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NO. 21~79. H'{ ).C
PETITION FOR LETTERS OF ADMINISTRATION
IN THE ESTATE OF ......'..'..,.,..::.......H.........,......"H......'...,............., IlEl'E/\Slm.
," ( I!." ., '
To ......../:.1..:.'.,,,,:....; ........../..:.:..H,;;:i:...>'.. ;,:... ......... ........... ,..........., ,...', .......",.....,.....
Register of Will, fol' the Count;. u)' CnmiJel'ialld. ill the l'ol11l11,"\\\'"allh or 1'''""",\'11'1(1';".
, '
The Petition of ........:...:. .,1.:... ""':H...J.. .,..,...... .,.... ;.......:......,.,.. H...'.............. ......."...' ,...............,..,...
. ,
........H........................................,....... respect fnl1y ,howelh lIta I ,..,...... ,;....; .... .....c....... ..'....,....:. ...,..,.:... ........"
. ." _ .' /;!. I Township I 1 I l' ~l I I' I' I
was a resident of ...;.:.:.~.b..",("b,;:.....,..I:.................HBo'.ough ,('III11,el' I(lllounly, ,0 II ,,0 '!lln"y -
~ .
vania, and a Citizen of United States, IInd departed thi" life inle.tate in Ihe COUllty or :......,..:..."..!.::.....4,
..........."'...'..'0................. and State of ..H/L....,.,.,...:...:I.:.,....,......,-...........,....,.................,............,............... ..,...........
1~~!~ /UI (i7-~j.(? f. 7" ( . ,.< "", " A Il I')
on ...It'......n..''................... the ....H........'....................... d,l\ or ...........,...................,......,........... . ., '..........,
" , .
at the age of ...3.!:1...... years. I I
. i
That the said ....:.:;;:;.;..".........:,........:...!U..,..;.............................. d"CI'II."d, Idl "1lI'I'ivinJ( the followinll
named widow or -husband, heirs and next to kin. to wit ,
Name
He1alionKhip
Ht!Hi<<It~fl(~l!
... .~.'C;":. ..;, t.', ..::::.; ..f::1. r.. .~-;::.~ .-i;' .;:-;f........
, . J [
.. ;(-;v:/.~;~;;: :xN.. .<-.:........ "":'1. J. ,;..-.. r.~. ;::. .;'.~...
\1
......;:;...r...t...........................
.
..:...,...."...,;".....1.,,,,........::.....,........:....:...;,,.
"
...................."..........,...,.....,.
,.."..,.."....,..",..,.,..,.....,...............,.......,....
................................................................ ...........,........"......".,..,...,.,'" "".,.""",."...".,.".,..,................................
................................................................ ,...".,......,.......""..,."....",."., ,....""".,...,..,.."".,.",..,....,............".,........
................................................................ ....".",.,........,.,...,........"..,',., ...."..",....",...."""."...."..,.....,......"..........
................................................................ ,...........",.,.....""....,..,..,..,.". .,."..""",....,.".,.".,....................".............
................................................................ ..,....".............,."........,,',.,",. "",.,..",..,...."",.""...........,.......................
................................................................ ..."..............",.......,."..,."..,., ...",...",.."""........"..,...,...........................
........................................................."...... ......"......,.................".".,",., "".",.,.,...,.".".,..,.",."..............................
That those above named include all of the next or Idll, HI' fHl' II" kIlOWII.
The said decedent was possessr.d of pel'sol1111 propel'ly 10 Ihe ,,"til1l1lt,'<I 1'1I1ue of $.......'...:....:..;....:...;......
and of Real Estate, 1esK incumbrance, to the eKtimull'd value of $......;...........c.............. a" near as can be
ascertained.
That the said Real Estate in "0 far IlK iK known iK local<'d in ..........~....,...'..'...................................,........
...........................,....................,............,.......,.........".".....,....,....,...,..,...,."......,..,,..."..,..",........",...,..,..........................
Th~refore, your petitioner(s) respectfully appl~'(ieK) 1'",' Ldt",." of A<lmini"ll'lIlion in t.he above
named estate.
Dated 1,)(" -" I,." ;?" A 1) 1'1
.......I.:.............,~".......,~~............ ..., . ,,,......
Signature and Addl'''""
of Petiliol1"rl'l
.1....'..:_
. I, , _'"
. .......,...... ._~...~.i..,J,~..:". ...;. :".~..................
,.......""....".............."....,......
..,.",..".1.,....,;...../.'."".....,,;-...::.'..(;'.................
...........,."......"........."...".........................
COMMONWEALTH OF PENl'SYL\'ANI,\
COUNTY OF CUMBEHLANIl
I
\ ",:
.............;...........1......."............. .
and :;lIl1~lTiltl'll
,,'..........,..,.....,.............. named
1l('{'lIl'dill~ to law, :my that th~ facts 8et
kllllwh'd~t' and helief.'
/ I I" /;, ^/,., .------
. ,.....' , "......... /. ,";'.... '.. ~,:'::..:. ."". ~,:.. :......... ,..,
- ...,. ~,:. /
.............................."..................... ,'.
in the above application I",;nl: <llIly
forth in the above aJl(llkatillll an' 11'11l' to till] hl,tlt HI'
before me,
"r'~:'-L/"-l ^ II III
"4l:ii"'E''-);..:>v.~'~ ' ~E~TY
H"~I.Il'1
"..,....,."...,........~.>~,f]
. .~" . ..1 (/I'J
,. II'-V-'l '
..,..,..,.. ...,;~-;:::::
Filed:
Il~c:e~ber J, 1979
.\1 I HI'Ill' \ :
111\'1'11
This return must lw cOnlplf'ted in detail nnd filed In dur,llcilt.., wllh t!l" I.',..d',ld n! ,',Ill.
year ofter dote of death, unl~ss an I~xtension 1~ ,:rdn",d by 11u' ',.'c:r,'lnl'Y nll,,'v"rllI"
Will oJ/70 J' or _______..m .
Admn. N~. - 7 - 19_1,--Ereda M,_Durbor'O\,. 01
(Nom!!)
Misc.
being duly sworn according to law, deposes and says thot ho i.. thl1
UO\;lII'/lwdalu
rtl'~. IlHouyf" 01 Town.hlll)
fluJ.Z;lluL ~,..19'/~..
((hll_)
consisted of the assets listed below and that allowable dabts and dnductlol\ta OllClJuJoJ tho fulr markot valuo of tho assots and
RCC.t03 (2-64)
COMMONWEAL TN OF PENNSYLVANIA
D~~hTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX DIVISION
of the estate of
.1 AWRS A
deceased, and that the whole of the estafe of said decodent, who died UIl
_._._.~-_._--_._-
no Pennsylvania Transfer Inheritance Tax is due.
Sworn and subscribed before me
the ..jOLt... doy of '71rzJ 19. /'9
c..,p. \..../
C.q /1 d ,,: ~ 7~7. ,.:::4-t (/ I Let' .;, .z
Typti ~f Asset:
Real Estote,fen.
Property, Jointly
Held Prop. or
Transfers
A:;:'rl'l~;, .
:M7 CUl11n,: .,'j
INHERITANCE TAX RETURN
FOR INSOLVENT EST A TES ONLY
OF RESIDENT DECEDENTS
.'43//1
ClJU~IY o.______C_~.~?ERLflN2___
in ,1,1' n\Jflty '''II,,'r,' II", ,!,.c., I. flI r,..~I,!,.d ,,,If'lIn on"
IJox 82, IJO\,mansda1c, ..J.'A__.__
(Addl"u)
fldlllinLlLr'OILrix
... --.-......-----....---.-
Ir..n . ",It,.., L"UIII"", lilt:.)
D-URIlOROW-.--.-. .
loll! of
.. .-..,.-----.--.-"--
(51I1rlolule)
. .___________Adminis tra trix
(TUle)
, .l\IlIly, 'PJ(
, . ""I't. 5, H'I,SSE.I~.
(Attach aadlll'onol .hoot. II nflcl'I..l1fY)
DOIellp!lo" of AII"t
Duporlmllnt
Volllotlon
CAUTION
(00 not wrltll
In tt.l, spoco)
EllitlrnCllod
Markot
Valuo
100.00
500.00
2500.00
1971 Ford Station Wagon
1972 Chevrolet Monte Carlo
1973 Concorde l~obile 1I0rno
~ational Life of VerrnonL Policy No.
153 9605
266.98
TOTALS
lis .J ,. (" 7.P
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointod Inheritance Tax Appraiser in and for fhe above County do respectfully report that I have
appraised the real and personal property a5 report~d in the foregoing Hhodule at the values 5o!!t forth opposite each item in
the last column to the right,o ( ____..___c~"IJ, ,,/) 1;{f'/I'Jl,)~4'/
Dated: December 19, 1 ~ 79 lohClrUanco Tal( Appralnr
Name of Pay Oil
Myers-Hall Funeral Home,
Michael H. Schaeffer,Es
Sears Roebuck, Co.
Exxon, USA
Master Charge
Pomeroys
Household Finance
Upper Allen Twp. School
/1
.' ;'
.,
~-_..._-- -----------------------------
TOTALS
10,549.00
, 0. 5 1/-7 l 0
DEBTS ANO DEDUCTIONS
--NDt~,~7CTolm
Amount
Clalmod
Amount Approved
by Reg.15tor
Inc.
funeral expenses
family exemption
administra tion
counsel fees
char'ge account
charge account
charge account
charge account
loan
Ilis\..
per':.;onal taxes
1407.00
2000.00
15.00
100.00
Ij05.00
248.00
474.00
75B.00
5036.00
106.00
REPORT OF THE REGISTER OF WILLS
I, tho undo"i;nod duly eloetod Reol.'e, of Wilt. in ond 101 ,ho obove County, do lo.peetfully ropolt that I have allowed
dedut:tio"s in ,h. amounh ut forth in tho aboyo "hC'dule as claimed, OMcept where I have set forth a greater or lesser amount
in the las' column to the fight, wtlich 'ifeater or leuer amount repre\cmh the su.mlallowo~ ~s.o deduction. I "'iJ
\,. -. " " . '\ .. l \~. -- "~!' j :.' 1-'
D t f A ,"01. ,: 'j,,"l ~...' . 1" .,. I, " \ \ ; -:. I ~ (1 \ J!
000 pp o. ._ ~-" ,~-- ----- -,~ "----.- -- - -----~- . .. ~
I.. \ RIl'olhrer 01 WI I, 1 - 1'1 \
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INFORMATION
To insure proper credit 10 your ill;COllnl, IlltJ 'hlllll.' ~lf tho tJ!;.lale ilnd file numb.H should he cloarly print.
cd on the check or money ardor.
This assossment is mado 10 accordllllct.' with Soc:liun 70B (If the InhcntonclJ and Estate Tox Act of
1961172 P,S, S 2405.708),
To tho ox10nt thai inheritanco lax IS paId wit/un thrcJO (3) months fltter (he death of the decedent, a
discount 01 live (5) porconlls allowed (72 P.S. S 2405.7161.
Inheritance Tax, olher than tOJ( on a fulUre IOlerc!>!, 1$ due ill 1110 d<.I\!~ of ttlH decedent's death and becomes
delinquent at the CI(piration of nino (9) months after the decedent's denth (72 P.S. S 2485.711). Inheritance
Tax on a future interest is payable within three (3) months ollor the transfer lIlkes effect in possession and
enjoyment and is delinquent thereaher (72 P,S. S 2485.712), Calculate interest from the delinquent date shown
on the face of this form to the dale of actual paymenl using tho following inlorcslloble;
---------~--------------------- ---------------- - - --- - --- -- ._----- -- -- -- - ----
1 month ,005 4 months 020 7monl11S ,035 10 months ,050
2 months ,010 5 months .025 8 months ,040 11 months .055
3 months ,015 6 months ,030 9 monlhs .045 12 months ,060
1 days .0001 7 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 '5 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 interesl, including the Commonwealth and the personal representative, not satisfied with
the assessment may object thereto within sixty (60) days <:lter r(!ceipt of this Notice as provided by Section
1001 of the Inheritance and E51ate Tax Act of 1961 172 P.S. S 2485.1001).
Make check or money order payable to:
"Register of Wills. Agent"
Mail to the address listed below: