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No. 21-79.
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PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of
M,Il"Y ~, !(pnnF>rly
, deceased.
To Richard E. Anderson, Register of Wills for the County of Cumberland,
in the Commonwealth of Pennsylvania.
IS
Petitioner(s) :aIIQ the execut or named in the Lost Will and
Testament of Marv 8. Kennedv dated M"rI'Y ?7, 19"9
Decedent was a citizen of the United States and a resident of
To~~p
Lower Allen :a0~, Cumberland County, Commonwealth
af Pennsylvania,
Decedent died on SlInrl"y the 18th day of March
A. D. 19 79 ,in the County of
Cumberland
State of
Pp.nn"'y1v"ni" at the age of 69 years.
.. ~ her
Decedent has not been married and has not had children born to /Imrl
since the execution of the above described Will.
Dece~ent was possessed of personal property to the value of
$4.000.00 and of real estate to the value of
$40.000.00 as near as can be ascertained; said real
estate situated as follows 6 Park Circle, Camp Hill, Pennsylvania
Therefore, your petitioner(s) respectfully = for the probate
of the said Last Will and Testament and for Letters Testamentary thereon.
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Dated M"rl'h 23. 1979 -- 1:'" , . /,' , '/ . '
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Name and address '" (;-<1.~!" /.-., , ..' .<~
of Petitioner(s) / John M. Kennedy
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COMMONWEALTH OF PENNSYLVANIA l
COUNTY OF CUMBERLAND f ss
John M. Kp.nnerly
named in above application, being duly sworn according to law
say(s) that the statements set forth in this petition are true to the
best of
h;~
knowledge and belief.
and subscribed before \
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19 79
John M. Kennedy
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Richard E. Anderson, Register
Filed; MArch 23. 1979
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Attorney:
John M. Eakin
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEAI,TH Q)<' PENNSYLVANIA}
COUNTY OF CUMBERLAND SS:
Beforc me, the Register for the Probate of Wills and grantinll of Letters of Admini8trntion in and for
the County of Cumberland, personally came ........................~.9.1.1n..~......~?r.X\~g.y...........................................
who, being duly ......:;;~~r..~.........., doe.a...... deposc and suy that as......F.W.c:ut.or.........................................
of the last Will and Testament of ..............f:\ary...~.,...K~.np.fi!.~y........................................................deceased
............r..~......... will well and truly administer the goods and chattels. rights and credits of said deceased
according to law. And also will diligently comply with the provisions of the law relating to Transfer
Inheritances. ......RXmr.n.......... and subscribed
before me.
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'(;' John M. Kennedy I
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..................................................................................
Richard
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DECREE
Be it remembered that on the ........~}!:.~....... day of ..............~~!.?~........................ A. D., 191~..... there
was probated and recorded the last Will and Testament of ..l1ftr.Y...!?:...!}.f:l.!1P..~.gy........................................
late of .......^'.9.~.f:l.r....~g.f:l.n.J'.9.~."'!!)}J.p......................., Cumberland County. Pennsylvania, Deceased. Letters
..................~.~.f},~.~.l.'!!!.~~.~.x:.y.......... were granted to ........,.........o!.~~..!1.~.~:-!.~.n..~!!!!.~~~.r.............
Witness my hand and official Heal the day and year aforesnid.
........................................... ..........................
Richurd E. Anderson, Register.
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1"1 Rccl,.12l771 COMMONWEALTH OF PENNSYLVANIA
NO. . 063537 DEPARTMENT OF REVENUE
a OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
\I
i RECEIVED ----------------------TWO THOUSAND
II
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DOLLARS-------------------------
dollo"
representing Pennsylvania Inherllance or
Estate Tall duo from 'ho following 8s.tate:
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"jJohn Melvin Kennedy)
:e.. Market Square Bldg. ~
211 la, on 5
Dofe of Payment
March 26.lf79
MARY S. KENNEDY
Cumberland
II la, on 5
Estolo Tall. Act of
May 7, 1927
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s 2~105.26
s 101j.26
6'A Tall on S
Hechan1c.burS~Pa.
File No.
21-79-199
Dole 01 Death
17055
3~18-1979
15'" 10' on S
Name of Deceddnl
larks:
PAID ON ACCOUNT.
lOlAl lAX CREDIT
len five percontum of lox If
paid within Ihree monlhs ofter
dole of deolh
Plus Inlerest 01 the role of
_II from
to
s
Counly
li'OO ~ [?[L~@ffi li'rn
SEA l
TOTAL AMOUNI P ID
s
\(nn.no
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NOTE: Thl, Triplicate Recelpt 10 b. ret.lned for .udtl pu,po....
~ Received by
NOTE: In oectpUng 11'1. franl'" Inh.,lIanct talon 'l,llu,. "'01.., p,iar to th. d'Ol'" of '''', 1,1,
'.nont or "nonl for .,'0'1, o. ..ld,Mctd by 11'111 "C.ipl, Ill. \/nd"I'aod Ihall"', Common....alt'" I~all
I nol b. p'.elud.d or pr."n,.d Irom h".alt., ou.Ulng odd'lional Inh,'i'anCtI tal 01 lh. d'a'h 01 th.
Ill. I.nonl or t'nonl fo, y.otS ...h,n."., II opp.arl 'hol luth odd,lionol 101 mo, b, 'egoll, due Ql'ld
tollttllbl. for any flCllon ...1'101.0."",
ciA
R1chard E~g~r.
Re~1.ter otVIila
(Tille)
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REY.44g eN I.
COMMONWEALTH OF PENNSYLV ANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERAT;ONS
*
RESIDENT DECEDENT
COUNTY OF _Cl1MIlElU.AND__
IMPORT ANT,
Till.. m~n nmll he~~mlllC'~.C'd-i~ d~t~i~l-ufld 'ill'~ in dUJlliclIll', "11h nil Ullltt:hl'd. \\o"'I;'ihc J(C'&i1lc-,-uf "-i-II,, llf Ihe --
County "here decedent rnidC'd; RC'lUrn is lIlIe wilhin nine Qlunth" urler dnle of llt'Ulh. ullleu an cr.lrnsiufI iJi lURI1IC'd
by the Secfcuuy of KuC'nuc. fSCl.:liul1 70.1 of the Illhcrilullce alld f~!Uute Tu ACI of 1961.)
.
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IN Till! MAn'HR m' nm I~~TATH OF
Let. 01
Cumbe..rlilmi
} AI'FlllAVIT OF
HXHClITIlR
~X(.'4{
County
N1\RY S. I<EllliEDY
lSTATE FULL NAMI: Of' DECEDENTI
S'ot. a.
Pennsy.lv<lnin
} "'
Coun,y o'
Cumberla.nd
JOHN MELVIN KENNEDY, Illeculor
)6XrJGJGJCXQUC of the ..101. of the abon-no"'ed dued."t being duly ...,or". d.ponS and 10, S
Decedenl died March 18. t 19~ 'llI'af. leaving a Ia.f will, copy of whlc:h II h.,alo Olladl.d, }
IMONTHI IUAyl C;~~
Homa and add,... 0' otto,ne, a'} John M ~:akin, lIttorney-at-Latr!
olhe, outhorlud ,.p,...nloll__. 10 whom
all c:o"upond.nc..houldbemolltd. M;'ITk~'t. ~qn;t,..~ "nil,11"'], M~('I"anicsbur'J. Pa~
That os such ExeC'!nt:nr. depunent is familiar "'ith the arroirs of said estate nnd the property cunstituting
I EKECU rOR-AO,.,INISTRA TORI
the assets thereof nnd their fair murkct value.
That at the time or death there was no safe deposit box regislered in decedent's individual nome, or jointly with, or
as agent or deput)' of another, or in decedent's individual name. wilh right of access by another 8S agent or deputy, with Ihe
esceplion of Ihe following: -
NAME AND ADDRESS OF BANK OR OTHER INSTITuTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
THIS SAFE DEPOSIT BOK RENTED
IN NAME OR NAMES OF
REI-ATIONSHIP OF JOINT
HOLi)ER! TO DECEDENT
Mnn~
ThaI lhe conlenls of said safe deposil bos or boses arc ilemized uoder Schedules
with the esceplioo of the following, fnr Ihe re.sons hereinafler set forlh:
of th Is return,
Thai Seh.dul.. A auached herclo nnd made part hereof sets forth folly and in dellll all lhe real properly
in Ihe Commonweahh of Pennsylvania "f which decedenl died having an inlerest Iherein. II also sels fonh lhe
mortgase eneumbrances upon each parcel of renl property al Ihe date of dealh, giving the amounl slill due al
death, name of mortgagee, datc, rote of interest, Dnd bonk nnd page of record thereuf. It also sels forth in the
columns provided Ihererore Ihe assesscd valwllion of eaeh of said parcels, the eSlimaled market \'Blue Ihereof
as of dOle of death of decedenl.
Thai Sch.dul.. B allached hcrelo and made pari hercof sels fDrlh fully and in delail all personal properly
wheresover situaled owned b)' Ihe decedenl al lhc lime of dealh: all muneys Icrl b)' lhe decedenl al Ihe lime of
death, whether in decedent's iJ11merJinte IlO!iSession, slanding to decedent's credit in banks or deposit, SAvings
hanks. trust companies, or other institutions, whelht'r individuall)', or in trust for Rny olher pcrson or persons
giving also separately the accrued inlerest thereon. if on)', down to the Insl interest dsy prior to decedent's
dealh in the case of savinss banks, and 10 Ihe dale of decedenl's denlh In all olher cases: 1111 honds, poslal
savings, treosW'y certificates or notes dnd other evitJence of indebtedness of lhe United States to the de..
cedent; nil obligations, whether hy stalulc or agreement the)' arc designated os tax. free. of Ihe United States,
or nny slatc, or rolitical subdivision thereof, or or nn)' forcign country. which ore ow lied Dtthe lime of death;
all wcaring Bpparel, jcwelr).. silverware, picturcs, books, wurk!.; or art. household furniture, horses, carriages,
automobiles, 00315, and nn)' nnd all olher personal chattels of whatsoe"cr kind or nMure, left by decedent,
logelher with lhe f..irly estimalcd markel value Ihereuf: all honds aod mllllgases held b)' decedenl and of all
claims due and owing decedent at the time or death. and ull promissory notes or olher inslrumentli in writing
for the payment of monel' of which decedent died possessed, of whatsoever nature, wilh interest thereon. if
any, gh'ing tht': face value and eSlim3ted fair market value Ihereof, ond if !t.uch estimated fair market value be
less than the face ,'olue, it sets forth briefly the reasnns for such depreciation os 10 each item: nil moneys
payable 10 lhe es'ale frum lire insUlance policies carried h)' decedenl: all annuil)' and endowmenl cnntracls
the proceeds of which wcre paYllble upon Ihc dealh nf the decedenl: all Rnd lhe curporale slocks and dividcnds
due thereon Bnd unpRid os of the dutc of lIeDth. bunds and llccrued inlercsl thereun to the date ur decedenl's
dealh and other invcstment securities o.....ned It)' the lIecedent ut Ihe time of dealh. wilh Ihe markel ,'alue there.
of al such time.
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In the ca.e 01' .ecllrltle. ur clo.o or l"Ul1lly cor"oratlon., the val lies r""orled are as far ..
,,"solblo subslantl.te,1 by financial slalcmonto of Ihe corl,or.1I0n8, showing Ihe ....1. and l\fthlllUes
Ih"reof as of Ihe d.to of deslh. The 8ehedllle al80 sel8 forlh Iho Inlere8t or ,Iecedont .1 lhe 11m. of
dealh In .ny co_"orlnershl" or b1l81n.8S, ond In 8u""orl of the valllo of sllch Inlorest lh.re Is .nn.xod 10
.ald sche,llIle, \'I1I.nclal sl.l.molll. .howlng lhe....IS "nd l\8hlllll.. 01' ..Id c"..".rlner5hl" or Im.llles5.
^ co"y or lho co_".rlnar.hll' ogr..menl, (If oral, a .1.10""",1 .,'llln~ forlh lh. nolllre of lho ngreo"",nt)
lo~,.thor wllh . slalemellt ..IUIIII I'orlh Ihe char.cler of lho \"lSln"oo, 1\.. IlIc.llun, and .lIch olher fACIS
"orlalnlllg 10 thu h1l01n.8S R5 mllY hI! IlI,.I.lnenl Ie . rolr 11...1 J"ol ."flr.l.al of IJ,o doco,lonl's Inl"r"ot
Ihor.11I mlL.I hosnhmlllod. It shonld also 5el forlh In Il.ml.ed "orm, 101l"1h.r wllh the rolr m.rkel v.llle
Ihereof, .ny olher "rorerlY owned or IIoqllenlhed by the deeodonl .t lhe Umo of de.lh.
The Sch.dul. C at\8ebed horotn "nd m",le I,,,rt. horeol' ."ts rorlh a IrllO "ORW.r 10 oach In'Jlllry
conlalned therein a...lln lhe CllSe of Iransl'or. urllCol,ort.y, real ur "or.onal, wUhln Iwu yoar. or ,Iec.dent'.
doolh, In conlemr10110n 01' decodenl" doalh, or Inlerwled 10 loko erf,'cl In 1105",,5Slon or onJaymonl at or
a\'ler ,Iealh, 5a\ol 5chedlllo sets forlh the nalllre an,1 valllo of sllch "rol,erlY, 10 whom tr/lllsferred, the
rolatlon.hl" of the lran8feree. 10 the deee,lenl, Iho "ro""rlIOnRto .111,"0 roclllv",1 by each lra...feree and
all olhor facio of a porllnent nawre rellardlnll sal,1 transfe... In the cM" of trallRfe.. Inlende,1 10
tnke cIl'eel In "o..esslon or enjoymenl III or nflor ,Ienlh, lhore Is also nll.achc,1 III lho sche,llIlo n COllY
of Ihe dooot, lrllst agroement or 1I1her Inslrllment crenllng U,e I.rll't.. ThOr" I. al.o .ct rort.h In said
scl",dlllo n 11.1 of all "ro"erlY, renl arlll "er.oUlll, wllh lis vollle, which l""se. nt decClleot' 5 death hy
vlrluc 1I1' lhe exercise by decedont, ellher 11I,IIVldllnllY, or jollltly wllh anolher, or /Ill)' "ower or al.polnl-
melll vest.ed Indecedenl, elthor In,l1vl,llIallY or jollltlY, by Ihe will, deed, or olher In.t.rllmenl of anothor,
wllh a co"y or lhe Instrll",ent creating such "ower attache,1 10 lhe .che,llIlo.
Thnt Schedule 0 altacholl herelo /IIld malic "nrt hereof sets forlh 1.110 name. on.1 addre..e. or all
"e..oll' bonenc1ally Int.erested In IhlS estale nt lhe lime of decodenl' s ,Ienth, lhe nolllro of lhelr res-
"ecllVf! Intere51s, their rf!latlonshlp, If any, to Iho dece,lellt, tOllcU,er wllh Ihe ages at Ihe time of
deccdenl's deolh of 01\ ",Inoro, annullanl. and benonclarlc, I'or Ilre IIIl1ler decedeot'. 11'11\. It al80
cOlIll,lns 0 stolement showlnll which of tho benerlcl"rle. name,l In Ihe ,Iecedent'. will, If any, dIed "rlor
10 decCllelll, Um dotes or theIr de.th, their ISSlle, ,,,,,Ilhc relatlon.hlp of .lIeh Isslle 10 tho beneficiary.
ThaI Sr",dule E nttRched heroto and m.de a 118rt I,erellf sels forlh all "ro"erty, real al\ll "er-
sonlll, owned by the decedent jollltlY with allolher lIr others, Incll1,lInll Intangible, .tRndlng In Ihe name
of Ihe dccodent aod olhers, "IllS the dnte nnll "lace or recorrl of Inslrllmenl. ofreetlng the ,"stlture of
real o.t.te and the date of acquisition of "ersonalty, pillS tho nome, o,ldreos nnd relotlon.hl", If lUly,
of co-owners to the decedent.
Thill Sch.dule F atlached herelo ond made a "or I hereof .els ror!.h fully on,1 In detaIl all deblS
alld ,Iedllctlons claimed for and on behotr of Ihl. decedenl'. oalllle, Incllldlng 1'lIleral ex"ense. paid;
family exempUon, where a"I,llcable; eo.IS of odmlnlslraUon or lhl. estRle; eOllnsel fee. and l\Idlelary's
commissions paid or to be I,ald; co.t expended for burial Irll.I., tomhstollo. or grovomarkers, and rell-
(l,lolls .er\'lce., In conse'luenco or lhO death or Ihe dece,lollt; debts arlll claims owing an,1 un"ald at time nr
de.th; laxea aecrlled ehargeable for l",rlod I,rlor 10 decedenl'. ,Iealh (exee"l lho.e a1\owed under SflcUon
61;1 or lho IlIherlllUlee nnd Eolale Tax ,\cl); 10llelher wnh n .Ia!.ement. or colloler.1 l,ledge,l ror obliga-
tions, If nny. II Is agree,l thaI lhe 1'ldllclBry wl1\ pre.ellt "roof 01' snld clalm"d oblllloUons lI"on re-
'IUesl, lhnl If lhe amolllll aCll\allY l,"ld In .otllomellt. of nny fl!e, commloslon or debt IS II!SS Ihan the
esllmoled lU1lOlInt claiming nll,1 n1\owed. lhal lhe snme will he rOI,nrled 10 Ihe \leglsler of 11'1118, and that
lhe nmollnl of lax assesse,1 clUl be re.ssessed III nccorrlMel! U",r,'wllh.
TMI lhc lolllls lIr the "l'I'roprlale coll1mll. In Sehe.llllcs ',\', 'n', 'C', 'E', and 'f' as ,lIrecled lhereln,
11I'V<' t...o" cllrrle,l forworrl an,l "roperlY re~lsI"ro,1 In 1M SlImm.ry.
Subscribed and sworn to before me this _..-:9.............-..
... day of ...oecembar,.... .......19..7..9... .
_.~{)J .b\~'- , Notary..P.uPlip
My commission Expires: II-f"fr~"'''--'
".1-" .. .....~ '"';0.','"
1,-. . ;", 1932,
SOTE: 1I"l'ore .llInlng arndavll make sllro .11 hl'lIlk ."OCl!. III U'I! nl'l'Ido\'1l n...1 .eho,llIle. annexe,1 arc
1'111001 In wllh delal1' or the worrl 'Sone', and III cn.I! U'I! ..."t. IIIellllle rllre and ulIII.led .ecurllles,
sl!.lIrnll!' of c1o.e or familY cor"orallon. or .11 IlIlerl!.1 III any .0-1"1C1nl!"hl\' or hllslness, Ih.t tho
.Inln nn'\ .llll,'"",nlO reqlllrr',1 IIl1der t.he l,arllllral'h aboV" r<'lall"~ to Scl",dlll" 'II' .ro AltAche,l. ,\1.0 make
e,..!.n\II thaI column HI III Ihe 'SlInmary' hR. be 011 "rol"..ly eomrlele,l nS nIK}\'I!-,lIr,'ct.I!,I.
...............-...... ....-.-~.- . .
REV-"'U CI:lil
CO~l'otllN\\E^,.TII III' I'ENNSVLVANI,\
TRANSFER INIIERITANCE TAX
RI'SIlIENT llECEllENT
;:1'
,*.
'If' ,
_ '.. 'i/i
SCHEIlULE "Il"
IlENEFIC',\IUES
IIENEFICIAIUES ANll AllllRP.iSE.~ RELATIONSIIII'
(Stale rull "lIR1el und odtlreAlu", or nil _liD (lr Ilep-dlUdren ur SUR VI\' Ell IJATE INTliREST OF
lIun I1n hllcrclU. vr'Hl.tI. contIngenl or all,,:r- IlIeailImnle children IJECEIJI~T llF IIENIWICI.\R\'
wille. in elIUIC) me iuvulntl. let STATE \'E5 IIIRTII IN ESTATE
Corah thlli Cncl,) OR NO
John M. Kennedv
936 _. .L Drive.
Glen B"-~~-
M"-" ~~d. 21061 Snn V"G PG"~"~
-
Deponent further .oy. that 011 tho obovo.nomed beneliclorle. ore living 01 this time e.cept below:
NAME
DATE OF DEATH
RESIDENCE
~Ul"":
..< -
Is' ..
",' e
.-.. g
e_
.- ..
-11--
1= ~.8
~ u .
09...1
il"'-
:I ~
.. B 8.
III ..
_ co:
Real Properly
I'enonal Property
Tranden
~n~"~'y ~'~q~ n~operty
SUMMARY
(Seh. "A") $
(Seh. "II") $
(Seh, "COO) $
(1;,.b II!,!") $
$
$
(",rou Taxabl. Eatate
:,j:
!- ...,
.. Z .. .jJ
.. t:J '" 5
.. :e 5
>- t:J ~ il 0
II) U ....
- ~Q oC
< 'tl II>
c.:: U. ~ .. :c
c.. 0 !:l III 'c ~
c.. ... !': D..
OJ ..: ~~ ... ;:, D..
.c oC
0 !- t:J !-..: Gl '"
:l: Ul 1l e Q
Z .5 !- '-!- e ~
"Ill ..
U. t:J ~ :;l Cl.
0 U - l-
e ~ C> ~
" c.:: oS 0
'-
- ~ D..
:! ;; w
- - .. ~
VI C> ~
,- ..: - e
C >0 C>
--s :e C> C B
.. 8
::"0 ;; :I
:c": .... 8 u
(1)
(Aa Reported)
47,900.00
10.185.44
None
10,167.R'
69.253.26
(2)
(Aa Determined)
$
$
$
$
$
$
.
RE\I'.8. ell-al
.' N b d N 21 -
~ounty,' urn or an ame
21-79-0199
03/18/79
Cumberland
SUMMARY
FII. Numb.r
\Jot. 01 D.ath
E~tato Hamo
KENNEDY,
(LAST NAME::)
Marv
(FIRST NAMEI
S.
lINITIALI
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIOENT OECEDENT
REPORT OF INHERIT ANCE T AX APPRAISER
I, tho und.rslgn.d duly .pp.lnted Inh.rlt.nc. Tax Approl..r In .nd I.r the C.unty .1 Cumberland
Pcn."ylv.nl., d. r..p.ctlully rep.rt th.t I h.ye .ppr.h.d the r..1 .nd p.n.n.1 pr.p.rty.. rep.rted In tho I.r.g.lng return.t
tb~ '{,ll,.lc!' tiClt forth oPPollte each Item In the lalt column to the right In Schedulel "A", "B", "C", and fiE".
Oct..d:
February 21, 1980
'- -),11/lfA,} / JtI'H,'
INHERITANCE TAX APPRMSER
i
i
1=-
i
!
REPORT OF THE REGISTER OF WILLS
I, tho undenlgned duly .I.cted Regl.t.r.1 Will. In .nd I.r C.unty, P.nn.yly.nl., d. rupect.
lutly r.part th.t I h.y. .1I.wed d.ducti.n. In the .m.unli cI.lm.d by dep.n.nt, ..cept.. t. th... Item. wh.r.. gr..t.r.r
I",,-r uon.unt I. ..t I.rth In th.I..t c.lumn t. tho right In Sch.dul. "F", which gr..t.r.r I....r .m.unt r.pr...nli tho .um
(dl~"'1,cd as 0 doductlon.
DOled:
REQI5TEH Of WILL5
INVENTORY
VALUE AS APPRAISED
$ 47 900 00
10 185 44
10 167 82
None
68 253 26
ADJUSTMENTS
ODE (HARRISBURG USE ONLYI
00+
10+
20+
30+
REMAtNDER APPRAISEMENT CODE
Real "fOllcrtv ISchodule AI
P"lUfldl Ptuperty (Schedule DI
Jolnt.He!J Property ISchodule EI
T,andA~ ISchDdule CI
TOTAL GROSS ASSETS
Los.. O'!lJts and Doductlom
ISCltmULE FI
CLEAR VALUE OF ESTATE
92'
40.
9J.
VallJol!on of life utatu Dr
.:!:..--
PRINCIPL.E
FACTOR
VAL.UE
annuill""....................._ S
t=
t=
ESTAH TAX ASSESSMENTS _S
FOR lJ~t! OF REGISTER ONLY
TaJl on ~
Ta)! on $0
Tax (11 $
Tax en ~
To'l Ull S
EJlemptl..ms
Totol [,.tolC'
~
COMPUTATION OF TAX
2%
6%
16%
$
$
$
$
$
TOTAL TAX
$
PI As evidenced by Charitable
Exemption CertHlcates luued
by the Secretory of Revenue.
Lau tall previously paid
BALANCE
Leu ~..:, of lox If paid wllhln
3 m,mlh~ ahor duath
$
$
S
t=
BAL.\IlCE OF INHERITANCE TAX DUE
AdJ 1<111"10:01 at rota of 6% from
_..___ to
AMOtl" r OF ESTATE TAX ASSESSED
E.tul\. 1)1( pold
$
$
1=
$ ~
S
$ I
$
$
$
BALANCE DUE
AdJ Illl':I..,,1 01 ratb of 6% from
to
TOTAL TAX BALANCE
PAID
Suppl"'n.ntal C.d..: (FOR USE IN HARRISBURG ONL Yl
JH-./..djushnent
.1C 1/,djUl.tment
51J-A,,"uity
6O-LIf. E.t.t.
92+Rem.lnd.r Appr.I..1
93-R.m.lnd.r D.ductl.n
93C-Ch.rlty
94-Rem.lnd.r R..ldu.
96-Succe..ly.
LIf. E.t.t.
1('1' USE OF REGISTER ONLY
ADJUSTMENTS
IlDTE: Wh.re .ub..quent .dlu.tm.nh .r. m.d. t. the .b.y. comput.tl.n.1 t.. by tho R.gl.t.r.1 Will., I.r pr.p.r r....n
..m. .h.uld b. n.ted b.l.w, with .h.rt ..pl.n.tI.n. '
.~<~- ,-
-,'..,:
f- ;.J
Z '" ..:
~ UJ " tIl
.. -
" :;: n ..:
" "
>- UJ ... "
tIl ... C.
- Q
..: c.
" .. ..:
c. Lt. ';: Q
c. ..
0 > z
Ul ..: Ul UJ >. ..:
1= !::! 1= f- .. f-
ci c
?: - tI. ~ c "
Z f- 0 " 0
Lt. C. C.
0 ... UJ
~ Q "
" -= -",
.2 UJ ;;
- !:
" "
~ ... ~
- ..: Q
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';: Q ,., ~
='s ~ c
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~< ;.J U U
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. . . . .
. , .
. . .
. 0: . .
. . . . .
. . ca: . . .
) . . .
~ 1; . ..; . 0\ , . .
..... .
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w '" c:>.l . . . . .
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. 'rl: ~: N: ::l . .
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ca: :;g a: fii .
x 51 ....; u. 't:l' ~ .
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~ . f! '0 '0 ....: .c: c5 . ",' 0 ~ .~ l
"el: :<1 y: :s ~ f$t: I- 0 .m
ei w J!l ~ : !i. l!!
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....: ~ .: ~ ~; ~ ",' w Q,
~ z ~ 'fi
~: f! Ill: Ql: ,'" .e: ::!: <l; ~ <l;
Ql: ~: :31 .. I- 't:l 't:l
. ~i ii: '" ~ c: ~ 8
'=,- ~ a: .. 5 ::a
,....,! '"
w '5' - 's, ~ <l::
~ "I :I: fii N: '" .... 'ti 11 .0 ~
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