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OATH OF SUBSCRIBING WI1'NESS
COM, MONW~;ALTH OJ? PI~NNSYLV ANI A I ss:
COUNTY (}I<' CUMH~;RLAND \
This............. ..,.......... ...........,..........." ................ ..... day of ....... ..). ~.~:(..r;..(!.!Sj............ ..... ......" ...., A.D" 19.~~....,
bt\f(m, me Hichrll'<l K AndtJrson, IWgister for the Probate of Wills and granting letters of Administration
in Rnd for said County of Cumberland, in the Commonwealth of Pennsylvania, personally came ..............
.l f.. [.i.y. .1......l :...,... (,1,f..:~ .\1 (/ .~:). ~. N ./... 'y.~'.I!,.... hi. ).,... .~:! :J.8(~ .'.1,:: .c...,.. Fl. ..\i:i,l:..'r..... r:... (; L (..~!:.<..?;: .~?..........
(.... AI ~, ('I ,-
the subscribing witnesses to the fOI'egoing instrument of writing purporting to be the last Will and
Testament of ,...... ....,., ~.1..\)..~.!.........7.i..... .1.... ,~;:.(,... ............... ... ..........".,.... Dated ..~~.~.C !:.. .!.!,'...!..1..~:/... ...
late of.... ............!\1.r!.N. .t~.\1. t..,.... ....!...(:.."::J/.. .:i:t.( (,(,:............. ............... ..... Cumberland County Pa" deceased
who being duly .....~.~.~(!"N..................... according to law, depose and say, that .....?~.!U........\1:.:U..........
present, and saw and heard the testa.l..(~L~..................., .....S<'.,1.?u:........I,.....t.C?:...........................
sign, seal, publish, pronounce and declare the said instrument of writing as and for h.L!~........ Testament
and Last Will, and at the time of so doing .......5~u,......,......."................was of sound and disposing mind
memory and understanding, to the best of .......r.!.~-...~.C..."....................knowledge, observation and belief.
..s..0,:r!.(i:..y,......L~:.............. and subscribed before
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,. :;t", :..; to ,,:/,..,.:~,,:~~,:.., ,';:-,. it".,,, J,~~,,;-j ;';.;'r" ;(; ;";;... ;', Ii,'. ..;1'.."..
,/:/" /"', .::.,'1'/ I ,,' ~'.., ", '-1/.'.'
.,.,. ,....~.... ~,,...-,''''''''''('''''''''' ..'......." I. '~/' d.;" ....,.,...,..,.......
.,..,........;........""..".,...,,,,....,.,,,;.,...,..,,,.....,.....,.....'".,
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA I 8S:
COUNTY OF CUMBERLAND \
J~) I:! N \. L C; E b' d I
...............",."".....'..',.,.."".,..,. ...:.. ".......,'.,.,... ...,..., "..,,,,,, "..." ,..,.,.,..,....",,,,,,,,...,....., ,......." .............. elng u y
....s..~:.~!.1.().J......................... says that as nearly as can be ascel'talned the said decedent ..........................
\" f1 DIE: 1" LCi!:.. d'd
,..,...,",.,.".......,.,..,..".,.,",'~,..},....,'...,',....,",.... ,\"....,.".."""".,.".,..,.,.,.,..,."".."..,.,...,...."..,.",..................... te on
....\.,;;.Y..P.AY...,..................... the .......,...l..y................day of ........I~,~..~:..~..(.~.(".................. A.D., 19.7.1.,
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, bo t ,) . ';\ li 'I k I.) M
a" or au..............,.........................., 0 C oe 1"" ,
,; u'Jr't'/ IV To d b 'b d 'h'
.....:.........,,,.........,,.......................an su Berl e ... IS
...................n.:;~-;(................. day of ..':?.~.:~-!.\(~l.!.~l.
r/7 \
19,.V,~:(~~.........,....................
Richard K AndOl'HOn, R(~J:(iHt()r
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........, ;;/t.i. ".7.\1" ...4.",. ..(;1"....'.'.'....'.............'...
OATH OF PERSONAL REPRESENTATIVE
COMMONWI<;AI.:I'H OF I'I':NNSYLVANIA}
COUNTY OF' CUMIH;HLANIl SS:
Before me, the HegiBtm' for the Probate of Wills and grunting of Letters of Administration in and for
the County of Cumbel'!und, personally came ,,,,,,,..~F!.t!..N.,,,,,,.,,.0.""""~:"~:'~:""""""""'"''''''''''''''...."."."
h b. d I Swor:rv d L'\ d d tl t I.:'Xt'CUrQ;>
W 0, elng u y ..."...,,,,,,,,,,,,...,,,.., 0 "..""" oposo an Hay 16 ns,,,,,,,,,,,,.,,,,,,,,,,.,,,,,,..~..,,',,.,,..,,,,,,,..,,,,,,,,,,
(" T Fe'
of the last Will and 1'estament of ..."'"....':"~."0..!..1!.""""""::-:.";..""..,;-,,,,..,,'~,,,,.......,,,,. """..".....,...."deceased
....f!"~.....",,... will well and truly administer the goods und chattels, rights and credits of said deceased
according to law. And also will diligently comply with the provisions of the law relating to Transfer
Ih't' 'SU./OI'I.N re' db 'bd
n ert ances. ..".....;.."",,,..,..,,.. an au Bert e
before me.
-'--""'='
,:.0~w;/~,";.".....................
71:.k;-
lTnnunt'JT ;~J
,"..""."..... "" .... ...".".."",..,....,,,
.
Richard E. Anderson, Register
"""",'......";;;H......;,............".".....,;q......"................"
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DECREE
Be it. remembered that on the .......glt.t!L..... day of """....,....".i:m.l)!.;',r.~'.............., A. D., 19 7~."., there
b ted d ddth I tW'll dTt f '101die I. ,""0
was pro a an recor e e as 1 an as ament 0 "";"..,....".....~.."....L..........""".....".."..",,............,
I te f ibm'''!' ~'()\VnAhir) C bId C' t Pl' D d '-tte
a 0 ."..."........-.......--;,'....:.........."... ....................","....., urn ar an oun y, ennsy vanta, ecease. l.Jt' TS
rp(,i.1 trnrlon Lnry , te d t IToh_n s. l~r!,o
~.;~:~~~~..~;.~~~~"~.~~ '~~~;~;"~~~:te:: ::nand y:a:' ~ ;(~;~~~:~'.'''''''''''''''''''''''''''''''''''''''''''''''''''''' r"."""......
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Hichlll'd E, Andol'Aoll. H"'J-(iRtor,
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RCC.U 14-13)
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21-79-65
COMMONIWALTII OF PI~NNSYL\'ANIA
DI.iPAllHIENT OF IlF\'FNUli
BUREl\li OF COUNTY (,OI.lH'TlONS
*
RESIDENT DECEDENT
COUNTY OF .,J;JJ~UJliJl1AWL_
.~-.
IMPORTANT,
;'I~,~~ _H,.,L~"""'__ ---.'~,-~-___LI.., ._'~_.~_~_,.~
'rh18 return must II,! {,olllplt-!cd III lh'tnlllll1d nh'lI JIl dUpJI(.'1I11'f whh lI11nlludwdf with tIll' I{cglHltlr of WillN of 1110
COUflly wtWtv dc(.'cdCllll rl'Nidl'dj IhHtlI'fI IIi due wllhll1 Il11W mOllths f\fln dllte of dlHHh, unloHH 1\11 ""leflN/ull HI allHUlld
h}' Ihe Secretuf)' n( Rel,ic!Hw, (SCl:ilnn7n.l of lilt' Inlwtillllll-'l' I1l1d bHIIlc TIIX A~~l of IQ(d,)
...~,_.,-~
--
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-- -'~_.~,-,---~-~---
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IN TilE MATTER OF '1'111.': I':ST^TE OF }
----lIf.1JllLJ . EG n ________......_.,____.
(!HATE Fut.l. NAME 01" t'JEcr.rJE:NTI
Lot. of --------.-.CJllllhQ,r~ll11d_,.,..~__....~_. County
^"FIlMVIT OF
IiXEC:(I'['()R
^OMINISTR^TOR
S'o'. of _.E9_!1nSYlv..!lnj,.<!__~'__"'___)
, II:
Coun'y of_i':...I.!Jl!E.5'r1_!lllsl____..____.
-------,..JQ!lJL S. ~_______~______.
lUliAlIliXtlillilli: .f lh. "'al. of lh. ,boy,'noo..d .".d.nl b.'ng d,ly .w..., ..p... 'nd ..~
Deer-dent died JanUary 14 I 19~_{'0lIote leaving a leul will, copy of whIch I, ""''''0 aUQChed,,}
(MONTH) (DAYI IYEARI ~J\'!lI
N.m.'nd.dd.....('"..n.y.. } James R. Humer. Atto~
olh",r author/ud t.pruofltOIIVIl lc. whom
.1I""..p.nd.n,..ho"db,mollnd. 1 W. High St-'-1.Car1is1e. PA 17013
Exeoutor
---
That as such.JjXeruto~__del'()nenl is fumiliur with the affairs of said estate and the property constituJing
(EX ECU'TO R-/dJMINIST RA TOR)
the aSSets thereof and their fair market value.
That at the time of death there lI'as no safe deposit box ,,'gistcred in decedent's IndiVidual name. or jointly with. or
us agent or deputy of anolher, or in decedent's individuul nume, with right of .ecess hy unother as agent or doputy, with the
cxcepliOIl of the follOWing: _
NAME AND ADDRESS OF BANK OR OTHtR INSTITUTION
IN WHICHDECEDF.:NT RENTED A S,\FE DEPOSIT BOX
-
Cnrnmnnwp.n] th...Nat'i nn".L..RRnk
,-1~er.-.S.L_->-.c.ar.lliJe. P
THIS SAfo'E DEPOSIT BOX RENTED
IN NAMF. CiR NAMES OF
RE!.. A TrONSHIP 0 F JOIN T
HOLDERS TO DECEDENT
~'ia.d.ie.....L.....E.ga
That the eonteats of said sufe deposil hox or boxes ure i1emized under Schedules B
with the exception-of the fOllOWing, for the reasons hereinafter set forth:
of this return.
Th.t Schor/u/e A attached hereto and made pUrl hereof sets forlh fully and in delail all the real property
in the Commonweulth of Pennsylvani. of which decedent died huving an interest thorein. It also Sets forth Ihe
mortgage cncumbrani,)es upon each parcel of roal property fit the date 'of deuth, giving the amount still due at
death, name of mortgugee, dute. rate of interest. und book und page of record Ihereof. It also sets forth in Ihe
columns provided therefore the uosessed valuation of each of said pu,cels. the estimated market vulue thereof
us nf date of death of decedenl,
Th.t Scher/ule B IIttaehed hereto und nlllde pt\l't hereof sets fOrlh fully and ia detail all personal property
wheresover sitnuted owned by the dccedent ul Ihe time of dC"lh; all monej'" left hy Ihe decedent .1 the time uf
death, whether In deecdent's immediate possession, SIIInding 10 deccdent's credil in bunks of deposit. savings
banks, trust eompunies, or olher instilotions. whether indil'idually. or in trust for any other per.on or persons
giving also separately Ihe ae",ncd Interesl there'll1, if nny. down to the lust interest day prio, to deeedeot's
death in the cuse of savings banks, and to the dale of deel'llent's dealh in all othor cases; all bonds, postal
saviogs, Ireasury cerlificates or ooles and other el'idence of indebtedness of tho United Stutes to II" de-
eetlent; all oblignlions, whether by statute Of ugreemenl Ihl')' lire d,,,lgnuled as tax free. of the lIaited StoICS.
or anI' ;;tate, or political subdivision thcreof. 01' of 11111' foreign c"uutry, which are owned (,t the timc of death;
all wearing appurel. jew"'ry, ,ill'erw""" piclures, hooks, Wlllk, of art, honsehold fumiture. horses. eurriages,
antomohiles, bouts. and any and ull olher personal "''''tteh of whalsoever, kind or nature, left by decedent,
together wilh the fairlV eSllll1uted markel VII It", Ihe'"of: 1111 1"""ls and n""tgages beld by decedent ,",d of 1111
claims dne and owing decedent at the time of dellth. a ,,,I all promissory notl'S or other instrnmenls in writing
for the pnyment of money of which dl'eed"nl di<:d possessed, of whnts"el'e! nature, wilh interest therenn, if
any. giving the fuee vlllt", and estimnled fair Il1nrkcl I'alnc thereof, and if sneh estimuted fnir market vnlne he
less thun the fuee vullle, it sets l"'lh bl'il'l'/y the "'nsons for such deprecilltion liS to eaeh item; all mone)'s
IlIlYllhle to Ih" estate from IiI'" Insurunce "ollcies enrried by decedent; IIIi nnnull)' nnd endnll'ment conll'lIcts
the prceeeds of which were J1l1yuhle npon Ihe denlh of Ihe decedent; 1111 nud Ihe corporate stocks and dividends
due Ih,,,,,on a"d IInpllid ns of the dllle of denlh, honds nnd necrue" ioterest thereon to the dute of dceedeut's
deuth nlld nther inveslmellt SI'eU"II,', o"ncd hy Ihe dee"dent nl II", time of deuth. with the mllrk"l vlllue thero.
of ut such limv,
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III t.lw onHn ul' "(l(1\lI'It'lllfl of' O!OHf' or "tlflllly tHlI'jlflf'fltlufl!i, 1.110 Vlllllllf'\ ""pot't.orl /lrtl !l11 1'111' IHI
llflK~lhl(1 Hullsttllltt/ll\)d hy 1'11l1t1l(~11l1 flllltlfl1l(1I1tll ol' tllrf {illl'1l01'lttlllIlH, slwwll1K till' ,!IH'HJIH lIud llllldllt1.,s
thl'l'I'Or 11'1 01' tlw dtll,(' Hf' donUI. Till' ~f'III\(l\tll! Hl!Hl .\Iljt; f'nl'tll lhfJ 1111.01'(''1'" nl' llnlwdollt nl Ill" IIUI!! of'
11''11 III III ItP1'ro., 1'111'1111'1'''1111 II 01' llllh I IllJHflj Hllll ,Ill HllppUI't, nt' t-11f1 VIl)lln 0 f' 101\1011 I tl t(11'tHII, thol'(' I" IlnunXI'd III
Huhl hl'IH'lhllo, l'lll/Hu'llIl Mll1ft'Wdlls nhtlwITlJ', tllOlll11l('tS lllld lillhlllf1fJR nl' Hlllft co-tH\I'llllll'~hlp 01' hll~IIIf!HH.
r\ l'OPY 11f' fill' f'CI-Jl"I'tlll'I'!,hlp II 1!,I'pl'lIH'1l I , (If' nl'1l1, 1\ ~,tlltpm(illt H(lttill,~ f'lll'th ~t\lt 1I(IIIII'f,' of tIll' 11i!;I'f'11tlli!llf,)
tngntllt'l' \\-,[Ih II ~i1lill"III'II' !-it'U I lip.; 1'01'1.11 l!iu UIIl\l'I\(:t'1I'.of' tho IllIHIIlIHI"l1 it", 1/lf'flllDlI1 I\Tld Hll!'h /llhllf 1'1Il'!."
'll'rlllll1l11~ III tIll! IlflHIIIIHHl flS 11111,\' Ill! p"I'tlllolll 10 (t 1'11,11' /lull Jill'll' IlflprnhHt'I 01' till' (1"('I!!ll'IlI", (tlll'l'II!"
tlll'I'f'lll 11\Il!'oi1 tJf>sllbrlllttf'd. It !-ltl(lulcllllsll !.ot f'ol't.1t III Ilnttlll.od f'OI'IU, tOl1,ftLllfll' \1.'11-11 Ihi' 1'/\11' 11l11l'lwl VIIIIII!
I Ill1rl'ol', 1L1l~' 01 hili' [lI'OPOI'!,\' /lwllIHl 01' llnqlll'/lUllld IJ,\' thfl dOI1I'llfllll III till' 111110 of' dou"!l.
'1'111' \CI'f'r!Ui/, r. fll,t-Il('llocl I1n.'nto HlIll mudo pUI'l Ilt'1'oof' Hfl(S f'ortlll\ 1."\111 nllHWI1I' to uunll ItllluJI'Y
l)(Il)llllnpd tltol'I'ln find 111111,' Lt/.~('n('t1'HIIHf'llr~(JI'prop01't.y, rool or porRonnl, within two ~'(lllr~ of Ihwnrlonl's
r1c!IItll, III ('Ollttllllptllt Ifill or dl,t'p(lntd1 ~ /10111.11, Ill' l11I.(!lldml to tllkl\ l~f'f'nct 111 J10NSO!'lkIOIl Ill' tlll,I(I,\'lIIl!nt. lit nl'
11ft.fH' dOllt"l st'lll flC'lwdlllc' !';>n!.H l'ol'!.11 tho IlItt.lIro UI\f! Vldllf! of filWll 1'1'(jlHlI't.~', 10 whom tl'l1Ilsl'''J'forlt till'
fnlnl,jollHhip of till! tl'/llIsl'PI't!nS to tho dfl(:(~I\/'I\l'J tllp proport,jof\n1.{' siluro I'{!c{'f\'od hr olwll 11'IIIlHf'{'rnO /lull
/Ill othpl' fllels of II }ll1rlltH'nl flflt.\lfl' l'I'~',nrrtlny, Hniel tT'IHlRf'ers. 111 UHI (,liSP 01' II'1l11HI'I~I'H IIlU-'flrlnrl 10
t,lIkn l'f'f'fH't. III Ilf.,S.<il's!ilOI\ OJ' tlll.lO',\'II\(!!l(, I\t, or Hftnr rlt:l1ltll, thorn Is Il!A{J utt.nehnd tn UII' snht~dlllo II /~(lI1Y
of' Illf' df'ed, t.rmd IlgrllfJmollt 01' ntllnr IlIst-I'umolll cl'ohting t.hn t.I'IIRt. rrt1l1rl~ is nlso 'tilt f'of'l,/L 111 "wid
sl'ht:!lIulo It list of' nl1 Ill'OPOI't.,\', I'old IlIlfl j1ertwnlll, with Il.~ VlIllle, widell JlII~,l'lI'S III dfrl~,)/h'lltl~ dllll\.ll by
vlrf.ul' "I' !1I1' l'xol'(!IHP II~' dl't'lJlhllil, flll,hot' lndlvhlHlIl1,\'J ()I'.IoiIlU~' wit.h IIlloLhf:lr, or /tll~' !I'lwl'r lit' flppOilll-
nll'lll \,{!sl.i'(lllld('('odfllll, 01111\'1' IIHII\'1cl\lu11~' {JI' .l(jilltl~', h~'lhfl will, dnod, or nt!IOr IIIHII'lIlnl'llt 01' II11othl1r,
""I'th (I (~J))lY pf' Ihfi Illstl'lIl11l'llt. 'l'I'f'1It.11\v, Huoll pow1w lIt.t,Hr.hod t.o t.llf' R{lhttdHlo,
Thill. SChf'd(Jlf' ,:1 lit tll(,ltl'd hl'I,(.to /lIld Ill/ul!) plll't Ilt'I't'of Hnhl f'orlh Iho 1l11111W, /Ifill Illlill'I'S!;l'S of' 1111
IH~rsnns Ill'lwf'_le lllll~' III L(lrl'~l tl'lI I'll L]l I H ()!'I tllto 1\1, LIllI llmo ClI' dt'(~f'rh'll I.' FI dOll t.h, Un' lIit l,lll'l' (I l' till' I I' I'I'S-
p('dh'I' jllt,I'\"I!stH, Up'lr' l't'lnUllllstllp, II' ILfl'y, to t.I1f'dfJenclnnt., tOMHt_l1or willi I.In' IlI~flS lit UII' 11mI' of'
df'c,'d(llll.'g 1\1H11l11lf' fdl mlllors, Illltlllltnnts 111\11 hl'llpf'lcllll'1f'H 1'orllf'n IIndo!' df'cf'dnnl's WIll. It, ~lIS(J
l~nntll1l\s II Rt.HLnIl1PIlI showlllg- wldldl of' till' IlOi'lllf'lelllrtn~ lI/mulIl 111 tllo dnentlnllt.IH will, If' lillY, fllnct prior
to dt!I't'dl'lIt., UII' lllltHS of' llwll' t1I'IlUll tltniT' IS~ll('1 IUIII t11(l r(llnt1otlshLl' of' ~1l('1l tHHllP I,ll till' l1f1llr'I'I(~lll"r.
TllHt S\:/!r>du!e r IIU.llchod 1101'f1t.O IIOfI mucin IL Jlllr1- I1flroof sot.s f'ol'tll III I propnl'ty, l'I_'ILl 111111 pnr-
sonlll, Il\nlf!d h~' th.. clf'(~f>llnllt .lointly with nnntllnl' or olllors, In~ltlllinl!. Illtnn~ihlo, sl./fllcllnglll tllO 1l1l1l10
01' t.lll' dnetJI[.n\t /oul O!h(lI'B, p'lllH t.lle dnt.e filld p'lnlw of' rocord of illst.rlllllonts f11'1'oetilll!, tllll \'osttt.lJI'U of'
rewl I'stllt,P /lllll Lip! rtlll.tI of' fll)qtIIBltll1f1 of' Jll!r~ol1n]I,~', pI11fi tho flttml', Hchtrosfi (U\d rolnt.1nllsldp, 1f'1II1Y,
n f eO-OWIl(lI'S t.tl tllp i!ot'ndl'lI t.
ThntScf,f'dulf' r nt.tflchflrt hnrot.o IIllcl mucic II pllrt horonf SClI.H fot'th fully Illld 111 dt'tall nIl doht.s
nnd IlpdlH:tlons C'llllll1('lt fOI' Hllft nil hol!lll f' of' Uds dllcorlOllt's est.nl,I', tllCllUilllg l'Ulll'l'1I1 l'xpun."\tlK patel:
f'nlnlIy oxnmpUoll, wllt'l'l'! IlJlpl iC~flhlf11 ('(lAtS 01' nrlmlnlsl.t'fiUOII of this 0fit.lll,f'1 enllllHol t'l'flS /Iud I'Wl1ctl\l'Y'S
eomm1HS11lTlfi ]111111 01' l/f Ilo pnlll; (~osl (!x!lnndnr! f'or llllrlnl l.1'lIst.!i, t.omhHt.onfH-l or gl'U\'Hm/ll'kf'I'Sl Hurt ret 1-
R10lls ~wrvl('m;, III ('Ollsnqlll'!IeP lit' Ihn 110/1(,11 Ill' UIO dooednllt.l tlohts 1II1l1 c'lldllls flldllg und I1Hp"ld HI t.lme of'
rte/lt.Il; t.IlXI'A Hcel'llf'd l~hlll'l!,n/lhllJ ror pOI'lorl}lI'1(Jr 1.0 Iloeoc\lmt-'s (tl'nl.h (flxro}lt t,ho:<;(l nllnwI'd lindHI' Sn[~tton
fl51 of' nl\' Illhnl'llnllt'll 1I1111 Est.Ilt./' Till( Act); l.ogo\.hol' wit.h 11 Ht.ntemfll\t. of' r.ollntl'T'1l1 lilpd~/'d for oldl~II"
t101ll'>, II' all~'. II lk /lP;I'PI't! t.hnt tll'~f'lil11I1IHI'Y will prnHfJnt. proof' of' ~w1d e1/lltllOd olllll-!;Iltlollf'l uJlon I'n'"
l[lIosl, thlLt. If' till' ftllHlllll1 HI'ttllllly puirl In Sl!t.tlonwnt. of' fln~' r,,(li COfllllllsHlolI 01' dt'hl Is !I'ss t.hnIJ t.lle
('sUrnlltl'd IlIIltJltllt 1'1/111l111lg Ilntl 1l11ow(Ht, thnt ill(> snmf' will l)f' rnpnrtnd t.o tho H(l~-lsfpl' nl' \\,[lIH, IlIltl t.Il1lt.
tho /tlllOll111 01' Ill'.; IIHSl!S:'wd {~I\l\ hn l'OHSSflfHH'tl III UCCOf'(ll\llCf~ thnl'owl Uh
Thill Ihl' tntllls llr' tllf' nppl'nIl1'I(,tl' eolllmllS ill Schndlllos "A", "n", "e", "E", nntl "F''' fiR r11I'nf!toll thl)rntn,
l1nvl' 111~f'1l rHl'l'lnd f'nrwllrrl /Inri PI'{lJl{'l'l'Y re'J!.lst,nT'nd t,11 f,hn Snnunnry.
Subscribcd and sworn to before me this
" I :t-
. ..,.. ..<1,.."...,
1 "
f / (.'
\J_ -_ "j .~. f .
. _ ,_"""~ : ,..',;'" /:,-,2.~." ",;:..""" ~,_"',.., f,,, ,,~/.~5;...-:,~
/.' (E~e"utor.AdminWtrato1')
194 . X9xtRg!!c;L
(Stroet Numbor)
C ar1 i~l!l"J'A. .17Q13, .
(City or Town and State)
_Jl~-1i:~ {,
"- /1
dny of llf"""!'!!?:'{''''" ".10,7.2'.
J(/()A(;.<,.~
II,y
(li,lliio, f'A
:'!'/ PUrll!('
r'~!~in'\ ,hi',' I "~'.
Curnlwlor,d 'OUlll'1
NOTI':: lIf'f'Cll'f' Hll~lllnp, nf'J'ldllvlt '11l1lkl1 HUI'\! HII lllnllli SpllPOH ~11 Ihf' I\l'fld/\vlt /lud :'it!lif'dlIJ'''ol IllHl/'XI.ri flre
flll,'d III wllh df'lllll~; Ill' till' Will'rl ~SClllfl"l /11111111 ('IIHn tho IIHsnts Ilwluilo l'llrn Hill! 1I1lJIRII'd .....c.IIIIt.I(lS,
SPC'lll'llll'''! Ill' ('10"11' 01' 1'1111111,\ (';CII'Pfll'lIllo11S nt' nn llll-C'rmit ill Ull~' 1'0-P'II'tlllll'Ilh1p nr hllslnoflH, {IIIII Ih"
rill t II fllld t.; t /111'11I"111,," 1'1' qllll'l'll 1I1ldn I' \,110 11/11'1l1~1'llllh nlJll\'o 1'(11 III t n.u. 1.0 SI111nclu III "B" il r'l! Ill, l.1l('IH1d. AI fin HlIlK"
ol'I'I/lln tllIlt I'nlumll !fl III thn IIHllllUI)/II,~,11 II/Hi honl1 proporl~'(J(l",pll'tod f\S f\bn\'('~dlf(l(1tl'tl.
nee '~F,
J\\';Slll,.::l ill':Clml,:NT
HCIII'~1'I11J,1': 'H"
I'EIISlJNAL 1'1I01'1,:II'1'Y
M~:~,
. '-'1'
ffl
,~':~u,
('(JMMONWI':,\J;I'II OF 1'1':NNSYLVAN I \
'I'11.\NfJloEIl INIlJo:Ill'J'.\NCI': TAX
It\H'l'Hl!CTIIINS: 'I'ILIH Holl/HllIln nt\lHt. dlH\'lOfHl nil tlllIu,Jld(lllncl ~lllt/ll\gllll(l pfll'HOIII,1 P"IIJlfIl't.y tlWIlI't1 ~~I\'lclllllIJ\'
!2.....!.!!':.~~.:.:'.\dtlnl., 111 111(' (,lJiIl! 01' litH dn/tUIt PI'Ofllll'ty OWIIOtl Ily 1-1111 clll(J(!lli'"1 .I01111,ly wtlh 111101,111'1' rl" OII1I'I'S
11l1l~l- b" I bHmt llIutnr Sl1llnd\lln "1':". llltlltll~lhltl IwrHtlllul Ill'llPlll'LYl t.1t.1ofl tll Uw 1111111(\ of' Ih\! Ilnc'fHh'lll. hilI
ptl,Vnhll' III Itnnth to 11IIuthor Of- ol.hnrH, 11\(1111dllllJ, hill. 1I0t. IIU1ILnrl tu P.D.D, II. H. SIlVllll';S BnlldH /lHd ll'lltll~
I_lVI' \.I'll'il IH~llll\lIlt.H, IfIlltt!, hi' IIAt.lld, 11nl'l)lll.II till' f'lIt~t t,llIlI !.hoy /IN' not. (If' t.111! nilmtnlHtnr'(111 I1Ht./Itl'.
Tllnp;lnln ,pllrl.lUllnl "1'0\101'1,.1{ HllOlllft hn ltHtllll ftrHt (f"I~' .If'Wnll'Y, WfHlrlll$1, ItJlPllrl!l~ IlllllHflllllll1
1';IIlHIs, Ulllt flll'lll NIIIII$1,Fl. Ilool(~, pfllllt.II\~HI 111It.OIllOhlll'H, hontsf nl.e.)
Illtllll~lhl{1 IHlI'~{I1l1l1 )ll'up"rt.y, f1l1dl nH hOllltHI t.I'IlIlHIII'Y {J1l1't.iftO/ltfl~, (l/IHh 011 hltllcl IUIII 111 II/Ink,
litol'l;:,'i, IllO I' I 1-l;".lI;lHi, IHI U.'H , t.lJJ.!:~t,hf!r witll IIt~PI'HAd Int.tlI'IlHl 01' dIvlrlerulH, sllIllrloH or \\'Il~aHt illsurluwfl flIIY-
Illlln In till' llHtnt.fJ 01' f'tfhwluI'Y III rwlfl OllJlllt~tt.YI pl\l'tllfln:htp Int.flroHt.fll tn(.(JrnFlt. In IlTlj'IlIH1!Ht.!'thu{,no
I1st,llt.n of ol'llIeomn l'I'om lmy pl'opllrly hf11d III I,J'Ust. \lndor t.hn wIll or fl~roomollt. of' H.llnt.ller, nvnn thllll~h
lO(Htl.l!d olltfllfltl of' tho Btntn, nl tho I Jm.:' of' Ilflut.ll, HllouJd tJp I tst.orl '111 thts s{~1j(1I1'11n.
-
I tnm ITEM UNIT I'HTI MATIW 11I<J'AIlTMENT VALlJATION
No. L1Rt Ilnd II~HI'I'lbn !)i1ly VAW!>: lIAI\KI'71' VAWE (no not \\'I'it.e 1n
t.1I is splice)
1. Household goods sold at public sale 6790,20/-
6116/79
2. Com. Nat!. Bank, CIA /I 182-322617'8 1538.51'
3. Com. Nutl. Bank, cln /118-3558 8000.00.....
4. Com. Nut1. Bank, Interest to 1/14/79 11. 28
5. CVS&L, Cert. /16689858 1 00 0 0 . 00'
6. CVS&L, Interest to 1/14/79 29.77 ,-
7. CVSf;L, S/A 11121774 5005.55 ./
8. CVS&L, Interest to 1/14/79 10.09
IllHIW t. tllJ Ii tnl,nl oflpnlit. t.o "PtJrHOIln:-\ Pro!lor l~'", 101011(111\11 n "H" In
1.11(' "I\S Ihqllll'Lillllf (10111mtl 011 t,IIO l/is!. J1UU;u oi' tllis rotHrn.
x X
31385.401/ .JI;3,f'J,it
'/r
(Sill
hllVl
-~
20
Ca
II'
--
_.3Q
Ba
,~~
__L~
Ca
_Ca
_E-,_
Sii
Da
-B.,_
Ca
. -
IWV;4lI:l (0-10/
(,()~l\t()NWI'AI.TII OF 1'1':NNSI'I.I'ANI A
TllANSi'IoIlINIIHIU'I'AN('I', TAX
IlI'SlIlI'NT III'('HIWNT
SCIWllllI,1>: liD"
IlIINl ':FI( 'IARII ,:S
.~ ,..,.,.-"-'~. _.~._ ._,,;,__, <---__,_."' '~ _ ...._ __ _"_.__.+~_~~~. ~. ~'=_o~'.on _,~' '__
:::,:::~:,;,=C:C:,-:-__"_":::C:-:=::'=-~="'- .;:=-~,_",-c'.:::-~"" ,~::::~-=c,. ',';~_.c--,-~_,_c_c, -------.-- u -- ----~------~~,-----~....
--~"""'~~~~~~,",-
IIFNI':I'I('IAIU!(S AND AllIJIll\SSES IlHLATIONSIIII'
(c ru\\ IUillWH 1I1I<llIddrcSHC!i or III! who (If 'I.P'(j,ll<lf~n !If SUI(I'II'''') '11,1'1'1' INTI!
'1111 11lll~ ll' Ii I, Vl'lilcd, conthlMtmt or other- lIlt\gitimntu childrull IlECElH(NT OF liEN!'
wl~c, in cfitute) Ilrt."II1\'oIVlHl, Nt\( STATE YES IIIIlTII IN F.
forth IIIIN fuet,) OIl NO,
-.----,.--. ,--~,--' ..-~_.,'---~- .-'---'----- ----. -----.~~,_u,_'
Homer "J.l&..<L___'m'.___._ __.5llJL.,. ,___........;~ ,__.1:.U5...,..__ ~tA-.... ~-----
0 York Road -,-~~~--, ---_.,-_._-~-~ ...._'m.__.'_ ___~"........__n__.______' ~______________~.~.~.':o_,_
----,,_...
l' 1"i sIc . PA .17013 .. -- r---. --
~-,-.--._,~-----.....--..--- ------_.~---_._.,.....--~-- --_._,.._.~._._._- ..--.- .................-.~~-~
en9__D..&9.. Sh..ea l' er llil\tilllttl..__ ....__~c_, hI! ^ 1 ..5.__
3 Georp.c Ave . ----
Itimo~ MD 2122! ~-----
-_..._,---- ..- ----. .~
hn ~__Eg\L....____.__ .SQu...--- Yes hI! A 1j.5.._
4 York Road -
rlisl~L, PA 1 7 013 ._-- -- .-
-_.,-_.-"_.---~~,-_._-----,. .'r___'__'___ ----.--,
thryn E g ~-1.9.L.. DauohteL Yes hI! ^ 1/ 5
.-
6 C St. -- -. - .-.
,~--,
rrisle , PA 17013 - .,- f..--.
,
, ~ -------
-..-
rwood L. Ege Grandson Yes N/a 1 11 n -.-,
DL... 1 , -
r1is1e Ph 17n1~ ,
-.-. n
-..-- ..- ~.
r1en9 F. Ege Kerch Granddaui:!!)ter Y<;1S N/A ._.1110
D _,_..2..._____ - -- ..
rli.sle , PA 17013 ..- --,-~
.-. --_......----..-.--~- ...--..........----
.
--
n
-. - -..
..--- ..- -------~ ~-~~...............-
--- -, -- . -----~
--,--.----,......., .--.- ._-,- ---- ~--
-'---'_...-,------ 1----- --~- L.----
-- - "~._-----.,...-.,- ,- -- -
- - ------------~.------ ..
IH}, I' (lJ<'
FI<'IAIll'
STAn,:
Ka
42
De
D.pononl lorlh.r 'OY' Ihot 011 tho above.nom.d boneficio,I.. a,o living ot Ihl. time oxcopl below:
==-===-~~-=:--===~~----~-==--==----..,---- _.~-_.,. --=-~-:=----------,::=---'-=::':=';:;;-,~:;;:,~~.;:~;~;,:;;,~
NAME
DATE OF DEATH
RESIDENCE
.~tew~.rt T. F:~ husband
__, March..l1 1962
~1onroe Townshi.p r Cum.b..e.r..l.and_.Go~lln1.y
Pennsyl V!l..!1i.o1,...,....
--+~________,___._______.__________,.._.__.~....._ ~---..___r___
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" 8 8,
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ROlli Pro"erly
PcrNol1ll1 ProperlY
Trulltlrcrs ___..._.....
SUMMARY
(Soh. "A")
___ (Seh. "Il")
(Suh. "(''')
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(As ROlllJrhld)
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f{1 '.'- <If> ,1 lll~ I III
, """'Y. Numhor and Namo,_ 21_ - Cumberlluld.,_,
SUMMARY
I'umhor.
2;J.-79~OCJQ5 ____.____'"
January 14,1979
Sad ie
,',;1' ,;1 UlIiJth__
,(''It' Nellno . __~ J9E~__
II A'; 1 NAMI )
(n'H;t N^Ml')
I.
--.-.,.~tINiTiAi:i
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER It~I~ERITANCE TAX
RESIDENT DECEDENT
REPORT OF INHERIT ANCE TAX ArPRAISER
-,- ----
I, :I", und...lgn.d duly oppalntod \"horltanco Tox Approl.., in and lor Iho Counly al Cumber1J1nd_____,__
.l ,-Jvlll1iCl, do rOlpoctfldly roport thut I hove appraised the real and p.rlonal property 01 roportcd In the forCtgoin~ rohlrn l,t
tl I,,;'~, '.('t forth opposlto each l1'em in the last colul11n to the right In SchedulolllA", 11811, He", and liE".
Iv,,',ftbrua,ry 7. 1280____,
_,ll'l},"JU~l J 11,~,Ao '(II)
INH~:nIT^NC". T/,I( APf'IiAI!iEH
REPORT OF THE REGISTER OF WILLS
I. I;'" und...lgnod duly .I.clod R.gi,lo, af Will, In and fa, County, POIIII,ylvanlo, do ,.ap.ct-
I, -_'(H.rt thot I have allowed deductions in the amounts c1ulmod by deponent, OKcept r.s to those items where a gl'oator or
It .1 i' (1lllount is sot forth In the last column to tho right In Schedule "F", which groater or losser amount representft tho sum
(. ",! \1>; n d('ductlon.
l'
'.
".
fiLG1STEIl r}F WILLS
INVeNTORY
HI' ;fiy ISchadule Al
f)eh "",'l'lI!llJrty (Sch'IJdulo B)
JOII" t kd f'nmorty (Sr.hodulo E)
Tr,. I (~;dllld(lln C)
1: '"I..d_ (lUnSS ASSETS
LlI';; "l,,~ ,Inll Doduotlonl
',(;, il'_nUIE Fl
VALUE AS APPRAISED
...!-
ADJUSTMENTS
ODE (HARRISBURG USE ONLY1
00+
10+
20+
30+
REMAINDER APPRAISEMEN'f CODE
92+
40-
93-
CL I' \'1 VAI.UE OF ESTATE
ES'I ,\, I T,X ASSESSMENTS _ $
t=
FACTOR
1=
VAL.UE
9~\,E
Vo' "'il (,f Iii" 0910109 ot .2L--
anll~ I '.,' ........,..,.........._ $_
f'RINCIPL.E
t
'rOlAL lAX
29..!?!!.
2% $
6% $
$
16% -- $
--- $
--
$
$ 1=
$
I .
COMPUTATION OF TAX
E.9_ I'F t.2.f FIEGISTER ONL.Y
To)( c l :t.
Teo "
To>
TCI)( ",., ~,
1'(1'
T(ll" \rIll
(,I) A. evidenced by Charltobl",
EKamptlon Certlflcatos Issued
by the Secretary of Rov~nu(t.
El<f'!o,;': i;HI~,
1./'
3 II;
Ltl!l!l tal( prClvlourdy paid
BALANCE
"r I[I~. If pl:1ld wIthIn
uftfJl (1",0111
TOTAL TAX BALANCE
PAID
$ i_
$
$ J
$
$
$
nAI il'.
Acl,
C1IINHERITANCE TAX DUE
I" \ 111 101(1 of 6% from
to
: -------t:::
AM" ". "" ISfATE TAX ASSESSED
El1ll Il,dd
BALANCE DUE
Add 1;0,; it' ,1,01 HilI) of 6% from
'0
$",...1, """",I Codoll (FOR USE IN HARRISBURG ONL Y)
,djl':.floont
i~it'i,1mcnt
;'I,lld i\y
6O-Llle E,'ote
92.R.malnde, Appral,al
93-Romolnd.,Oeducllon
93C-Cha,ily
9J-R.malnd., Residue
96-.Succoulv.
Lif. E,tato
: ,'~,I OF R EGISl ER ONL Y
AOJUSlMENTS
rlU I L Whoro subsequont odjus.tmonh are mado to the above ((Imputation of tOK by thlt Reglltbr of Will. for proper r0050n,
\.umo should b, notod below, wIth short explanation. '
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J~FORMATlQJ!!.
To Insure proper oredit 10 your ACJCOllnt, tho nomo of HIO osluto And fila numbor should be cloarly print
ed on Ihe check or money order,
'rhls 8SSefillmerH is mado In accordance With Section 708 01 thEl lnherltanoo and F.slftte Tax Act of
1961 (72 P,S, 9 2466.7061,
To Ihe eKlenl Ihet Inheritence 18, is paid within th,oo 131 monlh. alior 111<' doalh of the docedent, a
discount of five (61 perc.nl is allowed 172 PS S 2486.7161,
Inhoritance Tax, other thnn taK on a futuro interes', is due 811ho dAtil of the decadent's death and becomes
delinquent at Ih. axpiratlon of ni". (91 monlh, IIlier tho doc.donl', dOlllh 172 P,S, S 2486.'/111, InhorllOnce
Tax on B fUluro inl(HBsl is payablo within throe (3) months aftor tllo 1ransfflt lakas offot.:1 in ponesslon and
enJoym.nl and is dol,nqllentlhe,eafter 172 P,S, 9 2486.7121, C.lclllate Intere.t from Ih. dollnqullnl dala shown
on the face of this form to tbe date of actual paymonluaing the following Inloros! ltlbla:
_________..__ ____.._... _.. _ ______...._ __on.. ___ _ _.__ _...._., _ 0_ _ ...~. __ _ _~ _ ___ _ ___... __ _ _ _ _ _ __ __
1 month ,006 4 months ,020 7 months ,036 10 months ,060
2 months ,010 6 months ,026 8 months 040 11 month. ,066
3 months ,016 8 month. ,030 9 montlls 046 12 months ,060
-~---~~
1 day. ,000 17 11 days ,00186 21 day. ,00352
2 days ,00034 12 days ,00203 22 days ,00369
3 days ,00061 13 days .00220 23 day. ,00386
4 days .00068 14 doya ,0023" 24 days ,00403
6 days ,00086 16 day. ,00250 26 days ,00420
6 day. ,00101 16 days 00267 26 days ,00437
7 days ,0011 6 17 days ,00284 27 day. ,00464
8 days ,00136 18 days ,00301 28 days ,00471
9 days ,00162 19 dsys ,00318 29 days ,00488
10 days ,0015U 20 days ,00335 30 dsys ,00600
-_ _ __. _ _.____ __ 04.______ _ _,_._~. .._~,., _, _ __ ..,._._ _ _...._.~ _ _.., _._,___ __ _ ~M _... _...____,__.. __ _ ....
Any per-1y In Interest, including the Commonwealth !Ind tho ptH9or;al r~prl1'98ntatlve, not satidied with
Ihe assessment msy obJeot therato wit hi" .i'ty (60) dllY' altor ,"csipl of thIS Notico es p,o"ldeq by SectIOn
1001 of the Inherltsnce and Estste Tax ACI nf 1961 (72 1'8 \ 2485,10011
Make chack or money order payable to:
"Re~lster of Wills, A~enl"
M1i1llo Ihe address IIslod below:
'H~ 'I.."!!,,, (1\'111)
21-79-65
DeDUCTIONS AllOWED III
THE SUM OF I ,//~ ('> ',., 1 V
_______.. ~..._.'____~______."...l_'~,_
1H Id'P~OVED .,h\l1>i.t:'i.'I_JL,..
,~ " 'II
}, 1', !' I. J
, '\"" 'f' , ' '" " '. ..
--,. ',--- _ ,,',_,-- ""v",'-
..., __,_~"_.!...,~~,~.._""L_~_~~
/: ,_' R (,'!i'tE;~ or WILV:, ^fjU~T '
i/ .-/ ii / .. .".. " rI,>.
__'_-;":'-____-n----n-- .~-~~'----~--~.~"j,l.W"~..,,
OfF lel Of THE
REG/HE: R or WillS
STATEMENT Of' DEBTS
AND DEDUCTIONS
Of__ C_ulllb,~!~.t(md _ COUNTY
AND AGENT Of THE COMMONWEAL TH
~-~'
ESTATE OF _,.~,~~,~.I~lg9._~__....__ LATE OF ____..Moproe Ipwnship ___._'"___~,","
DATE OF FILING APPRAISEMENT ,LJ...:l...~_...1!ri<) ()ATE OF DEATH -1ant,1.~, l4J.....197.2.~______.._._..,.. ,_
_'_".'_T'''."'.'~___' ___'~'_.,".~..____~.__n_.__,.__,,"':"",_-----"~__r_.---:'~__._ _.~___~__.~._______.._.~___.~.____...~_ _~~._______..~.____.___.___...._ _
'__mmm'_"~ .._.._ ,.~_.___m'~__"___'__'I__'____"_'____"'__"_"" -.----,~.....,..-
DATE V~~C~;'R IIAM~ or PAV~E HEMARKS AMOlnlT
. Re..&.l!l toLQ_LWiJ..llL _____~ ____ .1Jtt..tor.LT..o.sL._.e..tc..._.______,_ __,_,-42..
!{~&t~J:~~.r_of.lViDJL_~_.~__~~~.Eli.i 11 bLllc..C1LJ.illIL__ ~~__~~"" _.,_,6.~
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~__.________lj0fman Fun_().t(ll..Jlome___~__ ~()x.ylce..2....__.________".. ,_.tSA1L. lL-
H. Robert Davis M.D.
____,___ __________,_ ~___~___,_~__.~_________.'_.t.._,_____..._ .~_~___,__.,
;;~t_.Uln.e.s..,s..
_,_~_m..,., ..".".... .,. 1,!,(ln:Js..._.{\_!!..?_Q.~j.atc...s....._____"__._"___ ..x~____,__.__~_~____...:.. ___39 .0___
__.___.~ _.______ PEr:J..~~l:_~~r ~~~_.lL()I!l.e~_._._,_, Las !....i) lne s.~,...____,__~___"..., ___,_1_ __L.
___.,_.......,_. _''''.....__. .fllIl_~l'l()...J}9.s pi!. a 1 _____ ",Las till n e s s
.,m.,_.Q1l;l:..1.~_s....~!:!()1112_t~il",1.~!'r.Y.l.ce. j,~tter.}n!L memorial
............JL. ..L
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0___
...I\!()_t.:..~~<i,'_,___..._.________.__,...li1ec ty ic service
A w~_lnc.. ......_,____,
Fuel Oil
J~J..iz a bQ.th..X, A rno 1 d___ . ,'}JLl&....JL.T.lY1l..Js1X e s
Ge._().I1\.~Jr.:-_.Eben.()..!..,______._Re,al Est.. Appraisal
::..S.cl1,__ __..ill..... :L_
122_ .9.._
2llil.o..._
127. 0
._,----- ---.--
___,..,._",_.,"",c",.____.R.QJ_GottsJwll , ...Auctioneer
__.__,___,__.___ K i mSJ..9 t t sha 1...L.._________ Sa 1 e C 1 e r k
.~_~_____. L_~..s_t.~!_Ir im.~:,()..1:____.,.___._,__,__
Sale Clerk
127
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... ."..__... !?.fll,()II~1.E, .
___..J ...0_
,__._."" ""~, _._____n ~ily_'~~_f!.l_" ""...'
328
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Te1()Pllo 11.fJ.. uE~,p,()..ns.('1~,____
Steve Fisher
Rec;'ordEIYu-or De el15".-."-"...---.-
James R. lIumer
_-----.LL..z. ___
~cc__,_ ~,___~_,n
~~~~~.-.-
Reservecl for.llIis.~~7~c~cn!;~
,".~~,1.:Y~ of Mountain Land __
Realty Transfer Tax
fI.!.!.~_I!.~ F e~.._-',_________
_'"....o~f~_ a ~~~~,I2,~~~f 10 s i.n g
_U.L 0
1281 0
7000 0
350 0
--._, ---.....
-~-'-~.__.---.....
COMMONWEAl. TH OP PENNSYLVANIA I
COUNTY OF'n_,CuD1!!,qrlgl1~L J 55,
I. ,_... n. ~.J,Qlll1,S~...J::gQ___~_____n________'_"'___' tiEREBY CER TlFY, THAT TO HIE BEST OF
MY KNOWLEDGE AN)) HF.LII'F, TtIE FOREGOING " A .11151 AND 1RUE ST/"JEM~NT QF O[BTS,.FUNERAL EXPENSES AND
EXPEN5F.S Of At>MINISTRATlON ~,t>11MITTto f(l'rHE ESUTE OF__ Sadle I. lill.0 __'___
DECEASLD. AS DFIJUrT IONS FOl< ItJlil' RITA~I('E TAX PIHlPOSES';-9"t : / (.:11 cf' /
( /VJ~' /", ('iU~ ~__ (L.S.)
SWORN AND \IH~,'-RIUEO UEf ORE ME THIS 9th ___ DAY OF (;' (/
_,.,__ ~Jay '" . .___.__.._ 19,(jJL .
TOTAL
16033.20
~'._.. ,.\---..., ~' ,L_',--_,.. " ,..~.,' ...~__< ___ _._._.....;.. _.......... L!.-;!.......L_____...-._~__~._____._ _,_
NO'1',~ q'/ Pur:ll.'"
Mv [,'II! !If,lion r.~"'i(- Inill
(i1tHt:c, PA Cu'nh.',':',d Cuunl\'
COMMONWEALTH OF PENNSVtVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*'
COUNTY FILE NO ".
/ ,/
DATE
"-' (, /,
'~_--+--"""---T._----o.--._
TO:
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ESTATE
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fiLE NO,
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Appraised V.ILle of Estate:
Aenl Estate
.( ,'-'
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COUNTY , ,. ,. ( (( I ~ ..' \, ~
, .
DATE OF DEATH I I. I /1'-/ ' I /, /
" . / /
"
.
Persons I Property
+
Joinlly Hsld Property/Tran.lers
+
Totol Gross Estate
.
Total App,oved Deductions
Clear Vslue 01 Estate
.
Lass: Approved Charitabla Exell1pllona
~
Clear Velue of Estate Subject to Ta.
.
Amount Taxable @ 6% Aata
.
lax due
.
Amount Texablo @ '6% Aate
tox due
'* '* .. '* '* '* A five
will be groMod If the Inheritonoe
TOTAL PE~NSYLVANIA INHERITANCE TAX jUE
, .{ /, ,,'l) ~I.' , ! 'I ' / /
t 1'-< "jr _ -'~ 'It.. ")",) /
peroent dlsoount tot frog . .
Tax la pold by
- I' -'
. / /' / .,)
" / (' I -~/
,/ 1'1
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'--.._--~-,.~
II) '!~ .
'(, "/"-.
less Credits:
~i~~
"',1
'. I, ,( t
AMOUNT PAID
DISCOUNT
$ //1 '/
/ "
-,
/......1
+
$
INTEREST
..':' I '/
TAX CREDIT
LL/("1.,,;<
=
+
=
+
=
Interest accrues at the rate of 01. 161 percent psr annum
on the unpaid balence of Inheritance Ta. from , ""__..__
to dAle 01 payment, Intoreat due If paid by___,__.._____ ia _.
BALANCE OF PENNSYLVAI\IIA INHERITANCE TAX DUE
~' , ./ f'
!i '- ;',~,i '-~-.,"i, L'/i:'..( (.._~..-'"
Asse&Bod by:
SIJO In' ormation on ROllorl:lo Sido
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1,:/'
"' "I~.(<( 'f . I
/1' i~
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INSTRUCTIONS
To Insure proper c,edit to you, account. the name 01 the estate ond file numbe, should be
clearly printed on the check or money order.
This determination and assessment is mode in accord(1I1cewith Section 421 and Section 732
of the Inhe,llance and Estate Tax Act of 1961,72 P.S. 2485--421.732.
The cstate tax Imposed by Section 421 is due at the dote of the dacedent's death but shall
not becoma dellnquenl until the expiration of eighteen (18) months ofter docedent's death p,ovlded
that any estate tax occasioned by a fln(ll ch(lnge in the Federal return or of the tax duo thorcon
sholl not becomo delinquent until the expiration of one (1) month (lfte, the person liable to pay
the tax ,ocelvcs, final notice of the inr.reasa. C(llculote Interest from the dellnquont dute shown
on the face of this form to the dote of payment using the fallowing intc,est table:
----------------------------------------------.---------,-----------------------------
lnXlnth .005 4 month 5 .020 7 months .035 10 months .050
2 months .010 5 months .025 8 months .040 11 months .055
3 months .(lIS 6 months .030 9 months . .045 12 months .060
----~ .....----<-------. -~-_.,-_... -_..<-~-
1 day .00017 11 d(lYs .00186 21 doys .~0352
2 day s .00034 12 days .00203 22 days .00369
3 days .00051 13 day s .00220 23 day s .00386
4 days .00068 14 days .00237 24 days .00403
5 days ,00085 15 days .00250 25 do ys .00420
6 days .00101 16 days ,00267 26 day s ,00437
7 days ,00118 17 day s .00284 27 days .00454
8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 days .00318 ')!/ days .00488
10 day s .00169 20 days .00335 30 days .00500
,--- ------ ---.,----.------ ---- --- --- -- -----.------ ---- -- ~ --- --'-- ----'-- --- --- -- -- ------
Any party In Interest, including the Commonwealth and the porsanal rep,esentative, nOI
satisfied with the assessment may object the,eto within sixty (60) days altor ,ecelpt of this
notice os provided by Section 1001 of Ihe Inhoritonce and Estate Tox Act of 1961 (72 P.S.
~ 2485-1001)
Make ,check or money order payable to:
"Register of Wills. Agont"
Mail ta the address listed bolow:
INSTrWCTIONS
To Insure proper c,edit to your account, the nClnle of tho estate and fila number should be
clearly printod on the check or money order.
This dote,minallon ond assessment Is made in llccordClllce w/lh Section 421 and Section 732
of the Inhoritance and Estate Tax Act of 1961, 72 P,S. 24B5,~421, 732,
Tho estate tax Imposed by Section 421 Is duo ot tllU c/llto of the docodent's death but sholl
not becomo delin~uent until the e"plration of eightoon (18) IlHlnths after decedent's death provided
that eny estate tax occasioned by d final change in the Fec/orol return or of the tax due thereon
sholl not be como delinquent until the explrotlon of one (1) month of tel' the person liable to pay
the tox receives final notice of the Incrooso. Celculote Inte'est from the delinquent dote shawn
on the face of this form to the date of payment using tho f(,"owlng Interest tob'e:
-----------------------------------------.------------------__________H_____________
J month .005 4 months .020 7 months .035 '10 months .050
2 months .010 5 months .025 8 months ,040 11 months ,055
3 man ths .m 6 months .030 9 months .045 12 months .060
___,________._,..,uu._ "._--'-'-'-_._~~-
1 day .00017 !1 deys .00186 21 days .00352
2 day s ,00034 12 days .00203 22 days .00369
3 do y s .00051 13 days ,00220 23 day s .00386
4 days .00068 14 days .00237 24 days .00403
5 do y s .00085 15 days ,00250 25 days .00420
6 days .00101 16 days .00267 26 days .00437
7 days .00118 17 day s ,00284 27 days .00454
8 days .00135 18 do ys .00301 28 days .00471
9 days .00152 19 days .00318 '}fJ days .00488
10 days .00169 20 days ,00335 30 days .00500
,--- ....----- --"- -....-- -------.... -- --- --........- -------- --,"'" _...._-_..._-_.~, --------, ----- --- -- -- -------
Any party in interest, including the Commonwcdlt!j and tho personal representative. not
satisfied with the assessment may object the,eto wilhin sixt)' (60) dol'S afte, ,ecelpt of this
notice 0$ p,ovided by Section 1001 of the Inhe,ltonco and Estato Tax Act of 1961 (72 P.S,
9 2485..100 I)
Make check or money order payable to:
"Reglstor of Wills, Agent"
Mail to the address listed below:
COMMONWEALTH OF PENNSYLVANIA )
: SS
COUNTY OF CUMBERLAND )
.John S. Ege, being duly sworn, accord~ng to law, deposes
and says that the fac ts sot forth in the foregoing Sta temen t of
Proposed Distribution are true and correct to'thebest of his
knowledge, information and belief.
Sworn to and subscribed
before me this je'tlc day
of December, 198~
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