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" ',l '. " " , , ,. " I"'; I' II <11 . ' 'II ' " "".1 " i (' ',i '" T> ,,' ,'I'll/ ' . ',,., '. " ," , \ '.1 ~ ", , ~, \1 ,,1",' '. I, , ,'~. '.', i, ,I '1' ';:+'\1\,:'>:,:.1'/ '" , I , I ' , '~-" _ " ;,' ~,\ ~ ','. .,:,: .1 ", , ~ , " '" .','1 ,; I", ,,', '" " ,. , ," 'j' , ,," , , "ji, ".' .1 " ' :' ,. i. ,I" ,. " . . fllY 1~(l('l [~f P !-fill . . /L/"- / gJ,/_ 7 INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) ", I- 0>: "._Vl un~::t: wo.u :r.~g Un.Ill n. 0>: I ifi~ ,",", '" " o Z lJ 0 n. I~I~};~~" . " :(;..,.. CO/.\/MJt.IWf,AlItt Of PENNSVlVANIA {)[I'ARIMENf OF REVENUE DEPr 290601 IlMH~lSi\URG, PA 1/129.0601 ..O.H' -Or(\'b(t'H;i'~IA.M-E ilAsl-,-fii8:e~No~,JiDOl( l{l(IAU n_ ---... 'OR DATIS O' DIATH AmR 12/31/9' CHICK HIRE ~o~:::'.n:~DIT IS CLAlMID [] PILI NUMIIA .u,.___..,_~....m"'_'" d, / '1'1 0097 COUNTY CODE YEM "~"~!iU/,\B,ER .~- E -ibNit's CClMP'lE"lE AOO-RE'SS-' ,- Z "' Cl "' lJ "' " Shoap, Clark R. 420 Britton Road "()(~~~'~~;f~~~~~T '~_-".....'..ID~fE1~~~~i::_=]'~A;~~i~:~;~--- ~,~: II i l)~::~ ~;~~l ~(IP~__I.:~__..._, !XI I. Original Ro'urn [) 2, Supplomon'al Ro'urn [] 3. R.malndor R.,urn (lor da'o, of doalh prior 10 12.13.921 [] 5, F.d.ral E.lal. Tax Rolurn R.qulrod _ 8. Talal Numbor 01 Safo DnpaJlI goxo, z o ~ :;) I- 0: ;j "' '" [J 40, Fuluro Inloro,' Compromlso Ifor da'o, 01 doalh ahor 12.12.82) ] b. Docodonl Dlod T."o'o [I 7, D.cod.nl Moinlaln.d a lI,ing Tru,I (AUach copy of Willi (AUach copy of Trull) All CORRESPONDENCE AND CONFIDENTIAL TAX INfORMATION SHOULD BS DIRECTED TO, H^~iC--~- - jCOMPLETE MAIliNG ADD~m .. , ..J.~,r.r.y...A. Weig~!'.L~Squire .,,___ NARK, WEIGLE AND PERKlNS Hlll'lImlENuMBER 126 East King Street 71LJ=243c::73fl!!~".~===~=~=~",=. ..,. Shippe_nS~u~g, 01: 172:7 -." 'CJ i. Rool E,'olo ISchodulo AI I 11 ,-.-.............-.... . ' " ' , 2. Slock! and 80nd'ISchodulo 81 I 21_,_._~____..,_.. "1 U J. Cio.oly Hoid SlocklPar'norshlp In'.ro"IS,h.dulo q (31 I .1. Morlgago' and Nol.' Rocol,ablo (Schodulo 01 I 41 ----.-.-- ' , 5. Cmh. Bank Dopo"II & MiJCollanoou, P.rsonal Propor'yl 5) ___---1., 700 .90 ISch.dul. EI 6. Joinlly Own.d Proporly ISchodulo F) 7. f ron,foll ISchodul. G} (Schodulo LI O. To'al Gran Anol' I'olalllno, 1.71 9, funoral hp.nl.'. Admlnl,lrail,o CO'"' Mlsc.llan.ou, I 91 Exp.n,o, (Schodulo HI 10. Dobl., Morlgago Liablllilo,. lion, ISch.dulo I) {101 1 i. T alai Doducilon, (Iolalllno' 9 & 10) 12. Nol Valuo 01 E"alo (lino 8 minu,lIno 111 13, Chorl'ablo and Go,.rnmon'al 8.quo," ISchodul. JI i~. No!, Valu. SubloCIIO To, (IIno l~u, Iln. 131_, 1 S. Amount of Hno 14 taxablo 01 6% raiD (Includo ,aluo, from Schodulo K or Schodul. M,I 16. Amount olllno 14 taxablo 01 15% raID Ilncludo ,alu., from Schodulo K or Schodul. M.I 17. Principal I'" due (Add 'a, 110m IIno 15 and from 1100 16.1 I fl. Croulls Spousal Povorty Crodit Prior Paymonh Discount lnlorel! + -....-....- +, --,---..- -------..,.. l'i. If IIno 18 I, gr.olor Ihan linn 17. .nl.r Iho dill.ronco on IIno 19, Thl'I,'h. OVERPAYMENT. eCl C> t') ..." I ~. lImlt.d ElIal. . .U J.1(1) 11 r'l , 161- ( 7) " r-,-l ( 81 - 2.700.00 3.248.40 (15)_...__.. (111.__ 3,248.40 (12)__Gi!&.t.{j,Ql_____ (131 -------" -.----"'-.. 1141 J54.li, !lQ) pp X ,06 = cNONE...::_J]~OL.Y!U:tL,_, {16} _..,_.______._..__,X .IS = z o ~ ,-. ~, a. ~ o u >< 0>: ,. {171 .....--.... -,- (181 -...,-........-.-..,..-..,. (19) ,.. ,.. ...,_. ..._....._..__..___., Cho(~ 110ro If you aiu foquostifJU (l rofund or your ovorpnymonl. 70 If II no 171s groa'.r ,han lino 10, onlor ,ho dlff.r.nco on Iln. 20. Thl' Is Iho TAX DUE. (201 -.------..,............. ......,......, A. Enlor ,ho In'.r.,1 on Iho balanco duo on IIno 20A. (20A) ..__...._"'u..................h,..." n. En'or Iho 10101 olllno 20 and 20A on IIno 208. This h Iho 8ALANCE DUE. 12081._....._.._...........__,_..,_....._, c:~"ck..~~;~~Pay:"bl..~~,~~~~~..o!~I~I~~~~t=~==-=':;__, . _ '~-=_..___ .. .. BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECk MATH....' . - ---.-"'" Un~lor pCdHlllill\ ll( 1,;lrl~~y,-r~l~cloro Ih{I'Tho-;o--~.~-~;ml;.;-~cfihTt-roiUrn:~ludl~~pClnylng-,chod'ulos and Ilolomonh, und 10 tho bOil 01 my knowlodgo and boli~j; il h two, rorfocl ond (onlpllllo. I doclorn thol 011 ronl 0$1010 nos boon roporlod 0: Iruo mnrkol voluo. Doclorolion 01 proparor olnnr Ihnn tho porsonal ropralonlnlivo Is tlCllod I'" oil illforfl\(I1km of which propmor hm (lny kllowlodgo. ""]z: a:~'~~'''''' . "'" :;'";': Sh";,4;";;;;;';:';~~d, "";,;;;;;,,,,;;, ';;;7;57;-~ '1'1 "~C\~"'4i/Vj !lV'" )~~~~O:~~~~~~gl~.,J'2~'_I~::~:::~~::L'~~~i~~~~~~II;~' ~:r 1725 7)-3,Q Y . . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK kIlN 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, ''1'' X 1. Did decedent make a transfer and: X c. retain a reversionary interest or ...,............."..,..,,,...,,,..........,........,.,,,........... X d. receive the promise for life of oither 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 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' bank account at his or her death?..................... X X X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. _',v,nll... ("U) ISTATI OF ITEM NUMBER SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES PI.al. Print or Typ. ---.. ---- ,.. - :LffitAr -..- . Clark _~_ Sh~~~_____..,_'- , _, ____ _.., ___,_u_ _. _____ .___ . ._,_:~ ~'~:9~ '04~>>P COMMONWEAltH Of PENNmVANIA INHERITANCE lAX mURN REIIOEN! DECEDENT DESCRIPTION AMOUNT A. Puneral E~p.n"ll II. C. 1. Fagelsanger-Bricker Funeral Harne - mnaunt nat prepaid 135.26 1. Admlnlltratlv. Co I'" P.llonol R.pres.nlallv. Commlulonl Social Security Number of Personol ReprAI.nlallvel __ Y.ar Commlulonl paid u"____..__,___ 2. Attorn.y F... Mark, Weigle and Perkins 150.00 3. Family Ex.mpllon . Clolmant ~l~~~!~ap Relallonlhlp Spause 2,000.00 Addr.u of CI~lm.nl at decedent I, death Stre'l Addreu __~.!!!J:~lon. Raad City Shippensb,urjL_________Slal. _,PL_ Zip Code. 17257 4. Prabat. feel 1. Mllullan,oUI bp.n.." Register .of Wills, Cumberland Caunty - filing Inselvent PA Inheritance Tax Return Keystone pathelegy Associates, Inc. 10.00 10.42 2. 3. Chambersburg Health Center 14.24 217.54 710.94 4. Pulmonary Asseciates 5. Chambersburg Hespital 6. 7. 8. TOTAL lAlla enter on line 9, Recapltulallon) (If mare Ipaull n"d.d, Inllrt additional Ih"'1 of lam. 111..) S 3,248.40 ~ REV-1547 EX AFP (10-93* 1 i~::~~~m 1~r':t~~~~~"Y,"lA NOTICE OF INHERITANCE TAX ACN 101 BUREA" OF INOIVlDUAI '"'' APPRAISEHENT. ALLOWANCE OR OISALLOWANCE ~i:~is~~~~~IPA 1111..,601 OF DEDUCTIONS, AND ASSESSHF.NT OF TAK DATE 05-23-94 ESfATE OF'="~flOliP===~~"'~-Crl\llr='=F"~==r=,=='_- n, . -iiLE NO. ~~-21 94-0'0'91 DATE OF DEATH 10-02-93 COUNTY CUMBERLAND NOTE. TO INSURE PROPER CREDIT TO VOUR ACCOUNT. SUBHIT THE UPPER PORTION OF THIS FDRH WITH YOUR TAK PAYHENT TO THE REOISTER OF WILLS, HAKE CHECK PAYABLE TO "REOISTER OF WILLS, AGENT" REMIT PAVMENT TOI JERRY A WEIGLE ESQ MARK ETAL 126 EKING ST SHIPPENSBURG PA 17257 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 t_'_-~ll.unt !!."_~l.!l~d '.-=:J CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ R! oj: is(ii - EX -j, jip- - f i b-: 9iY -Niir i 6 r -OF - i"N'HEiii i' ilNCE - 'fAx - "A-ppit;i is EHENT ~ - - j, t 1"6 w ilifc E - b-Ii - - - - - - - - - - - - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SHOAP CLARK R FILE NO. 21 94-0097 ACN 101 DATE 05-23-94 If an assessment was issued previously, lines 14, 15 and/or 1& and 17 will reflect fi9ures that include the total of ALL returns assessed to date. ASSESSMENT OF TAXI 15. Amount of Llnl 14 tlXlbll It 6% rl11 16. Amount of Llnl 14 tlxlbll It 15% roto 17. Prlnolpol Tox Duo TAX CREDITS I PAYHENT DATE TAK RETURN WAS, I X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE APPRAISED VALUE OF RETURN BASED aNI ORIGINAL RETURN 1. Rool E.toto ISohodulo A) III 2. Stook. ond Bond. (Sohodulo B) 12) 3. Cla,"ly Hold Stook/Portnorshlp Intoro.t ISohodull C) 13) 4. Hadglgu/Nat.. Roaolvlblo ISohldulo D) 14) 5. Co.h/Slnk Dlpo.lt./Hlso. Plr.an.l Praplrty ISohldull E) 151 6. JointlY Dwnod Proporty ISohodul1 F) (6) 7, Trln.llrs ISohldulo 0) 17) 8. Toto! A..lto APPROVED DEDUCTIONS AND EXEMPTIONS I 9. Funlrll Expln.I./Admlnl.trotlvl Ca.t.1 Hhc.Uaneoutil Expen... I Schedule H) <<9) 10. Dlbt./Hortgogo Lllbllltll./Llln. ISohldull I) lID) 11. Totll Dlduotlons 12. Nit Voluo of Tox Rlturn 13. Chlrltobll/Oavornmlntll Blqul.t. (Sohldulo JI 14, Nit Voluo 01 ~.toto SubJoat to Tox NOTEI 1151 1161 RECEIPT NUHBER DISCOUNT I') INTEREST 1-) J 1 CHANGED n '.00 .00 ,DO ,00 2.700,00 .00 .00 18) 2.700.00 3.248.40 ,00 III ) 112) 1151 114) 3,248.40 548.40- .00 ,00 ,00 .00 ,00 .00 ,00 )(,0(, :I K.15 , 1171 AHOUNT PAID TOTAL TAX CREDIT DALANCE OF TAX DUE INTEREST TOTAL DUE -~ .00 .00 .00 ---.-----.-- .00 . If PAID AFTER DATE INDICATED I SEE REVERSE FDR CALCULATIDN OF ADDITIONAL INTEREST, I IF TOTAL DUE IS LESS THAN 11. ND PAYHENT IS REQUIRED. IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICR), VOU HAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUC110NS. I .\ " . I' , . , , " '..' , ,. 'j., ' M:IERYATJONI Est'tll of dlced.ntl dvlng un or blfor. Dlolllb.r 12, 1912 ~~ If Iny future lnt.rllt 'In thl ..t.t. II tt'n"~rr.d In POI.I..lon or .nJo~..nt to ct... I (col1Ittr,1) bln'ftol,r.,. 0' tht dlcedlnt .ft,r tht Ixp.rttlon of Inv ..t.t. far 11'. or 'or VI.r., tn. Co-.onwellth htr'bY Ixpr...'v rl'lry,. the right to ,ppr.I.. and ...... tr.nsf.r Inhtrltanql 'IX" It thl !",'ul ellll . (coll1"rIO rtt. on any luch 'utUrt Int.rut. PtlIlt'OIE Of NOTICE I To fulfill thl rlquirl..nt. of Section 21~O of the Inhtrltlnol .nd E.tlt. Tlx Aot, Aot 22 of 19'1, 72 P.S. 10.lIon mo. PA~~NTI Dltleh thl top portion of thll NoUCI .nd tub,1t with your plv..nt to tht Rlght,r 0' Willi prlntld on tht rlVlr.. lid,. --"01<1 chock .r o.nov .rdor povoblo 1., REOISTER OF MItLS, AOENT All PIYIt"t. r.celvld ,hell flr.t b, .ppll.d to anv Int.r..t which ~,y bl duo with tnv rl.elndlr epplltd to the t... REFUND (CA)I A r.fund of e tl. crldlt, which WI' not rlqul.tld on thl T,. Rlturn, "V be r.qu..tld by co.plltlng an "Application for R.fund of P.nn'vlv.nll Inh.rltlnc, .nd E.t,t. TI." (REY-1Sl]). Applloetlon. arl ,vallabl, at the Offlc. of the R.gI.tlr of Will., .nv of the Z] RIVlnue DI.trlct Offlol., or by ollllng thl ,plolal 2~~haur an,w.rlng 'Irvlol nu.blr. for for.. ordlrlngl In Plnn'Ylvlnl1 1-800-362-Z050, out,Idl Penn'Ylvlnl, ~ within 10cll ttlrrhburg .r.. (111) 181-150'4, TOOt (711) 71Z-2252 (H..rlng IIpllrld Only). OIJECTIONSI Any p.rty In Interl.t not '.tl,fled with the appr.l.a..nt, .110wlnol or dl,lllowancl of d'ductlon., or ........nt of tl. <Including dltcount or tnhrlltJ II .hown on thll Notlal .u.t cbjtct within .hctv (60) day. of rtcllpt of thll Notlel bVI --wrltt.n protl.t to the PA Dlplrte.nt of RtV.nul, lo.rd of ApPlel., DEPT. Z81021, H.rrl.burg, PA 17128-1021, OR .-.llotlon to have thl eatter dlter'lntd It audit of the tooount of thl p.r.onal r.pr...ntltlvl, OR --'PPIII to the Orphan.' Court. AOfII" ISTRATlYE COlIRECTlOHS. Ftctutl .rror. dl.cov.r.d on thl. ........nt .hould b. .ddr....d In writing tal PA D.p.rt..nt of AIVenut, Bur.au of Indlvldull TIM", ATTNI Po.t A.......nt R.vlew unit, DEPT. Z10601, H.rrl.burl, PA 1112'-0601 Phone (717) 7.7-6105. S.. PIgI S of the book lit Hln.truetlon. for Inherltlnc, TIM Rtturn for I R..ld.nt Otcldtnt" (REY-ISOl) for en IMPllnation of .dalnlstrltlvtlv corr.atabl. Irror.. DIItOOHT. If DRV t'M due II plld within thr.. (]) oll.nder lonthl aftlr thl dlcldlnt'. dl.th, . flv. p.rcent (5~) dl.count of the t'M Plid I. allowed. INTEREST I Int.rllt It oh"pd bqlMlng with flrtt d.V of dellnqulncv, ar nln. (,) eonth. .nd on. (1) dav fl'ol thl dlt. af dI.th, to thl d,tl of p.y""t. TIM" which btcl... dlllnquent b.fare JanulrY I, 1982 b..r Interllt It thl I'.t. af .he (6~) perCl.nt per ' lJVllle calouletld .t a d.lly rlt. of .0001". '11 "Mil which b.e... dlllnqu.nt on.nd .ftlr Jenu.rv 1, 1982 will bier Intlr..t It I rlt. which will v.rv frQl ctllndar ve.r to o.l.nd.r year with thlt rate ennounold bv the PA D.ptrt..nt of R.v.noI. ThI tppll~.bl. Int.r..t r.t.. fnr 1982 through 1994 .rll !!!!: Interllt R.tl DIllv Int.r..t Faotor :!!!r IMlrllt Ret. D.llv Intlr..t Fftctar 1912 20X .000541 1916 lOX .ooom 19ft! 16X .000651 1917 9X .000267 1916 Uv, .000501 1911.1991 l1X .000301 1915 lSX .000556 1992 9X .000267 1995-1996 7X .000192 --tnt.,..t I. oalcullt.d a. follow'l INTEREST . BALANCE OF TAM UNPAID X NUnBER OF DAYS DELINqUENT X OAILY INTEREST FACTOR ....Anv Notlo. I..u.d Ifter the t.M blCOHI dllInquent wUI refl.at an Inter lit oeloulltlon to fUt.an (11) dllY. beVond thl dati of thl ......Hnt. If pavont 11 lIeft .fter ,thl tnterltt C10llPutlUon dati shown on thl NotlCI, tddltlonal Interllt MI.t bl ollculltlel.