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(Vl,,./h I'Ili~U~(<'11 /(.. f'
Counly._ C......"-'1
County File No,
Bureau File No, '_H __'___
We hove received notice that, os 0 result of Ihe death of rI;.~IIoKltt~ J . ___..-__..___.___._____..
on___l.........1t'J n._~ 19--11, you c<lme into ownership of .t.:ttrilrjrlll'pmy-rlrrol1\Jh righl of survivorship, which
was formerly owned by the deceden I.
Under the Inheritonce and Estale Tax Laws of the. COl1lmonwealth of Pcnn,ylvonin such transfars ore taxahle
and the liobility for tho paynlent of the inherilance tox due is imposed upon you, os Ironsferee.
The property on which tax is hereby assessed consists af:_.ol01!~ "o~t. .t_~h. )~~r. N.UOA.l_~"k!.
. hw1ri t lA._1'L-1n..tJra.. '".-..Q1...tM_M~n\ _or ft~.~!!~~.L"'tlll!.U~.UDl74.~dJI~~L1'~._
appraised by the Commoawealth, os of the dote of death, at $.. ::12,9:51.60
___..SO-- 0; of thi s olllount is taxable at the rote of _~____m___ 0;
ORIGINAL ASSESSMENT
AMENDED ASSESSMENT
7Qf:9 -T1rz-
I~ ~<5)'. l'
I T/ .
$
-7<1,< j. u;
....- .. .. TI-~r:ir:b5.._
J'?..(. 5 ~
DATE OF ASSESSMENT ,
T AXABL E AMOUNT $ _L /
LESS: ALLOWED DEBTS
NET TAXABLE AMOUNT . /
AMOUNT OF TAX DUE / 'I
, ..---
If you pay the above amount within three (3) months of the
dote of death of the decedent, or on or before__._______.-.
19.___, you may deduct 0 discount of
5% of the amount of tax due, or
.. - - - - - - - - -
This tax become delinquent nine (9) months after death
(one year if deoth occurred prior to December 22, 1965
and fifteen months if deoth occurred on or after
December 22, 1965 but prior to June 17, 1971) and in
addition to the tox, statutory interest at the rote 01 60; of
h ' I d f ' 19'
t e tax per annum IS 0 so ue os 0 ... "7'/"'- _:_
in the amount of (.) -VI', Y,/9'lr
,(.)/~ 5"0
'If the tax is not paid by the above dote addition"j
interest is due ot the rote of 60; per annul11 until paid
- - - - - - - - - -
/10,91
~ - - - -'- - - -
TOTAL AMOUNT DUE
$
$.
/) g- d'If'l
(Inherltanco Ta~ Approlr.or)
k:~,)~..,; '~i~'
,oftlmonwcolth ~ . r:J J 1,'7\.
APPRAISED BY:
INHB_lL~11ON_~ TO__TAX.E.A'l'I:_RS
Make checks or money orders payable to:
To insure proper credit to your account
this Official Notice must accompany
your payment, Mai I or bring it to:
,;y(
?9--/00
(
ID ",)'/J'
/
(,
NOTE: Any party in interest who IS aggrieved by this notice 1Il0Y object thereto within sixty days alter receipt of
said notice os provided by Section 1001 "f the Inhelltonce and Estate Tax Act of 1961,72 P,S, 2485-1001
QUAlJl:UPIICM[ . I:U;I$HR Dr WillS COpy
If you hove already paid this tax to on executor, administrator, attorney or other personal representative of th~ .
decedent for forwarding to the Commonwealth, list below the dote paid, nOrne and addres,,~ of the person to whom
you made (loyment, their olliciol title and tho amount.,
Date Pol d
Nome and Address of Payee
Offie/cd Title
Amount Paid
Undor cortoin eirculllstoncas, if, after tho dote of death of the docedant, you parsonolly paid funeral expensas
or e,thar just dehts of the decedent, with funds darived from the property haroin taxad, suth orllounts expended
by you may qualify os deductions against tho 9ross vulue of tho property in tho computation of tux due, If ony
such expenditures maet all 01 tho throe following tests, it is recomrllended thot you itemi,ze the paymonts below,
oxecute the affidavit, ond return this not ira, Tha Ragister 01 Wills will exomine tho dehts clelimad alld allow
tho sa which he detern""as to ba proper, Tho tnx will than be racomputad ond you will raceiva an amanded
os SCSSrTlcnt of tox.
THE THREE TESTS WHICH MUST BE MET ARE THAT:
L You were porsonolly lagally respo"sibla lor thesa dabts, aad
2, You actually paid th01,e debts ond con furnish proof 01 such payment, ,if required, ond
3. These snme debts ora not "Iso clnimad, f"r tox purposas, by CHI axacutor, administrator or other
personal representative of the decedent handling tho administration of the general estate of the
decedent or any other transferee,
------ -----.--.-----. . -. ....- -.~CHEDULEOE.DE.aIS_n_~p.._
.Q<1l~E91<L, _.,_...../'.Im."e .of pay,,_a__ DesClipliollofObligotioll
... "u_ -Rof"-....-J'w\er.l F'\lftoral elltpA'1".
---_.,---CnU.el.Ho.pl.tal aat..QCtl
n. AlINblalwe ..rylce
Unlc:.d Te1ephoo. Co Telephone bill
fiUUJ1It~:ral1l.n ~rUidHAn of t:D returns
Edpr MclHhan Reia.oifUPUfvtSi fOOC1. e c.
__ ___uB!.!!.o u n U:!!iE.... _,_ .___
-.1..611.00 ._n._.._
--- 3...20. ... ....
-3$..00. .
12..45-
:-t;j8 '.. .
150.00
.. ---.~.__._- -~ ,..~---_..
,.,..___u,..._~ --~" ..._~_____._ ,_" ~__~__. __~__~_~n ~"~_.___-'----,
._._~_...._---..---_.,-~--~..
. -~_-~_..n'...~_...___..u__._____........ ____
~_._.---......_--,.,--_.._...__.. -
"...----~-....-._.~-~."..'__'T~.
'''''-'.~'~-----'''''-''--~~'''''--'-'-
(attoch separate sheet if required)
COMMOI~WEAL TH OF PENNSYLVANIA)
S5:
COUNTY OF ...f.~~N.D.___n )
TOTAL $ 1.923.15 I
- -.. .. -.. ... __ ._.__..n.....__ ___,..__ ..._____ ___'__'_'''__''_~'__ _.~. ._. _.____
I, .~!,,"'~g,~f!..,,_._._ hereby cerlify that the 10.ego1l19 is 0 IlIst and true statement of funeral expenses
end ather debts cf the decodent, 1.0A"K..,..He..JE1HAH ,._,,,,____. , for which I was legally responsible and
which I did poy out of fhe property haroill 10xeJ, I IlIther crrtify, fhot to tho bast of my knowledge and belief.
these SOme dchfs willnol he c/{Jilllcd by ony other pCI_C,OIlI fo, inhlHitCltlCc tax purposes.
SWORN AND SUBSCRIBED BEFORE ME THIS ,/uc DAY OF
,
-\)(';';:I:~~~~~~~{l~:,Zt(19 -19" ,
"MJ .,~ UI h.lonhptr..-H...~:pt~T ~a~ EGISTER '0 FwiLLS-
..u."1-+U.-.11J..1..J~dt.&"J--~_.___"..__~
/ SiYIIOillll'td Tqxjloypr
I, the undersrglled, duly elrcted Register of Wills in and for tho above county, do respectfully report that 1
hovo "lIowed denllc ti"ns listed above in the total amount of $ u_L~~'t..f2.......____ ,
(I /..-7('~
' .., ~ :\t." (, t. ~_ '. \ _ >_ "
Date of Approva'}:>!.. u~IUi..".".'L_-1lj 7/ ' .t. 'R" L C. Lf_(,..., __ .1;;;,,,,, '.[,1, J.
( ~rOWi!lr. -'.
tJill~
'.
II you hove already paid this lox to on executor, administrator, attorney or other personal represento'live of the.
ddcedent for forwarding to the Commonwealth, list below the date paid, nome and address of the person to whom
you made payment, their official title and the amount.
\
Date Paid
~.~r:::._a."LA.ddre s~~~~r.?.?..
Official Title
Amount Paid
Under certain circumstances, if, after tho date of death of the decedant, you personally paid funbral expenses
or other just debts of the decedent, with funds derived from tho property herein taxed, such ClInounts expended
by you may qualify as deductions against the gross veilue of the property in tho computation of tox due, If any
such expenditures meel 011 of the throe following tests, it is recommended thot you Itemize the [Joyments below,
execute the affidavit, al1d return this notice, Tho Rogistel of Wills will exomlne the dehts claimed and allow
those which he determines to be proper, The t(lX will then be recomputed and you will receive on amended
assessment of tax,
THE THREE TESTS WHICH MUST BE MET ARE THAT:
1. You were personally leglllly responsible fer these debts, and
2, You actually paid these dehts and can furnish proof ef such payment, if required, and
3, These same debts ore not also claimed, for tox purposes, by on executor; odmin istrator or other
personal representative of the decedent handling the administrotien of the general estate of the
decedent or any other transferee,
._PalLE.gLd
._ _.5.cHED..ULE.OLD.f.IUS.__. . . _
Nome 91J>gJ~_~ .___~_Q9scrip.tiotl_olQbllgotial'_.__._ ___ Amount Paid
_~___..._U" ._.._.._~~_".____."..L'._~_______~~ ___'__~._______.__'~_____~_~_
__~"_ n. _ '
--- _.--._~ --.-,--~.._.._-~~._<- --~------;.--,_._-~-
.---------._--~-~-,~~..;...._~_...
"..----.,""'.~-"..,..""',-..~.....,.~.......,.---c----~----'---~____----: ------'~~~L_~.~_~____~_.~__
-..-.~--_.--,-.--~.------,-- --------_._-----.+------~-~-~-_._---
-_...__.._,.__,-----0.._____ ..._i~_______________.___~_'..n__.'~.__,~.____._..:_.._...;..._____~__.~
________~____._~,~----.~--.-"r..."-'"'-'-n-..---.. .,..-__.,."'._T<_~,_~_._,_.....
.,....~_~~_~~-----.-,-,,____'____-~_ __~.T_._n.___._;_'_~T.. _._u_;.._.,
---~._._~"'--.~.........~,-~"-~~~~-.......
TOTAL $
(attach separote.sheetH required)
COMMONWEAL TH OF PENNSYLVANIA)
SS:
COUNTY OF_____.___H_________ )
I, .___._______.___ hereby certify that Ihe foregoing is a iust and true statement of funeral expenses
and other debts of the docedent,....._~________'____.;._.__..._.._. , for wh.ith I wos legally .responsible and
which I did payout of the property herein laKed, 1 futher cerlify, Ihat to the hesl of my knowledge and bolief,
these some debts wi II not be claimed by any other porson, lor inheritance. tax purposes,
SWORN AND SUBSCRIBED BEFORE ME THIS.---.--.. DA Y OF
_.__.____.____.___..___ 19-__,
Signuturo (If T(ll(r<.1Y~lr ;
REPORT OF REGISTER OF WILLS
I, the undersigned, duly elected Register of Wills in and far Ihe above county, do respectfully report that I
hove allowed deductions listed above in Ihe total amount of $.--- ..- ,
Dote of Appraval:.____
Re{/Ister of Wills