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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTV COLLECTIONS
INHERITANCE TAX DIVISION
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES ONLY
OF RESIDENT DECEDENTS
*'
COUNTY OF Cumberl and
This roturn must be completed In detail and filed in duplicato, with the Rogistor of Wills in tho County whoro tho docodont rosided within nino
months aftar data of doath, unlos. on extonsion 15 grantod by tho Secretory of Rovanuo.
Will .;)./"'I9-,.,s'-t
Admn. No. I _ I.
Kenneth T. Myers, Jr.
(NAME)
434 Market Street
or New Cumberl and , PA
(ADORESli)
17070
Misc.
being duly SWllrllllL:cordillg III law, dcp(Js~~s and says Ihlll he is lhe
((o:XEC., ADM" LEGAl"E~!~,--~ci-TC.)--------
or lhe eslate or ----11arthL,J._Bryan,,_____ ,__,_,_______' late or the Borouah.. ot Ne)'LCjJ]11jJ,g,rJ ansl.
(CITY, BOROUGH, OR TOWNSHn'l
deceased. aod that the whole or the estate or said deeedeot, who died Oll ,_NO.'Lemb,e,r_l._l919______,_,...__,
\DATEl
Executor
consisted or the.: assets listed beluw und that :IIlowahlc <.Icbts and deductions exceeded the fair nlllrket valuc of the assets and
no Pennsylvania Transfcr Inheritance Tax is duc.
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/( "J./.Lf)"~{/j~,="/,'
~ (SlGNATU~T-'
Executor
( TlTl.E)
Ty f Auet:
Reo estate, Pen.
Propuly, Jointly
H.ld Prop. or
Transfer.
, ..0,; ~ : ....Jv(', e, ;'.Cl.:ry ?ub!;c
lV, ("Mnll:~.~n r...;w bu. n, :')llJ ASSETS
It 'ul':'jb~rIJHd f',~ (~'lll,~'l1n" r -
, "\'A'tTtle-A:.ciUdltional sheels if necolSary)
Doscrlptlan of Assot
Estlmatod
Markot
Value
Dopartment
Valuation
CAUTION
(Do not writ.
in thl. I co)
Personal
1967 Oldsmobile Sedan
150,00
Personal
Capital Blue Cross Refund
Insurance Refund
220.87
Personal
248.00
Persona 1
CCNS Bank, N. A" Checking Account #001 001322 5
CCNS Bank, N. A., Savings Account #001-100470-2
270.70
513.86
PersDnal
TOTALS 1 '03 43 HI. ,/-0-1.'1.3
,4. ,."
REPORT OF INHERITANCE TAX APPRAISER 4!f1f
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the above County do respectfully report that I have
appraised the real and personal property as reportcd in the foregoing schedule at Ihe values sct forth opposite each item in
the last column,lo the right. ';,'.j 1 J '''I'f I ! )
Deb 19 1970 .!!.I' 'I I, ,/~__"'r'J ~ "
Dated: e em er , '" (INHERITANCE TAX APPRAISER)
Namo of Payee DEBTS AND DEDUCTIONS Amount Amount Approvod
Nature of Clolm Claimed by Registor
Gilbert W, Pa rthemo re
Funera 1 HDme Funera 1 Expenses 2,149,50
Jon F. La Faver , Esquire Legal Fees 100.00
Register of Wills Letters & Certificates 14.00
TOT ALS
2,263.50
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REPORT OF TilE IlEGISTER OF WILLS
It the undersigncd duly elected Register uf Wills in iJl1d I'm thc abll\'C County, Oft rcspectfully report Ih"t I havoC allowed
deductions in the amounts sct forth ill the abovc sl.:lh:duk as claimed, cxcept whcre I hilvc set ftJrlh i1 grcater or lesser amount
in (he last column tn t he righi, which greatcr or lesser amount represcnts,' thc,su!il alll) '~d as a deduction.
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