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ACC.134 (1C).751
COM\lONWEt\I.TII OF Pl':NI'iS\'I.\'ANIA
DEP,\I~TMI':i'rl' OF IHSE:"lI'I':
BllRFt\l: OF ('t1C:\lT\' ('(lI.I.I'TTI()~S
1:-OllFIUI ,,:-on. TAX 11I\'ISIOS
01'1'\('1\1. \OTH'E OF 'NIIEIUT,\N('I'
'1\\ \I'I'R.\ISI.\1I'NT 'NIl\SSI'SS\1I'\1
111 \SSI,ml S \111 SI:II.II'.1'1
111\lI\lI\IS 11(\1111\
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______n__. _.,_____
TO: _l'luC)' B181,r __
8 B1ahland Lane , Apt. 101
Dote:
Novelllber 28LJ:9'l2.__
Cap H1ll,__P.A l~~_.u_____"
Caunly__~'lIber~~
County File Na.___:~~_1~L '/(. (.
Bureau File No.
We haye received notice that, os 0 result of the deulh af.J!I~r~.t B18IDI'___________
on Septelllber 10, 19.1i., you cume inla ownership of certain property through righl 01 suryiyarship, which
was formerly owned by the decedent.
Under the Inheritance and Estate Tax Lows allho Commonwealth of Pennsylyullia such Ironsfers ore taxable
and the liability for the payment of the inheritance lax duo is imposed upon you, os Ironsferee,
The property on which lox is hereby assessed callsists of: Joint Account at the Keche.nic.. Savings 8<
Loan A..'n. or Dauphin County in the nalllllll ot tho dacodont or de.~ter. AocOUl1~~.!!'~_nblieh"d.
J\U1e 8, 1979.
appraised 'by the Commonwealth, os of the dote of death, at S 10.:>97...,4
100 % of thi s amount is taxable at the role of 6 q;
ORIGINAL ASSESSMENT
DATE OF ASSESSMENT
TAXABLE AMOUNT
LESS: ALLOWED DEBTS
NET TAXABLE AMOUNT
S
S
(
1
AMOUNT OF TAX DUE
-50'(,0?
If you pay the above amount within three (3) montl15 of Ihe
dote of death of the decedent, or on or before
19_, you may deduct 0 discount of
5% of the amount af'tax due, or
~J",?:'J
----------
- - - -. - - - - - -
This tax becam.. delinquent nine (9) months after death
(one year if death occurred prior to December 22, 1965
and fifteen months if death occurred on or after
December 22, 1965 but prior to June 17, 1971) and in
addition to the tax, statutory interest at the rote of 6~; 01
the tax per annum is also due os of -=--_____ 19
in the amount of
----------
----------
'If the tax is not paid by the above dote additional
interest is due at the rote of 6% per annulll until paid
....'
TOTAL AMOUNT DUE
S
S
"7.'50 "'(
( 1':-::'
APPRAISED BY:
ASSESSED BY:
(Agent lot the Comll,onwcalth)
(lnhcrltoncc ToIC Apprais.er)
lliSTfiU_GI.c)~_UQ.J A~PA YERS
To insure proper credit to your account
this Official Notice must accompany
your payment. Moil or bring it to:
Make checks or money orders pay ablo to:
::)( I - 'F; \7 0 b
/ t,. ,~,.\ ( .1
~-r
fIr I; 1)/
NOTE: Any party in interest who is aggrieved by this notice Illay abiect thereto within sixty days after receipt of
said notice as provided by Section 1001 of the I"heritance and Estate Tax Act of 1961,72 P.S. 2485-1001.
QUADRUPLICATE - REGISTER OF WillS COPY
If you hove already paid this lox 10 on executor, odmillistrular, altarney or olher personal representutive of the
decedent for forwarding to the Call1lllanwealth, li,t beluw Ii", .lute puid, Illlme IInd address of Ihe person to whom
you mode payment, their official title und the amount.
Dote Paid
~OI~~ndAdd~es~~f_P~ye e
OfficIOI Title
Amounl Paid
Under certain circumstances, if, after the dole of deoth of the decedent, you pcrsonolly poid fUlleral expenses
or other just debts of the decedent, wilh funds derived Irom Ihe properly herein laxed, such lImounts expended
by you may qualily os deduclians against the arass vullle of the property in the camputotion of tax due. If any
such expenditures meet 011 of the three fallawina tesls, il is recammellded that YOIl itemize the payments below,
execute the affidavit, and return this notice. The Register al Wills will examine the debts claimed and allow
those which he determines 10 be proper. The tax will then be recomputed and you wi II receive an amended
assessment of tox.
THE THREE TESTS WHICH MUST BE MET ARE THAT:
1. You were personally legally responsible far these debls, and
2. You actually paid these debts and con furnish proal of such payment, il required, and
3. These some debts ore not also claimed, for tax purposes, by on executor, administrator or other
personal representative of the decedent handling the administration of the general eslate of the
decedent or any other transferee.
Dote Po id
ErlULUlF DEBTS
~me af0P,aYjE <,~, (j~;- 0~e'}Hl'f'O!'~L9-lligatior!.__-_-
L________._.__..____
... !~',.JtJ..(,. f n1"--: ':2U-;ltt't,~f ~4,jL.:./n...,/
-- ------ ---------/./-------.._-------~-
Arnaun t Poid
oS:>.,!'"
2' /: i'
________~__~_____". __._~__.__ _.__.___._uu
-- - .---- ---------------.
____..u...._....__......_____ -...-----------
.-- ---- .--- .-._~--_.._- --------..
.__.~------ ---------.--.------.--------
:------~-----1--------=.=:-=:~=:-=--========--
------==--===-::=-=.,.\_.._=.:::-.:
.------ .._-~-"---_..-_...-
_-~ _=_-_-J-=~-=-- -.
TOTAL S
~
8- '::':(" 0 0
---------------------...---..
(attach separate sheet if required)
COMMONWEALTH OF PENNSYLVANIA)
C 55:
COUNTY OF --'-\Lli)..W~ )
I, JY.~\,( '1 j r2J"-"I~ hercbx certify thotlh~ f9,ego ing is a just and true statement of funeral expcnses
and other d bts of the decedent,.nn1JldUtdl'.i:.L--GLf:'lLL.-i- _. , fOI which I wos legally respan&ible and
which I did pay aul of the propert)' herein laxed. 1 futher c6rlify, thot to the best of my knowledge and belief,
these some debts wi II not be claimed by any other perSOIl, for lllhctitancc fox purposes.
SWO N ~N~~~B~C~IBED ~EFOR= ~~~~~51..L\t..DAY OF _7'{,~~iU__3o',-/~.:ft-:::------
~ c;..1~" . \)f.7o\~Y , 5"gn..',"" o! 1...p,,"
REPORT OF REGISTER OF WILLS
I, the undersigned, duly elected Register of Wills in and for the above county, do respectfully report that I
haye allowed deductions listed above in the total amount of S --------
Dote of Approval:
Rt'9istl'T 01 will~