has now been given
Rule 5.6(a) except
Address
---
']DIJ Urb1(m21c1~' N,\,\). jLlen(\I(,VC\, J,~/&D
,j,,?l/ kiQIlr.!'118J2d, Shlrp.Dl1sJ~1Llj' 'Pit 11~S7
dDIt>c ~a( _~din~1 Oal,:(O((\IIL ~~:j
3,') 14)1J?J.L_-_Shlr~LJ...Q!;)1
to all persons entitled thereto under
Datel~
-'i~tJ .
\ - II JlUl 0._
Slgna'tJr.e
Name~ 41\lrJ ;)IV(l,rf'L-
Address ,~ i3 L/ {21! orL (13 ~cI .
.~Lupp.Q (\.<;,~U( r;y eA I '7,) ~1
Telephone('llll ~") ')).- 3~~<[
,Capacity I ~ Personal Representative
o ILL. l) IJ--d dt'o--
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1'1
U.
.~ f.e
',jd..
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f.; n: F~A' ,:}; ~
r.r. (5u
_.___ Counsel for personal
representative
. .
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.., __ __._.. ~~ _~.. .._.._ __ ._. _.. ...._.. ~ _.;__ __'_._ __. ~__ _._... __ -:.-. __ _ ___ _ _.._ _ ___ _~ _ _ _ -J.._"
RECEIVED FROM,
I
AcN
ASSESSMENT I!'
CONTROL WI
NUMBER
AMOUNT
I,
KlrrHEfH NI! A llWARTl
E?34 READING FlU
--;-(t I
.141~
Sill PF'ENS[lURG I'A 1 '7e57
,
l:1~JN 'f!(l9-1 ~-84fl9
MI
I
I
I
'OlOHlIf~
I
,
,
I
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I
I
!
'OIOH'"
KATHERINE A. !3WAfHZ
r4 TOTAL AMOUNT PAID
.141.~e
PEt
REGISTER OFWILLS
, . ';J
,,/" ., " "
RECEIVED8Y; h/,0;d"4 'bW"'// ,) ii/.
/-!IO~A' I" Ii;;
Mt:1nV'C~ I.Elm'....., ,~~;/ ~ ,.JllfJl
m.tH BlI:H OF WI L1.\:1 !' (I
1/1
SEAL ,CHECK" 4f>1t
_ _ _ _... __ ___ ~._ ._e. _____._'__ ___ __ ~_ ..._ :-0-- -- --_. -... .-_.. __eo -- .....-. --- -- .~,~ _.- -- --'7 ---
,
, .
R!V.1JOO IX. {11.911
.. ..
,
JL( _n-y -fr
1. Real E'lalelSchedule AI ( 11.........__..._...............___..__.
2, Slack. and Bond. (Schedule BI I 21_ .._~_.._...__..__.._..
3, Cla.ely Held StacklPallne"hlp Inl"e,1 (Schedule C) (31_.__.._....__._...........__
4, Mortgage, and Nole, Receivable (Schedule 01 ( 41.._....._......_............__...._
5, Ca.h, Bank Depo.ll. & MI"ellaneou. Pe"onal Property( 51.~34~~Q...........__
(Schedule EI
6, Jolnlly Owned Propelly (Schedule F) ( 61....Q_,.."'1.li.,..~4
7, Tran.fe" (Schedule G) (Schedule LI ( 71.._.._.....~..._..
8, Tolal Grall AllOts (10101 line. 1.71
9, Funeral Expen,e., Admlnlslrative Co,", MI"elloneou. ( 91.A.....436_,lQ..
Expen.e. (Schedule HI
10, Debts, MOllgoge lIabllltle., Lien. (Schedule II (101____.
11. Tolal Deduction. (tololllne. 9 & 101
12, Nel Volue of E.tale (line B mlnu, line 111
13. Charitable and Gavernmenlal Bequo.II (Schedule JI
14, Net Value Sublect to To, (line 12 mlnu. Itne 131
15, Amount of line 14 loxable 01 6% role
(Include value. from Schedule K or Sche~ule M,I
16, Amount of line 14 taxable at 15% rota
Ilnclude value. from Schedule K or Schedule M,I
17. Principal lax due (Add lax f,om line 15 and from line 16.1
18, Credit. Spou.al Poverty Credil Prior Poymenll DI"ounl In1"e.t
.. --..--............-.. + .... --.......-..- + ......-.. ............ - ...-........---..-
19. II line 18 I. glealer than line 17, enter the dllle,ence an line 19, This II the OVERPAYMENT.
aD
20, If line 17 I. g,ealer Ihon line 18, enlelthe difference on line 20. Thl.I.lhe TAX DUE.
A. Enler Ihe Intere" on the balance due on line 20A.
B, Enter thelotal 01 line 20 and 20A on line 208. Thl. Is the BALANCE DUE.
........._..____ M~~o Choc~ Payablo t., Rogl...tor _01 Will., Agont ..
-----..--.. ... IIIURI TO ANSWER ALL QUIITIONS ON RIVIRSI SIDI AND TO RICHICK MATH....
Under penaltIes tlf ptHlury, I dedar. Ihall have e,.amln.d Ihls relurn, Including aC(ompanylng schedules and .Ialm,nh, (Ind 10 lh, b.11 of my knowledge and b.lI,f,
Ill, Iru., (orreel and complete. I declare thai all real tlllat. ho. bun reported at '/ue markel value, Declarallon of preparll other Ihon lhe penanal r.pr...nlaHv. I,
baled on nlllnformallon of which pro arer hat any knowludge,
~1~u~~',~'UJb:;SP9'ffB[ffO mIN~'L!~;U~N -"~;A~;I! (J~~'-;";I"il"(-,,' (f,~"" \{I:-l~=~~~ /(l~~-""" 0" DAfE!) I. J (1'/
!1~clHihpARrR'Ofl{~t'H N1;Alrv'fLt---"1boml........U-;uo ( .L..u_....JI- 7T,/L'i.1!.... L /dJr om-4L1pJ--
IJ , ,
i
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Il
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C~il
~
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ill
oz
U2
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8
a
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
'OR DATil 0' DIATH AnlR 12/al /9, CHICK HIRI
IP A 'POU'AL
'OVnTY CRIDIT .. CLAIMID 0
PIll NUMln
,~f
COUNTY CODE
:.
,,~ITJ.'~~
..,,1.:'r.'iJ,'
COMMQNWEAlHl Of PENNSYlVANIA
DEPAiHMENT Of REVENUE
DEPT. 0180601
HARRISBURG, PA 111019.0601
.----... ~.- M l- ,I ,'fWMIODLE IN1TlAl)
N'/i(
YEAR
s~
NUMBER
Kiner Alma G. 201 E. Ilurd Street Apt.
lbCiAi.S!CU"fi'lUM'!if--~-..TA'nifD!AT"~f!O;-.TRm----... Shippensburg, PA 17257
29J-I ~-8~~..___..__.......__......!. -03::2.4....___......12:.2.:.-25_....... c,,"'1..~~l11ber1..a.!ld
[] 1. Original nelurn [] 2, Supplemental Relurn [] 3.
[I 4. Limited E,late [J 40, Future InlorOlI Comproml.e [I 5,
(for dotel of death allel 12.12.821
[1(J 6, o.cedenl Died Te.tote [] 7, oecedonl Malnlolned 0 living TrUll
~ (Attach copy of Willi (Attach copy of Tlu.11
ALL CORRGSPONDINCI AND CONfiDENTIAL TAX IN'ORMATION SHOULD 81 DIRlCTlD TOI
M . COMPl E MAiliNG ADDRESS--
108
_8,
Remolnder Relurn
(for dole. of deoth prior to 12.13,82)
Fedelol e.late Tox
Relurn Roqulred
Total Number of Safe oopo,ll Boxos
',"'"
Katherine A. Swartz
l PHoNfNuMBfli---------.-.------.--------~-
234 Rending Road
Shippensburg. PA 17257
......LL17..J 532-3428
z
o
i
(8) 6 , 795.24
(11) ...4,436.56
(12) .1.,l18. 68
(13)
(141 ..bl58. (>8
(151.1...358&!L_____~x .06= 141.52
(161.._________...____x .15 =
(17) __l!tl....5.~
Cho{~ here if you oro INI"os..no Cl refund of your OVlHpClVml'lIl.
(181 __N.Q.tlli__
(19) ....
1201 .........l4lL5L_..__
120A) __....._._..
(2081 ___..________
----- .._--~-----. ...- -~.- - ...- --+-----_._--~----~-_.-.---~._--------~._--------..~----.----.-..---.----.----..- .
t' .
.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (...) IN THE
APPROPRIATE BLOCKS. .
c. retain a reversionary interest or "....",...,,,.,,.......,.......,,,,,........,...,.....,,,,........
1. Did decedent make 0 transfer and:
a, retain thEl use or income of the property transferred, .....""......"..........""........
b. retain the right to designate who shall use the property transferred or its Income, _
d. receive the promise for life of either payments, benefits or core? "".".....""....... __
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? ....""........"""........."......"........
3. Did decedent own on 'In trust for' bonk account at his or her death?.".......""".....
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST ~~MPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
.' ~(! . .
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'\1.. f.l~
.IL
. ~..
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GO
F';
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'I
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (..-) IN THE
APPROPRIATE BLOCKS. .
,
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,
I
I
I.
I
I
1. Did decedent make a transfer and:
. .. t
c. retain a reversionary Intares or .........,.."".......,,,.......,,,..,......,......................
d, receive the promise for life of either payments, benefits or care? ..........,............ _
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 aftElr December 12, 1982, did decedent transfer property within one year of
death without receiving adequate consideration? ................................................. __ _
3, Did decedent own an 'in trust for' bank account at his or her death?.....................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST C9MPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
11) .
f'.
....';
" ,!l
{'J (1"'
rr: :
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p\
. i:
,I) 'j
uO
..V.lJotl..12,'1I
. . *
COMMONWlmH 0' /lHHIYlVANIA
INHIRIT CI TAX mURN
RIIID NT DICIDINT
ESTATE OF
L SCHEDULE E :J
CASH, BANK DEPOSITS AND
MISCEllANEOUS
PERSONAL PROPERTY Pie,!" Print or Type
FILE NUMBER
..
Alma G. Kiner
IAIl proporty lolofly.owood with tho Right ol'u,.lvarthlp mUlt be dloclolld ao 'ch.dul. FI
ITIM
NUMBI~
DESCRIPTION
VALUI AT
DATI OP DIATH
1.
u. S. Savinga Bond
Denomination $500.00
Surrendered before maturity
348.60
"
,. ,
,,;0
TOTAL IAllo enter on line 5, Reca
$ 348.60
IAttach addlllonal 81,' H II" ,h"llll mort .paco II ...d.d,1
4
I
I
SCHEDULI H
FUNERAL EXPENSES,
ADMINISTRATIVB COSTS AND
MISCELLANEOUS EXPENSES
Plla'l Print or T I
, RIV.15l1Utj',UI
J:J~'~
'OlI(~W
COMMONW!A\H1 or PINNIYlVANIA
INHUITANC! TAX R!TURN
R!5ID!NT D!C!D!NT
IITATi Of
Alma G. Kiner
ITEM
NUMBER
DESCRIPTION
AMOUNT
A.
1.
Fun.ral bpln..11
Fogelaanger-Bricker Funeral Home
Spring Hill Cemetery (grave opeaing)
3,928.00
325.00
R.
1.
Admlnlltratlvl COlli I
Personal Reprelentatlve CDmmlnlonl
Social Security Number of PerIanal Reprelentatlve: .,
Year Commlnlonl paid
,.
,
2,
Attorney Feel
100.00
3: Family Exemption
Claimant . Relatlanlhlp
Addreu of Claimant at decedent'l death
Street Addren
City
Slate
Zip Code
Probate Feel
Register of Wills
MI.e.llanlou. Expln...1
Penelec (lsst billing)
62.00
21.56
, I.
TOTAL (Allo enter on line 9. Recapltulatlonl
(If mall .pael II nlldld,' Inllrt additional .hllt. of ,oml "...1
54,436.56
;',
(I
1I.~'UI:lU.I}.l71
, -' ,.
SCHEDULE J
BENEFICIARIES
l
,,'
'*'
COMMONWIAUH O. .INN$YIVANIA
INllllnANCI 'Ak _"UIN
IUIOIN' OleIOIN'
ISTATE Of
fILl NUMBIR
Alma G. Kiner
N~~~IR NAMI AND ADDRISS Of BINlflCIARY
AMOUNT OR
SHARI Of ISTATI
RILA T10NSHIP
I
-
A. Taxable aequolllI
1. Katherine A. Swartz
234 Reading Road
Shippensburg, PA 17257
Ch:l.id
25%
2.
Roger S. l~o1tz
33 High Road
Shippensburg, PA 17257
m
Child
3.
sharon E. Hawley
20159 Karp Lane
Redding, CA 96003
, '
Child
, 25%
4.
Child
m
Ronald L. Woltz
709 Upham Place N.W.
Vienna, VA 22180
ITIM
NUMBIR
NAME AND ADDRI,SS Of BENlflCIARY
AMOUNT OR
SHARI 0' ISTAT,I
a, Charitable and Gavernmenlal aequel!1l
1.
I'
TOTAL CHARITAalE AND GOVERNMENTAL aEQUESTS lAlla enlor an line 13, Rocapllulatlon) $
(If mort Ipa.. II "..dtd, In"'I addlllonallh.... of lamt lilt I
/? ,{
RIV-1547 IX AFP 110-93*
. COMMONWEAL TH OF PENNSVlVANIA
DEPARTHENT OF REVENUE
BURfAU OF INDIVIDUAL TAMES
DEPI. 240601
HARRISBURO, PA 17121.0601
~
ACN 101
NOTICE Of INNERITANCE TAM
APP~AISENENT. ALLOWANCE O~ DISALLOWANCE
Of DEDUCTIONS. AND ASSESSNENT Of TAM
DATI! 09-26-94
o FILl NO.
DATI OF DIATH 01-03-94 COUNTY CUMBERLAND
HOTE I TO INSU~E PROPER CREDIT TO VOU~ ACCOUNT. SUBNIT THE UPPE~ PORTION Of THIS fORN WITH YOUR TAM
PAVNENT TO THE REOISTER Of HILLS. NAKE CHECK PAVABLE TO "REOISTER Of WILLS. AOENT"
REMIT PAYMENT TO:
KATHERINE A SWARTZ
234 READING RD
SHIPPENSBURG PA 17257
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
A.ount Ro.lttod
l
CUT ALONO THIS LINE .. RETAIN LOWER PORTlCN FOR YOUR RECORDS ...
if IV : is'(ii-Ei("AFii -f i '0-.- 9i"i -NilY! cir-oF - i: NHEiiiTA'N"C E" T"AitAPjiii'A IS EifENr;-A t i."ciwAifC'E "bii-" --- -.. m__ - - -.."
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTAT! OF KINER ALMA G FILE NO. 21 94- 0054 ACN",lOl DATE .09-26-94
APPROVID DIDUCTIONS AND EXIMPTICNS:
9. funorol E,ponl.I/Ad.lnhtroUvo C.ltol
NlscoUonoouo E,pono.. (Sohodule HI 191 4.436.56
10. Dobts/Nortgogo L1abIlIU../Llonl ISchodulo Il 1101 .00
Totol OoducUono IU I
Not Volua cf Tax Roturn U21
Chorltobl./Oc.arn.ontol BoquOlto ISchlclul. JI (151
Not Voluo of Eototo SUbjoct tc Tax U41
If .n "'II..m.nt WI' i..u.d pr.viously, 11n.. 14, 15 .nd/or 16 .nd 17 wUl
r.fl.ot figur.. thlt inolud. the totB1 of ill r.turn. .......d to dltt.
ASSISSMINT OF TAX:
15. AMount of Llno 14 taxoblo ot 6Y, r.ta
16. ARount of Llno 14 toxoblo at ISY, rata
17. Prlnolpol To, Duo
TAX CRIDnS:
PAVNENT
DATE
TAM RETURN WAS I I X) ACCEPTED AS fILED
RESERVATION CCNCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN lASED ONI ORIGINAL RETURN
1. Raol Eltoto ISohadula Al
2. Stockl Ind Bondi ISchodula B)
5. Clololy Hold Stock/Partnorlhlp Intorut (Sohodula CI
4. Ncrtgogol/Notal Racal.oblo ISchodula 01
S. Calh/Bonk Dapollto/Mho, Parlonol Propartl (Schadule E)
6. Jointly O.nod Prcporly lSchodule fl
7, Tronlforl (Schodula 01
8. Totol Allah
11.
12.
15.
14.
NOTlI
-
RECEIPT
NUMBER
DISCOUNT I + I
INTEREST 1'1
05-17-94
186088
.00
. If PAID AfTER DATE INDICATED. SEE REVER~E
fOR CALCULATION OP ADDITIONAL INTEREST,
I I CNANOED
11)
121
151
141_
ISI
161
171
,00
.00
~
.00
3~.B..ft
6.446.64
.00
181
6.795.24
4.436,56
2.358,68
.00
2.358,68
USI
(16)
2,358.68 M,06 a
,0lJ.M,Ua
1171
141. 52
,00
141.52
ANOUNT PAID
141.52
TOTAL TAX CREDIT
BALANCE OF TAX DUI
INTEREST
TOTAL DUll
141. 52
.00
,00
,00
( IF TOTAL DUE IS LESS TNAN n, NO PAVMENT IS ~EQUIftED,
IF TOTAL DUE IS REfLECTED AS A "CREDIT" ICU. YOU HAV Be DIlE
A REfUND, see REVE~SE SIDE OF THIS fORN fO~ INSTftUCTlOHS.1
"
,.
RUlRYATlO+f1 Eltltll of cteo..",. dvlne on or before OtOlitHr it, 1912 .... If "'Y future Int.rll' In tM I.tlt. 11 h'enl'lrrld
In po.....lon or .nJoy..", to CIII. I (ooll,tlr.1) blntHcllr I". 0' thl dlc.dlnt Ifter thl' IMplrlUon of any IIt.t. 'or
lIf. or for Vllr., the Co..onw.t1th htrlbY .Mpr...h nllrv,. thl rlllht to IPpr,lu end ...... trent'.r Jnhlrltoncl Till"
.t thl lawful ell.. . (colh'trlll rtt. on tny lueh future Intlntt.
MPOIE OF
NOTlCEl To fulfHl the requlrt..ntt of Slotlon 2140 0' the Jnh,r1tancI lInd Est.t. Till loot, Act 22 of 1991. 12 P.'.
SIOtlon 2140,
PAVIENTI O,t.en the top portion of thll Notlel Ind tub.lt with your paY"n' to tht Rtollhr of Willi printtd on the rnlr.. .Ide.
--Hlko chock Dr 00... ordor ,'.01>10 tDl REGISTER OF MILLS, AOENT
All pay.."'. rlulvtd ,h,l1 flr.t b, .ppUtd to any Int.rut which "V bt due with tny r...lndtr IflPUld to the till.
Rt'UND (CA)I A refund of I tlM el'ldlt, whloh w.. not rlqueltld on thl TllC Alturn, .IY be rlqueltld bv oo.,I,Une In "Application
for Rlfund of Plnnlv1vanJ_ InhllttlnCI and E.tlte TIX" (REV~l]UI. Appllcltlonl Irl Iv,lllbll It thl Offici
of thl RI,lttlr of WHit, any of thl Z3 Rlvlnul Olltrlet Off Iou, or bv tlllln, thl .pI01II Z~'hour
"'1.lIrln, ..rvlel MlJIlblrl for for.. ordlrin'l In PIMlylvlnl. IMIOO'56Z~ZOSO, ouhJde Plnn.ylven', and
wlthJn 10<111 H.rrhbur" trll (117) 787~ao9", TDO' (717) 77Z~22SZ (Hltrlng htpIlrtd Onh),
OIJECTJOHtI Any p.rtv In Intlrut not tltltfJed with thl IPprllllllnt, II10WlftCI or dhllloWlnol of deductions, or ''''"Mnt
of tllC C1nolucUn; dlsoount or lntlruU II .hown on thl. NoUel IU.t obJlot within .1lCtv (60) dlY' of rH.lpt of
this NoUcl bYI
".wrlttln protut to thl PA DIP.rt.lnt of Alv.nul, lurd af AppI.II, DEPT. 211021, Utrrltbura, PA 17128"1021, ON
u,IItOUon to hlv' thl ..tt" dlt.reln.d It ludlt of the loeount of thl p"lonll rtpr...nt,tlv., ON
....IIPPI.I to thl Orphtnl' Court.
IOHIN
.ITAITlY1!
COAAECTlllHt.
INTEREIT.
F.atu.l .rror. dl.oov.r.d on thl. ........nt .hould b. .ddr....d In writing tOI PA Dlpart'lnt of A.vtnue,
'Bur..u of Indlvldull TllC", ATTNI po.t A..tI....nt A.vl,w Unit, DEPT. 280601, Herrltburg, PA 17121.0601
Phone (717) 717~6SOS. S.. P'OI ] of thl bookllt "lnUruetJon. fer Inhtr ItMet Till Alturn for I AIIIHnt
OIOldlnt" (AEV-150U for In 'lIpllnetlon of .~lnlttrttlvl1Y eornettbl. "rort.
If Iny tllC due It Plld within thrll (]) ul.ndlr lonthl efter thl dICld.nt'l dllth, , flvl p"elnt U:O dhoount of
thl ttJIC plld II eUowed,
Int.rllt II cherllld bl"lnnln, with flrlt dlY of dlllnqu.nov, or nlnl (9) lonthl Ind on' (l) dlv fru the dlt, of
d..th, to the dlt. of ply,.nt. Tallll whlttl biOI" d,lJnqulnt b,fers Janutry I, 1912 bltr Inter..t it th. rite of
IllC (6~) percent per lMU. ollculat.d It a dilly nt. of ,00016", All \llClI whloh b.c... dlllnquent on and Ifter
Jlnulry I, 1912 will bllr Interllt It I retl whloh will vary frol elhndtr Yltr to oeltndtr Yllr wJth thlt rltl
ennouno.d bv thl PA D'Plrh.ent of A,v.nue. The Ippllelbl. Interllt rltu for 1912 throu"h 199" .rll
OIICOUHT I
~ Interut R.t. Dilly Intlre't Flotor ~ Int,rllt Rat, Ollly Int"ltt Flotor
I9IZ ZOX .000501 1916 lOX .00027'
1'15 16X .000011 1917 'X .OOOZ'T
1914 llX .0mOl 1916-1991 m ,000501
1911 lJX .OmS6 1991 9X .000Z47
1991-19'4 IX .0001'2
.-Int,,"t It ce10ulltld II (ollowlI
INTERUT 0 BALANCE OF TAX UNPUD X NUNIER OF DAYS DF.LINQUENT X DAlLY INTEREST FACTOR
"'Any HotlOI IlIuN Iftlr thl till btoa.. d,lInqulnt will refllot an Intlrllt cllcullUon to flft,en UI) dlV'
blyond the d.tl of thl ........nt. If Ply..nt It lIeft Ifttr th. lnt"ltt co.put.tlcn dlt. .hown on the
NoUo., Iddttlonll Intertlt lU.t be 01lcu1eted.
.3 - ,31..... ,:L) oJ
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STATUS REPORT UNDER RULF. 6.12
I
I
, .
I
Name of Decedent I . A\ N\o,_ (;.. . t..< I f0~
Date of Deathl ( -3 - 9Y
Will NO.-2.L:. 9y- Ct:J5y Admin, No.
Pursuant to Rule 6,12 of the Supreme Court Orphans'
Court Rules, I report the follow.ing with respect to completion of
the administration of the above-captioned estate I
St~t~ther admin.tstration of the estate is complete I
Yea No
~. --
2. If t.he anawer Is No, stat.e when the personal
representative reasonably believes that the administration will be
completel _____
1.
3, If the answer to No. 1 is Yes, state the followin91
Did the personal r~resentative
account wlth the Court? Yes No~_.
b. The separate Orphans' Court No.
the personal representat.ive's account iSI
a.
flle a final
(if any) for
c. Did the personal representative sX,te 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 Orph.".' COort .., m.y b'let"he, to thll repert,
Datel ,,,,1M I "l{ ;j~dw.fLt Q, ~u.4.~
~ Signat.ure -0
_JL.LHl1(\'(\('. A, ,S w a dz...
Name (Please type or print)
I) ") , 'J
,7-, Y H\.cLLf\ (}. .
Address ,. pp..tI1Sb.U.~' A.17';'5'/
.1.1!1J ~.3), -.3 'I J.l
Tel. No.
Capacityt ~personal Representative
Counsel for personal
representati ve
(MAHlrmf/AM3)