The URL can be used to link to this page

Home My WebLink About79-00691 j:i ~ ~ . (J) I pi! I ~ ~ 0 ~ ~ . :li: ~ ~ ~ (J) ~. .~ (J) ~ O'l @ [3l (,0 ,.. 0.. ..... : I - N :! '0 , I~ III OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF I'ENNSYLV ANIA} " CO 'Y OF CUMBEHLAND SS: Before me, the){egister f(>I' the Probate of' Wills and J.(rantinJ.( of' Lettel's of' AdlT)irii~~tration in and f'or the County of Cumberland,.personally came ......................... ...........................;;............................................... "', who, being duly............................; dq. .......... depose and say that as..<.:........................................................... '-" " " of the last Will and Testament of' ..............:::.<:.:.................... ..............................................................deceased """", ......................... will well and truly administer th~' ods and chattels, rights and credits of said deceased "'~. according to law. And also will diligentl comply with the,provisions of' the law relating to Transfer ". '-. Inheritances. ............................ an '" ", before me. . , ~'" .... ....................................... A. D., 19............ ......... -".,- ..................................................................."............. , ... . ... "..... " ..~....,....................,.....,......,...................,...............,..... Richard E, Anderson, Register '. .................................................................................. :..0 ad :<ll 1"-: :<Jl :al CJl :~ 1"""'4:- :<ll :P .-I: u.. CDi 0 :>1: :#:l \D: ~: ~ Ni .-I: ...J 5! 0 k: 0 0\: ~ r \D: ...J ~'.' ! I: .: - . , - . ct; 0\: - :1:: .~ ~ .,: 1"-: $ a: >, ". I: .c: .5 rsl 0: .-I: Ul: z: .~ N: Ul: 't:l Ill: <ll N ~ 0 Q: 't:l .., Z oi .... CD 3 0 :#: - .s u N .5 ~ <ll 't:l 0 't:l tlD <ll <Jl <= OJ - Z .~ f;l:l al il< ... DECREE Be it remembered that on the ..........~~.~~..... day of .................J~R){~.lI)!?<\!;'..........., A. D., 19 ~~...., there was probated and recorded the last Will and Testament of' .....9.4~.!!~.l[I...".,...~.I,l,!;'~~.Y..............................,...., late of .................~~.~.~...~~.:i:.~y~.~~............................., Cumberland County, Pennsylvania, Deceased. Letters ~~...~.:!:~Al[I.~.J;'.~~.~.9.nA.. .~..1.,."'were granted to ................... Evdyn ..G....Bw:ke.y............... ........ ............ Witness my hand and official seal the day and year aforesaid. \., -.J l ,.Iii '":f,:'VJ:" / . i. .~}p,.....W....:.... )..+:::01.w-."<:.:.......eeputy ~l6oQa:Id... -1Cl; Heglst.cr. . . 'J1-79 eO'; CUMBERLAND~ . , .' I . BECISTEB OF II'II.I.S OF ..."................,..."............,.. COU1\'TY :\0, PETITION FOB !'!lOBATE OF WILL AI'>D LETI'E!lS OF ADMINIST!lATIOI'> Cll~1 TESTAME1\'TO A1\'I'>EXO llnXJXmiX(l{D{)UOXllOOl\'KOC>l{l){MlK)OB{KQlXJX:1\lON{ 1~~}!.KK<l(~KX~KN~wrK~NKJ~~)lMX~xml lI'K~nlN'lJOlVmm~ in th" Estat" of ...ClP~,s..s..~...~)..~....I3,,\J,~~J:;:Y.,L.............. d('c('ased. P"litinn,'r( s). ................1'.~.':~y..I1....~.:....~~E~~Y..."....................,.....,..............,...................,....,............. al\"~e(s) Ihat: is ~ 1. P(!titiollcr(s)X~X tw('nty.om' y('ars of age or ohll'r and ilpplies for Il'll('r.~ tlr administration .........~.....~.~.~.~.""..,.........,......,.,.,....."".,.....,,"............. in ll]t~ allov(' captioned ('slal(', 2. Dec"d"nt died Oil ,..............9.~t.C:>.b..E;!:r.....~.~..!...),~.7..9.....,..... al .~..:..o.g.P...M. in the Connty of "".....f.':!.lTli?~.r..!!!:.n.,9........ Slat" of ........P..~..".............................. atlhe age of ................~..L... y,'a". havin~ made .h.~.r...... Last Will and TeslamcIlt dah.d the t7..1:.~... day of .........q.s:.t.C:>P..E!.E............, A.n: 19..7.9,.. \ "llt~rcin ...{?h~.... appointl'(l ..,,,.. ..,...,...,.".D.9.....~.?:;~.9.'h1::t.9.r........,........,..,..."..................".,,,..... KX\':H:. ................. XI.~k~XXXXX~KHo<'K........................................................"",,........,................................................................ OB On ................ day of ...""...................,..,......."'...., HL..."" Lelters of Administration W('fe granted to ...."..."....... ...,.....................,...........,............,..,.,.......".,...............".................,.,.......,.,................,..................,..,....,.................................... xblMl. }lMM~X.K- ~ 'J P~;() 3. Letters of Administration (.',t,a. are nl'cd(ld because ...ll.l?....t!?t.t;.~f!.r!~.".........'1:......................~ ~ Evelyn G. Burkey .. ~. her . ................................................................................................. ~ petlhOller( s) applies 111 ...................... capuclty as ..........~.9.J~....!!:!:!.~....:r.~.S..~,9~.1l:;:Y.,...~.E;!(1.~.:t.~~.,. . 4, Decedent died domiciled in "................."?,~............""'..,,.."'.,,.. with his 11Ist fllmily or principal . 411 Fairvie\~ A'\Y1\'h'lieo,un\lfJst Fairview, Pa. resldenceat,....................".............................,...........,.'"".."".................,..'.........................,............................................... wns was 5. (\Vherc decedent died testate) Decedent was not married and a child was not born to or adopted by decedent after execution of the will (and wlwrc applicant is alleged spouse) nor was decedent divorced from applicant after execution of will llnd at death. 6. The said decedent WllS possessed of Coods. Chattels, Hights and Credits to the estimated value of $......J.?.1..9..Q.Q...... and of Beal Estate, to the estimated value of $......l?.r..Q.Q.Q....... as near as can be ascertained. That the sllid Helll Estate in so far as known is located in ................................................ 411 Fairview Avenue, West Fairview, Pa. ................................................................"....,..........",,......,..........................,.........,.."..,...",.....,.............................................. ~~ 7. (\Vhere decedent died intestate as to any portion of this estate). Pt.titioner after a proper search has ascertained that decedent was survin'd hy the following.named persons entitled to distribution under the lntestale Act of 1947: Name Helationship Residence 1. ....................................................,............................"................................................................................................"........ 2.............................................................................................................................................................................................. 3......................................................."....................".......................................,..,.................................................................... 4..........................................,....................................".........................................................."...............................'''''''''''''''''' 5..........................................................................................".........................,........................................................................ 6. .........................................................................................................................,................................................................... ............................"""......,,,...,......,.,,............,,,..,......................""..................",........,.,........."......","."...........,......."....,.......... ~ Thcrefon~, pctitioner(s) rcspe('tfully applies for (probate of the will presented herewith and for) !ctte:s of administration f.....~.~"t"~,!\~...,.....,...,,,..................,,",.,,,,.~...:,..''''..:......''''..:.:''.''.'.j'......'.................'.......... Datcd: ...h.~.Y.:.:..b<'.Tt..r. 71 Signed: .r.......!:..~?k.".h."':.:.:L.{)'."'d"l' Co................ Address: ~I..:::....?6.9....~.t.,...<....~.~.~........f..!!:;L..r..y.iew I PA COM~ION\I'EALTII OF PENNSYLV AI'>IA 1. S5 .........................................,.................................................. .......c:g!1.1l.!':13~!.\l'!:!?...................COllNTY: I .. ...........1'y..El.~X.I1....~.~.....~~.r..~.':X.r.,...............................................................,............................... the petitioner( s) in tl1(' abovl' application, llt'ing duly ,....5.WOr,o....... a(:('ordin~ to law sllY(s} that tli(' statements set forth in this petition an~ true to tilt' ht'.~t of ...".....,,,..,he.rkllowlt'dge ilno ht'1id. ..........~~g.;:!:!....1:,9........... alld sllhscrih"d l)e[ore .><.."....<::~:....,.!:::}..""...:.'.!.....I.L.,..:,,;/.:.:]::............. Nov. 20 79 \-4J r:.....iD......1?~.C<~.......:9~~~ty ~ Hl'gish'r November 26, 1979 IrJYO Filcd: AttorJwy's ~:tmc ,md Address James K. Arnold, Esq., P.O. Box 737, Ca..mp....iii.'ii';...PA....i'7.ii'ii....................................... ,..",.,.".,....................".........................."................................... . {, \ \ ~- ~-.j/I~~ r ; - I .,.~ L.'. .., (ovt'r) OATH OF PERSONAL REPRESENTATIVE COMMONWEAL I'll or PENNSYLVANIA COUNTY OF CUMBEHLAND i ss: ......... ..........~:'.~.~y.~ ..g.:.... .~.~.r.~!7.y... ................................ ,...... ................ ................... .................... ....., petitioner ( s ) bcing duly ...........................!?W,9.!:'.lJ..................... according to law doEIS................. dcposc and say that llS the admiuistra t.9.!:'...C.,..'J:...A ~Il(' cstatc of .......O'dessa,..M.....Burk.e;y...................................................................... .................................................................................................................................................................................................. deceased ..~.J:l.~.................. will well and truly administer the goods and ehatte!s, rights nnd eredits of said deceased, aeeordiog to law. And also will diligently comply with the provisions of the law relating to Transfer Inheritances. ............................l::!):?9.:r.P....:t;.9............ and suhserihed before me. , )i'1....:M~......~~y.!~~.r....~~...., A. D.. 19.??....... ~ *'~C~~,...................................... ~ister ( ,) ..? , '-', ,,1....,/,., , /1/..J<~LL,..'jc.:. ........................;..]......................................./;................ DECREE Be it rememhered that on the ...................................... day of ................................................ A. D., 19............_ ------ . ------- Letters"'iif'-Admin!stration , C. T. A. in the estate of ......g.~.~.~~~...!i,.....!!.\!.:r.,~5!y.::-:::...................... ------- .----- ................................................:=._=................................ late oC....1'!.?\:?t:::P.!i!.J?.!Hi.l.?.9..+..9....19.W,!).Il.b.i.p..,..... . . ------ ~- Comberland Couoty, Pennsylvania. deee~-:we~n;.rted to .............................................................................. ----- ...................!;;Y.g.:),Y.P. ...G..,...~;\t.rkl;fy. ................................ ......................... ... ................................................................... ~ ~d and official seal the day and year aforesaid. Register ') /.: ,r ,....... ../ ' --- .- / CERTIFIED COPy GENERAL POWER OF ATTORNEY No............ ~.5.0.O'().................. KnillI."' nil .H~'n fJY '!.PIU' I'rl'.h'lItJ: That U:--;ITEO ST..\TES FIDF:l.lTY A;-':D (',C;\[l.\:\TY CO~IP.\:--iY. :l. clIrpor,lliUll r;r~;]lIi7l.dlllOj dh!in~ under t:~c la....~ IIf th~ St.:Hc of ~ll1ryland. and hJ.\illj; il~ ~'dncipJI 0fficc at the City of D(\ltimlm~. ill the StJle 0f \lJryl.Il,J, d,)t~ haci'; l'<ln~;itutc ;.lud ;1I;puilll Blair G. Husted of the City of Camp Hi 11 it~ lrue and lawful atlOrner in and for the State of . State of Pennsylvania Pennsylvania for the following purpose!, to wit: To ~ign its name as surely to, and to execute, seal and acknowledge ilny :Ind all hands. and to n~s\lccth'cly do and perform any and 311 aeu Jnd things set forth in the rr:solution of the Board .,f Directors of the said U~ITEn STATES FIDELITY AND Gl'ARA~TY CO~[PANY. a ct:rtined copr of which is hereto annexed .11ld madc a part of this Power of Attorney; .mrlthc said UNITED STATES FIDELITY AND GUAHANTY CO~lPA~Y, through u~, its Bonrd of Directors, hereby ralifit::l and ~onfJrms all and whatsoever the said Blair G, Husted may lawfully do in the premises by virtue 01 these presenl5, In 'J1'itne.u Whereof, the said U:-;ITED STATES FIDELITY A1~D GUARANTY COMPA;-.iY has caused this in~trument to b~ sealed with its corpor:l!e seJI, duly attested by the signatures of its Vice-Presidcn~ Jnd Assistant Secrdary, this 2nd day of August . A. D. 19 7-\ UNITED STATES FIDELITY AND GUAHANTY CO~IPA8Y. (Signed) 8r........ .GS.q,".. ,\ ,.. S.~.q\~'.'.rt.l. .-1:<:.'.............. Vice-President. (SEAL) (Signed) ....... ..':1.~. .Y.:. I.'.~.~;Y.~rd......................... rJ.sJistant S"crer'J,,', STATE OF ~IARYLAND. BALTI~IORE CITY, ) r ss: On tl1is 2nd day of August , A. D, 19 7.\ before m~ personally came Geo. A. Stewart t Jr. . Vice.Preoident of the U:\ITED STATES FIDELITY AND GUARANTY CO:\1PANY anr~ W. G. n i lyard ' Assistant Secretary of ~aid Comp;1n~', with b,)th of whom I am perSOLlaUy acquainted. who being by me se~'('rally July sworn. said that they resided in tIll' City of Ballimore. ;..laryland; tIH:t:hty,tn~saiJ Geo. A. Stewart, Jr. and \V. G. Hilyard .....crc.rc~pectheiy the Vice.President and the Assi5tant Secretary or the said U~lTED STATES FIDELITY A~D GliAlL-\~TY COMPANY, the cor. poration described in and which executed the foregoing Power of ;\ttorney; that lhc~' I:!ilch knew the seal of ~aid curporJ.tion; that the seal affixed to said Power of Attorne)' was such corporOlte scal, that it wa~ so fixed by vrder of the B(,ard of Directors of Slid corpora. tion, and that they signed their names thereto by like order as \"icc.Pre~ident and As~i~L.mt Secretar)", respectively, of the Company. My commission e:tpires the first day ill July, A, D. 19.7.8..,.. (SEAL) (Signed) ....... ..!I~.,~).en.. ~,..:\':'.\;C..................... Notary Public, STATE OF ~IARYLA:O:D BAL Tl~[6RE CITY. T. Hobert n. Douse ,Clerk of the Superior Court of nJ.ltimrlre City, .....hich Court i:l a Court of Record. and has 3. seal. do herehy certify that Herbert J. :\\111 ,Esquire, before whom the 3line:ted J.ffidavits were made, :md who has thereto ~ubscribed his name, .....;lS J.t the time of ~\l doing J :\,)tary Pu!.llic of the StOlle of :-'hryland, in :lnd for the City of Bahinwre, duly cumlllbsioueu ;lnu "....IJrn :mu J.ulnorilcd by 1.1..... 10 J.dmini:>ler oaths J.nd take acknowledgmcoLs. or proof of dced; to he recorded thetcin, 1 further certify lilJ! I al1l i..lCtjulinteJ with the handwritin~ of thc said Notary, and verily bdicI'e th~ signature tll be his genuine :=ignJ.lure. In Tf.>stinlOnr rflllf!7l!of, I hereto ;el my hand Jnd J.ffix the SCJl of the SUJlcrior Court of !3Jhimore City. the :=:1!lle beinlt a C(;urt of Record. this 2nd day o( :\ugus t ' A. l), 19 7,1 (SEAL) (Signed) ..................R.ob.~r:t"ll~..~o.~?~.... ............... Clerk oj Ih~ ~';'q.lui')r t'v'Jrt ('If lh'limol"l' eil)', } Sct. ....,. . .~ FS 3 (~-llj) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 55: Evelyn G. Burkey being duly .f?W9_U1.. .. according to law, deposes and says that She is Administratrix, ..C. T...A. .__... of tho Est"te ofO.des.sa. }1,.Burkey ........ ...0'--- lat. of West Fairview _._._. ..__, Cumberland County, Pa., deceased and that tho i within is an inventory m.d. by. Evelyn G. .Burkey.. ...__, tho s.id Aclmi.Di.s.t.J;il.!l:ix,.C, T.AI of tho .ntire ost.te of s.id decedent, consisting of all the personal property .nd 1'..1 estate, except re.1 .state outside i th. Commonwe.lth of Pennsylv.ni., and th.t the figures opposite e.ch item of the Inventory represent it's f.ir value as of the date of decedent's death. Sworn and subscribed before me, . () 1..C-4 ,.:{.' 19 if 0 ~(J :J - .~~-- 'rhfnuJ jj );> c t..C<-4 ('~~ . , Thelm' S. /,\,(,uslin. N,\",,! Public Mv Commh.j~n [xriw My I. 1934 Camp Mill. PA (u:r:IJCrlijnd Coun1v () .._.L~&~IDo;ik~~:F--- Administratrix, C.T.A l):yeJyr:UL.. Jtu.:K~y_..__._. 67 Second Street West Fairview, PA 17025 --..--.-..---. --.- ._-_._---_._-----_..~'_.__.._.- Addreu 28 Date of De.th .._... .....-----. ..-. -_.,----_._----------------------------~ October 1979 D,y Month Year INSTRUCTIONS I. An inventory must be filed within three months after appoini-ment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of addition.1 ....ts. 3. Additional sheels may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. :3 ,-J'.. Cll ..-/ , .51 I I , ~~ :>;1 ~I ~ -ci >- >- 'ill ~ I- w ~i ~I ~ ~ '" I- ~i ~ 1 w <( ~ 0.. l- v 0 0 v> U-l ~ w w ~I 0 :r: '" 0 I- 0.. Z I- -' U. . I U. -' <( 0 i ,c. 0.. ."j "- W 0 <( w bO ,;. "l Ii > z '" ..:' ;:3, - Z 0 ~I c , . !i 0 (I)! , ~~ 0 I' v> z 0 '" (I)' U z 'I w ..; ~! 0.. 0' I ." ~ Ii 0 c ~ II - -.: ,,", 0 ~ ~ .D ." .... ~ E - ...!! 0 . , 0 -' U u: CD f'~llNSYLVANIA INHEI1ITANCE TAX GENERAl. INFORMATION 1. PERSONS RESPONSIBLE FOR RETURN Section 701 of the Inheritance and Estate Tax Act of 1%1 providf!s lhal the lollowinl', per:;ons shilll prepilre and file a return: a. The personal representative of the estate ollhe decedent as 10 propmly ollhe decmlenl i1dministered by him and such additional property which is or may be subieclto Inheritance lax 01 which he/she shall have or acqui re knowledge; b. The transferee of property upon the transler of whi ch Inheri tance Tax is or may be imposed by the 1961 Slalute, including a trustee at property transferred in trust, provided thiltno sepmilte retUlllneed he made by the transferee of property included in the return 01 a pelsonal representative. ". 2. PLACE FOR FILING The return is to be filed in duplicate with the Register 01 Wills of the county wherein the decedent resided. 3. TIME FOR FILING The return is due nine months after the decedent's death, unlr.ss an extension for liling has been applied lor and granted by the Secretary of Revenue within the nine-month period. 4. FAILURE TO FILE RETURN Section 791 of the 1961 Statute provides that" . . .any person who willfully fails to file a return or other report required of him. . .shall be personillly liable. . .to a penalty of 25% of the tilX ultimately found to be due or $1,000 whichever is the lesser te be recovered by the Department of Revenue as debts of like amount are recoverable by law." 5. TAX RATES Inheritance Tax is payable at the rate of 6% on transfers to lineal descendants, such as father, mother, husband, wife, son, daughter, grandchildren, grandparent, son-in-law and daughter-In-law and at the rate of 15% as to all others. 6. PAYMENT OF TAX The tax assessed on the transfer of property reported in the return is due 9 months after the decedent's death. Interest at the rate of 6% per annum accrues thereafter until payment is made. All payments received are first applied to any interest which may be due with any remainder applied to the tax. IF TAX IS PAID WITHIN 3 MONTHS AFTER THE DECEDENT'S DEATH, A DISCOUNT OF 5%OF THE TAX PAYMENT IS ALLOWED. All checks should be made payable to the Register of Wills of the county wherein the decedent resided and are received subject to the final determination of the Department of Revenue. 7. FAILURE TO PAY The taxes imposed, together with any interest thereon, are a lien upon real property, which lien remains in effect until the taxes and interest have been paid in full. The taxes may be sued for ilgilinst any real property in the decedent's estate or against any property belonging to a transferee liable for the tax. 8. FILlNGOF FALSE RETURN Any person who willfully makes a false return or report required of him shall, in accordance with Section 793 of the 1961 Statute, be guilty of a misdemeanor and. on conviction thereof, shall be sentenced to pay a fine not exceeding $1,000 or undergo imprisonment not exceeding one year or both. QUESTIONS CONCERNING PROPERTY TRANSFERS J. Did decedent, within two years of death, make any transfer of any material part of his estate without receiving valuable and adequate consideration? (Answer "Yes" or "No".) No 2. Did decedent, within two years of death, transfer property from himsel f' hersel r to himsl!ll'llersul f ;lIld another party or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) ~_ 3. If the answer to one or two above is "Yes" and the translers arc claimetllo be nonlaxable, provide the following information: a. Age of decedent at time of transfer. b. Copy of death cerlificate. c. Affidavit by the attending physician indicating the stale 01 decedenl's health at lime 01 tr,lnsfer. d. All oltrer informalion supporling nonlnxntriIi Iy of transfer. 4. Did decedent, in his/her lifetime, make any trimsler of property without receiving il valuahle or adequate consideration therefor which was 10 take effect in posseSSion or enjoyment at or after his/her death? (Answer "Yes" or "No".) No a. Was there any possibility that the property transferred might retufllto IransfelOr or his/her estate or be subject to hiS/her power of disposition? (Answer "Yes" or "No".) b. What was the transferee's age at time of decedent's deatb? 5. Did decedent in his/her lifetime Inake any transfer without receiving a valuable and adequate considerationlherefor under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end before his/her death: a. The possession or enjoyment of or the right to income from the property transferrerl? (Answel "Yes" or "No".) -112- b. The right to designale the persons who shall possess or enjoy the property lrclllsferred or income therefroln? (Answer "Yes" or "No".) No 6. If the answer to five b. above is "Yes," state whether the right was reserved in decedent alone or others. 7. Did decedent in hiS/her lifetime make a transfer, the consideration for which was transleree's promise to pay income to or for the benefit or care of transferor? (Answer "Yes" or "No".) No 8. Did decedent, at any time, transfer property, the bmeficial enjoyment of which was subject to change, because of a reserved power to alter, amend, or revolle, or which could revert to decedenlunder lerms of transfer or by operation of law? (Answer "Yes" or "No".) No 3. If the answer to eight above is "Yes," was the power to alter, amend 01 revoke tile interost of the beneficiary reserved in tlle decedent alone or the decedent and others? (Answer "Yes" or "No".) .' INSTRUCTIONS FOR COMPLETING SCHEDULE "E" Schedule "E" must include all property, real and personal, owned by the decedent jointly with ar.other party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be included. List real estate first. 1. Describe all real property as indicated in the instructions for Schedule "A". Describe all personal property as indicated in the instructions for Schedule "B". Include the name. address and relationship to the decedent of the co.owner (s) and the date the joint ownership was established. 2. Indicate the total market value of the jointly owned property. 3. Indicate the percentage of the decedent's interest. 4. Indicate the market value of the decedent's interest. t: "" 0 n ;.. r.; ;:- ::.; Z ;:- 0 0 0 VI " - Cl n c: 0 ....: % ?' % t""' t'1 t'1 ~ Z ;>.: 0 - 9 r- Z :>:J ..., Z Z t'1 ..., t'1 9 9 ..., -:: VI r.; - VI Z 0 VI 0 ..., 9 "'i "'I ;e .- I ;:- 0 ..., "rl (3 "rl I z 5 ;:- i r- I c: VI : t'1 0 Z r- -< ><: -< ~ t'1 t'1 > ;:- :>:J ;<l Fi I e Number INHERITANCE TAX SUMMARY SHEET (BYB~~~Y~~~l-::!:) 21-79-691 .REV-484 c.x+ (J.IJ()1 Estate Nome Odessa M. 13\lrke)' Dote of Deolh October 28, 1979 Social Security Number ._..nnJ.~5-50-3059 REPORT OF INHERITANCE TAX APPRAISER I, the undersigned duly appointod Inheritance Tax Appraiser in and for the County of Cumberland Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing retum at the values set forth opposite each item in the last column to the right in Schedules "AU, "B", "C", and liE" Doled: 10-/(,,-)'0 /fI jJ .(J/I /0 J --# ld iI.d) INHERITANCE TAX APPRAISER INVENTORY VALUE AS APPRAISED ADJUSTMENTS CODE (HARRISBURG USE UNLY) REMAINDER APPRAISEMENT CODE Real Property (Schedule A) Personal Property (Schodule B) Joint-Held Property (Schedule E) Transfers (Schedule C) I 19 500 00 00+ 92+ 17, 10+ 20+ 30+ TOTAL GROSS ASSETS .. .3.7,1l9.__nA6.__.__ 8,062 7540- 29,056 71 93- Leu D.bts and Deductions (SCHEDULE F) CLEAR VALUE OF ESTATE Valuation of life estates or annuities. . . . . . . . . . . . . . RATE FACTOR PRINC) PLE VALUE CODE FOR USE OF REGISTER ONLY 91.QF COMPUT A TION OF TAX $ $ $ I Tax on $ 6% T ax on $ 15~c Tox on $ To)' on $ T ox on $ I Exemptions Total Estate TOTAL TAX INTEREST FROM BALANCE TO $ $ I Less Credits DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST S + S S = + = BALANCE $ INTEREST FROM TO ___ S BALANCE DUE S TAX CREDIT $ t""",,,~~ .....~ ..... "'." , ' "-~ ~" . ~y ..\~t '\ ,(') " ....... ~ ~ ~~ -, .< ~ ~ ~~ ,.' "'" , -,' z ~ '. 0 ;>- ~ ~,~ , " ~ , ~ ,. .\: " <I) .l '1: ....... .~ , :;J " \" :' ...1 .:.;' '('.,.~, < \."\<... ......... ~..J ~ ~,. - '. ~ U Z "- '\ ',- '" l'- '. - 0 \,'" " ~ " ", ~ - ", ' . .' ~ "'. '. 0 ..... 0 ~ "- 11. , ~ r- "/, 0 <I) 0 z 0 <I) <I) ;>- r- ei - r.<l Z z 8 ~ r- ~ z :j ei - 0 ~ 5 ~ ~ ~ z ;:;; z Cl u " z - ~ <Il ~ 8 0 < :l ~ r.<l Cl '" .,;)1' /1' (''/1 !leV.455 EX' (3.'01 SCHEDULE "F" COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE STATEMENT OF DEBTS TRA~m~EI~~5~~TE~~~ TAX '2,~. ~N~ D~J~~::~'~~Y~dZ"L?~, Estate of--9.dessa M. Burkey Date of DeatlOct. WHEN CLAIMING THE FAMIL V EXEMPTION, COMPLETE THE FOLLOWING: ~ ) . ,..,. f "". t.. \ t:" -: f' '~___"____',.........".---'.o...:-- .: -.- " 28 , t21~ile No, Claimant Relationship to Decedent ._ Claimant's Address - ITEM DATE NAME OF PA yeE REMARKS AMOUNT NO. 1 Jack W. Richardson Funeral Home 2,632.88 2 Husted Insurance Agency, Inc. Bond Premium 128,00 3 West Shore Oil Co., Inc. 481. 57 4 PP&L Co. 66.82 5 Riverton Consolidated Water Co. 20,60 6 James K. Arnold Costs of probate and advertisements 76.00 7 William A. Sullivan, M.D. 60.00 8 Borough of West Fairview Sewer rental and sanitation fee 90.00 9 Lester G. Connor, Appraiser 100.00 10 J. Wesley Kugler, Tax Collector 1980 Borough and County Taxes 53.63 11 Rolling Green Cemetery Company Marker 415.00 12 Holy Spirit Hospital 2.55 13 Good Will Fire Co. No. 1 22.00 14 Bell of PA 11. 70 15 Shearer Haven Dog care 15.00 16 Borough of West Fairview Sewer rental 54.00 17 Evelyn G. Burkey Administratrix' fee 1,856.00 18 James K. Arnold Esauire At tornevs' fee 1 856.00 19 Reeister of Wills - Reserved Accountine 100.00 20 egister of Wills - Reserved Filine fees 9.00 21 ecorder of Deeds 12.00 TOTAL THIS PAGE L_ 8,062.75 I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral expenses and expenses of administration submitted to the estale as deductions for loheritance Tax purposes. (I . i I j i , J i /"1. ,,t, . , ~,.., .) ~ \ ' \_,/~.v'C_tA..y}\...I'r,. "'--"u<~/J''''~/- _J.:J..I \'j.-c.I_~--' (fa 51GN/\TUH!! or ATTOnNEl'/FIDIJCIA Y DA-f~ OFFICIAL USE ONL V DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM or s fJ i" J. 7_';j-- I AT h PERCENT. ;J}1 --J+. . I I ,"CtY /j -/l-rd [)ATI~ GENERAL INHERITANCE TAX INFORMATION Unsatisfied liabilities Incurred by the decedent prior to his/her death are deductible against his/her taxable estate. In addition to debts incurred by the decedent or estate, other items are claimable Including tile cost of administration, attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone o. grave marker. All debts being claimed against an estate are subject to the approval of the Register of Wills with whom the Inheritance Tax Return is flied. Evidence to support the decedent's or the estate's liability for the debts being claimed should be attached to this schedule. A family exemption of $2,000 may be claimed by a spouse of a decedent who died domiciled in Pennsylvania. If there Is no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of the same household can claim the exemption. In the event there is no such spouse or child, the exemption can be claimed by a parent or parents who are members of the same household as the decedent. The family exemption is allowable only against assets which pass by a will or by the Pennsylvania Intestate Laws. - ." I:l n ~ trl ~ !1 , - ~ 0 0 I:l [Jl " z C1 n c:: " ~ z ::: z l'"' trl 0 9 l'"' trl ;;0:: Z ::0 - Z Z t'1 ..., trl ..., z 9 0 ..., -<: [Jl trl Vi Z 0 [Jl 0 ..., 9 "1 "1 ::0 ~ ~ 0 - "fl 0 "fl - Z (") - ;l> l'"' c:: [Jl trl 0 Z l'"' -<: -<: -<: trl trl ~ ~ ~ ::0 ::0 INSTRUCTIONS FOR COMPLETING SCHEDULE "F" 1. If the family exemption is being claimed, indicate the claimant's name, address and his/her relationship to the decedent. Enter "family exemption" in the remarks column and the amount claimed in the amount column. 2. Assign consecutive numbers to each item listed. 3. Enter the date on which each debt was incurred and/or paid. 4. Enter the names of each payee. 5. Provide a brief explanation in the remarks coh,mn for each debt claimed. 6. Enter the amount of each debt being claimed. 7. The form must be signed by the person who has assumed the responsibility for paying the debts. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF EXAMINATION OFFICIAL NOTICE OF INHERITANCE TAX ASSESSMENT - COUNTY FILE NO: /.. /'/ '/ l DATE J"-'-- ',/ ,.'., .I / -/ ,: i/)';;_,' , " X.,-~ //', ESTATE 1/ ", , ", " ,/ //' ~1-' ':-"/ ,> 'j" I f/ . 1._ , ,r.~<l (.,I ._-. jy" FILE NO, / , L, .' .;/ .,'- /' .' 1// C",;rl/," I : .i";t. :/ ,',/,") 7 f;,,/ '_ '1:..- II COUNTY I I, ~: . ( I ' ,/,. I I I ,'-r' j A ..1'- ..... '-._ ~' /,' .~r /. ',,"/ DATE OF DEATH I I.i', I,,',) ~ \ /,'7;/1 " + / $ ;' ///,,-~, r1 " .; ,. /(1' o' .',/ I (J Personal Property "I (( ,. Jointly Held PropenylTransfers + Total Gross Estate $ :i'1 /; '/. i/ (( .. , , Clear Value of Estate //( " /"J ,- / s )11 ,11,1" .1/ // Total Approved Deductions Less: Approved Charitable Exemptions Clear Value of Estate Subject to Tax s >'/ /) <i/ '1/ Amount Taxable @ 6% Rate S :;/1/ /)/)(; h , tax due s I "I.j:j /() , ,. s .I '/L/ :.-.;' /;/ J , Amount Taxable @ 15% Rate tax due TOTAL PENNSYLVANIA INHERITANCE TAX DUE * * * * * * A five percent discount totaling $ will be granted if the Inheritance Tax is paid bV _ Less Credits: DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST TAX CREDIT s + s $ = s + = + = Interest accrues at the rate of six (6) percent per annum on the unpaid balance of Inheritance Tax from to date of payment. Interest due if paid by is , i-~/ .. )!);t..{.....;; s / 7//:'; <;ic1'?/i'i:,/.dt' BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE . /'i:', . ,/>., .';~', . ,J Assossedby: - / / ;.:'/'/11 ( /~J'.-(.(.1'-j See Inform81ion on Reverse Sid8 AQenllorth,8lom. onwe"--,Illh ',/' .y; I. ) ;1; ./':" . ,:~~_J...1 L . I .' l~FORMATIO~ To insure proper credit to your account, the name of the estate and file nllmbcr should be clearly print. ed on tho chock or money o:dor. This assessment is made in accord:mce with Section 708 of tho Inheritance and Es!me Tal( Act of 1961 (72 P.S. 9 24B5- 70BI. To the extent that inheritance tax. is paid within three {31 months after the death of the decedent, a discount of five (5! percent is allowed (72 P.S. 9 24B5- 716). Inheritance Tax, other than tax on a future interest. is due at the dale of the deceuent's demh and becomes delinquent at the expiration of nine (9) months after the decedent's death (72 P,S. 9 2485- 711). Inheritance Tax on a future interest is payable within three (31 months after the transfer lakes effect in possession and enjoyment and is delinqllent thereafter (72 P.S. S 2485.71 2l. Calculate interest from the delinquent date shown on the face of this form to the date of actual payment using the following interest lable; --------------------- ---------- --- ---- --------- - - - -- - -----.------ -- -- -- - -- -- , month .005 4 months .020 7 months .035 '0 months .050 2 months .010 5 months .025 8 months .040 l' months .055 3 months .015 6 months .030 n months .045 12 months .060 1 days .00017 11 days .00166 21 days .00352 2 days .00034 12 days .00203 22 days .00369 3 days .00051 13 days .00220 23 days .00386 4 days .00068 14 days .00237 24 days .00403 5 days .00085 15 days .00250 25 days .00420 6 days .00101 16 days .00267 26 days .00437 7 days .00118 17 days .00284 27 days .00454 8 days .00135 18 days .00301 28 days .00471 9 days .00152 19 days .00318 29 deys .0048B 10 days .00169 20 days .00335 30 days .00500 - - - -- - ----- ---------- --- - -- - - - - -- -- - - - --- - - - --- --- - - - - - --------- ------ Any party in interest, including the Commonwealth and the personal representative, not satisfied with the assessment may object thereto WIthin sixty (601 days after receipt of this Notice as provided by Section 1001 of the Inheritence end Estate Tax Act of 1961 (72 P.S. S 2485-1001!. Make check or money order payable to: '-Register of Wills. Agent'- Mail to the address listed below: INFORMATION To insure proper credit 10 yOlH account, Ilw namo of tllo e5!iJW and filu number should hll clearly print- ed on the check or money order. This assossment is made in accordanco with Seclion 708 01 the InheritancA and Estato Tax Act of 1961 (72 P,S, 9 2485.708), To the extent that inheriwnce tax is paid within throu (3) months after the deilth of tho decedent, a discount of five (5) percent is allowed (72 P.S. ~ 2485-716). Inheritance Tax. other than lax on a future interest. is dlJC at the dale of the decedent's death and becomes delinquent at the expiration of nine (9) months after the decedent's death (72 P.S. S 2485.711). Inheritance Tax on a future interest is payable within three (3) months after the Irunsfer takes effect in possossion ilnd enjoyment and is delinquent thereafter (72 P.S. S 2485- 712). Calculate interest from the delinquent date shown on the face of this form to the date of actual payment using the following interest table: ---------~-- --------- ---~------ ---- ---- --------- -. - --- - --- -------- -- -- -- - ---- 1 month ,005 4 months .020 7 months ,035 10 months ,050 2 months .010 5 months ,025 8 months ,040 11 months .055 3 months ,015 6 months .030 9 months ,045 12 months .060 1 days ,00017 11 days ,00186 21 days ,00352 2 days ,00034 12 days ,00203 22 days ,00369 3 days ,00051 13 days ,00220 23 days .00386 4 days .00068 14 days ,00237 24 days ,00403 5 days ,00085 15 days ,00250 25 days .00420 6 days ,00101 16 days .00267 26 days ,00437 7 days ,00118 17 days ,00284 27 days ,00454 8 days .00135 18 days ,00301 28 days ,00471 9 days ,00152 19 days ,00318 29 days ,00488 10 days .00169 20 days .00335 30 days .00500 -- --------- -------------- - - - -- --- -- - - ---- -- - --- --- - - - - - --------- -----. Any party in interest. including the Commonwealth and the personal representative. n01 ~atisfied with the assessment may object thereto within sixty (60) days after receipt of this Notice as provided by Section 1001 of the Inherilance and Estate Tax Act of 1961 (72 P,S. S 2485.10011, Make check or money order payable to: "Register of Wills, Agent" Mail to the address listed below: , 0; ;offl 0 " rTln l. 'c' <.fl .~ ~~,t~ ;~'jr .~::: ,1'1 ," " ",0 ~ ; ~ -.:> ., c' " -~ :z; >< 0 ~ H >-i E-< >< 0 \''-. :;: ::::> <: ~ , ~'" I:Q ~ " ~ <r:r:l OH -< " , Ul~ cG ~ ...l " < . UlUl E-<E-< f-'" ~ ~<r: ZUl ~ -< . ~ r:l~ ~H ~ on ... . OU :<:r:l >0" , .... OJ · , ~ ~ >-i Z . " ~r:l E-<r:l rJl . < p. () <r:~ e:=:: -;;: ..; '. E-<Ul _ 0 . " C({ ~:>< UlO A i:: 0 II: E-<~ i>< ~ < c:i 0 . ;:S~ 0 ~ gj cG Z < Ul::::> i>< ~ li ~'" -< :z; H CJ cO f'" ::::~p, <:> ",XI ~f;~ ill~ P';,!, z: 4;:0 ~ '.',::0 ::);;, '"" . ~l:-J " It ~!:~ ~;:t: -:J :) ~l .>"/ ; . .. " " .-.; , 'G ,) 0 I 'D r ;":~ ! . E-< ~'. ,:.-. .-1: __Xl Z . ' ., " '~, ). ;:J >< \J " ., ,~-( ,. a I<l :;: i '. :'~, u H _;~ .J.- U >< 5(;') ..: p . :, -?i ..: en~ ',. l' '-- ~ <: ~ t';:) enUl '0,' OJ) ...:I r!l " ~<J' "l <C ~ "" " z ,'),~ c(\ -' " p ~ ,1 Z .. . < t.;.l au < H I;( " ~ ,:':1 ~ < j ,j ~ I<l m ~ --\ .- 0 ~ P tX') ., ~ ~ V1 " m a ()-- . ,~ Q Go " ~t'- ... . '- ',1 .,,' Z H . ~:'') "' :>< t'.) . 0<".4 ~ (fJ z < '" r. E-<~ --: ". A ~ ..i ..:~ , "1'- E-< . " 0 ,;:"" ~ E-<P:: -:j :.. CJ --~ en H " ..: P:: en ::> ('~ P:: -...... ..~,~.Ii .,', " 0 ,!e "' P'l H Z >'--' :z; ':::-:' ~ < H ~ U -< AnNOLD,SLlKIt 6: BA,'LF.Y Anm,NfYSAT LA\\' ...... ~...UOT..H ('....H"'.,rU.....~..'.,,"" PRINCIPAL ACCOUNT Recei~ 2-1/2 story, semi-detached dwelling with a detached 2-car garage situated at 411 Fairview Avenue, West Fairview, Cumberland County, Pennsylvania $ 19,500.00 CCNB Bank, N.A. Checking Account No. 180-1680-8 2,790.49 Dauphin Deposit Bank & Trust Company Checking Account No. 12-7-0476-8 13,328.97 1,500.00 $37,119.46 Furniture and household goods TOTAL RECEIPTS Disbursements Jack W. Richardson Funeral Home Funeral services 2,632.88 128.00 481. 57 66.82 20.60 Husted Insurance Agency, Inc. Bond premium West Shore Oil Co., Inc. Oil PP&L Co. Electricity Riverton Consolidated Water Co. Water James K. Arnold Costs of probate and advertisements 76.00 Medical costs 60.00 Sewer, water and trash 216.81 Appraisement of real estate 100.00 1980 Borough and County taxes 53.63 !1arker 415.00 Medical costs 2.55 William A. Sullivan, M.D. Borough of West Fairview Lester G. Connor, Appraiser J. Wesley Kugler, Tax Collector Rolling Green Cemetery Co. Holy Spirit Hospital L:SER J7 ".~ (hj:\ ARNOLD, SLIKIt & D,A.VLI';Y AnnlNEYli AT LAW ."......u...n. r~... 1I...~.r..n...~M,. """' Good Will Fire Co. No.1 Ambulance $ 22.00 Telephone 11.70 Dog care 15.00 Oil 82.47 Electricity 41. 49 Fire insurance 183.00 Bell of Pa. Shearer llaven West Shore Oil Company PP&L Co. Doyle Ivey Agency Register of Wills, Agent Pennsylvania transfer inheritance tax 1,769.55 Husted Insurance Agency Bond renewal 128.00 Evelyn G. Burkey Administratrix' fee 1,856.00 1,856.00 100.00 9.00 12.00 $10,340.07 James K. Arnold, Esquire Attorney's fee Register of Wills Register of Wills Recorder of Deeds Accounting Filing fees Recording deed TOTAL DISBURSEMENTS tlBEH ',J" ,,.;( 'l.A