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PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of _
h",rl v. t:bncr
, deceased.
To
of Cumberland, in the Commonwealth
is
Petitioner{s) are the execut ""
Harold B. McLane, Deputy
, Register of Wills for the County
of Pennsylvania.
named in the Last Will and
Testament of Pcar] V. Ebner dated October lI.. 1'):11
Decedent was a citizen of the United States and a resident of
IR)tIJ~N,p
Upper Allen ~xCumberland County, Commonwealth
of Pennsylvania.
Decedent died on Fridao' the ')th day of November
A. D. 19---2.2..-, in the County of Cumber1 and
State of
Fennsylvania at the age of 96 years.
~ m~ix her
Decedent has not been married and has not had children born to ~
since the execution of the above described Will.
Decedent was possessed of personal property to the value of
$40,000.00 and of real estate to the value of
None
as near as can be ascertained; said real
estate situated as follows
apply
Therefore, your petitioner(s) respectfully applies for the probate
of the said Last Will and Testament and for Letters Testamentary thereon.
November 29, 1979 /'tfil!da;-tvc OMv1/411L-
Name and address Dp..uphin Deposit Bunk and :Ir:st Co.
of Petitioner(s)
Dated
213 Burket Street
Harrisburg, F.'nna. 17101
COMMONWEALTH OF PENNSYLVANIA}
ss
COUNTY OF CUMBERLAND
W.S.Scnford Trust Off~cer Dnuohin Dorosit Bnnk nnd Trust Co.
named in above application, being duly
say{s) that the statements set forth in
SHorn according to law
this petition are true to the
best of
hi~
knowledge and belief, 4r--
./7// / (11.
and subscribed before / v;;1 , 'v r'l7'\
(
me November 29 19 79
'-1I~H 15-\\,\C>J;CN"-'-
. -. uepUl:Y
Register
sworn
I SCjv
I
;:::;o,,:d ~.' , ~
n(',',
( . 11 (, " ri f"~ ..,. ';- ('\ ~
...-.
Filed: December 5, 1979
C:;/-')9-7/>-
Attorney:
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ITEM IV:
I give and bequeath all of my household furniture
and furnishings, books, pictures, jewelry, china, linen, silverware,
wearing apparel and all other like articlcs of household or personal use
and adornment to my niece, MRS. ROBERT CORNMAN, of Camp Hill,
Pennsy Ivania.
ITEM V:
I give, devise and bequeath all the rest, residue
and remainder of my property, real, personal and mixed, to the following
persons and in the following proportionate shares:
(a) One-fourth to my brother, CHARLES HERMAN EBNER, SR.,
3419 North Fourth Street, Harrisburg, Pennsylvania, if he is living at the
time of my death. If he is not then living, said share shall be added to
and distributed in accordance with Item V (c) herein.
(b) One-fourth to my sister, MRS. BENJAMIN MILLER,
Z403 North Second Street, Harrisburg, Pennsylvania, if she is living at
the time of my death. If she is not then living, said share shall be added
to and distributed in accordance with Item V (c) herein.
(c) One-half to be divided equally among my niece s and nephews
named below who are living at the time of my death:
MRS. DEVERLE FRUND, Zl Columbia Drive, Cedar Cliff,
Camp Hill, Pennsylvania 17011
MRS. BENJAMIN ROOT, 44 Wise Road, York, Pennsylvania 17403
MRS. ROBERT CORNMAN, 3136 Dickinson Avenue,
Camp Hill, Pennsylvania 17011
Page Z of 5 pages.
.' "
MRS. WlLLIAM WESTBERG, 706 W. Cherry Street,
Carbondale, Illinois 6290 I
MISS MARY RUTH EBNER, 4220 F. Williamsburg Drive,
Colonial Crest Apartments, Harrisburg, Pennsylvania 17019
MR. GILBERT C. EBNER, 1494 Dunster Lane,
Rockville, Maryland 20854
MR. GEORGE EBNER, 5249 DeerIield Avenue,
Me chanicsburg, Pennsylvania 17055
MR. WlLLIAM EBNER, 420 Reeser Road, St. James Place,
Camp Hill, Penns ylvania 17011
MR. GEORGE FORREST EBNER, 15 Poplar Street,
Wormleysburg. Pennsylvania
MR. CHARLES H. EBNER, JR., 3596 N. Fourth Street,
Harrisburg, Pennsylvania 17110
ITEM VI:
In the settlement of my Estate, my Executor
shall possess, among others, the following powers:
(al To sell either at public or private sale and upon such terms
as my Executor may deem advantageous to my Estate, any or all real or
personal estate or interest therein, whether owned by me severally or
in conjunction with other persons or acquired after my death by my Executor,
and to consummate said sale or sales by sufficient deeds or other instruments
to the purchaser or purchasers, conveying a fee simple title, free and
clear of all trust and without obligation or liability of the purchaser or
purchasers to see to the application of the purchase money or to make
Page 3 of 5 page s.
inquiry into the validity of said sale or sale s; also, to make, exe cute,
acknowledge and deliver any and all deeds assignments, options or other
writings which may be necessary or desirable in carrying out any of the
powers conferred upon my Executor in this paragraph or elsewhere in
my Will.
(b) To pay all costs, taxes, expenses and charges in connection
with the administration of my Estate. My Executor shall pay expenses of
my last illness and funeral expenses.
(c) To distribute my Estate in kind or in money. If any assets
are distributed in kind, they shall be distributed at their re spe ctive
value(s) on the date(s) of their distribution.
(d) To do all other acts in the judgment of my Executor necessary
or desirable for the proper and advantageous management, investment
and distribution of my Estate.
ITEM VII:
Any person who shall have died at the same time
as Testatrix or in a common disaster with her, or under such circumstances
that it is difficult or impossible to determine who died first, shall be
deemed to have predeceased her.
ITEM VIII: If at any time any minor child shall be entitled
to receive any assets hereunder, DAUPHIN DEPOSIT TRUST COMPANY,
Harrisburg, Pennsylvania, shall act as Guardian of the assets payable
to such child. Said Guardian may receive and administer all assets autho-
rized by law and shall have full authority to use such assets, both principal
Page 4 of 5pages.
OATH OF SUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLVANIA
COUNlY OF CUMBERLAND
1 "":
This .........................~().t:l1:.......................................... day of ............!.~().~J.?I.n.?':'.::................................. A. D., 19.:!.?..,
before me ................".~.~~~~...~.~...~~.~':'~.e..~...J?~p.~.~X......................................., Registcr for the Probate of Wills
and granting letters of Administration in and for said County of Cumbcrland, in thc Commonwcalth of Pcnnsylvania,
II !'!Ul'V L. ~3r(!n{n1~\n ..-lnr: V(~}:l;1 E. :':"r:,.ir:
persona y came .................................... ............................ ...................................................................... ..................... ...........
.....................................................................................................................................-............................................................
the subscribing witnesses to the foregoing instnunent of writing purporting to be the last Will and Testament of
.....~.::.I!-.!:.f....y.:....~!?~.~.!C........................................................ ................................... Datcd O.~:.t..?.b.':'.r....l.!:.J...).n~:........
, .
late of ...~P.l:.~.~:...!.".~.~.!:.l!....T..o."!.t:..~.~:.i.r!.................................................................... Cumberland County, Pa., deceased
h be. dul S\lorn d' t I d . d th t thev'
w 0 109 Y .................................................. accor 109 0 aw, epose an say, a..............................,...................
present. and saw and heard the testatXj.::;........................... .........r9.;l.,)...:v.......~.r.D.g.'-.................................................
sign. seal, publish, pronounce and declarc the said instrumcnt of writing as and for h...?:r........... Testament and
Last Will. and &1 the time of so doing ......................~.~.~..................................... was of sound and disposing mind,
memory and understanding, to the best of .......................~.l.l!'J!.:.......................... knowledgc, observation and belief.
................~~~;~......................... and subscribed before
)
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.......,....~....".n..i"......!...............~...-.........................................
,
;.........';l:r.(.c.~~.....?:!....lio,.i"L.l........................................
vl'l.r -..{'(1 'S~c.J , DeJ;luty
.....~.~.t.....:.l.\-l.....d.1..(:...~~..... RegIster.
.........................-..................................................................
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA 1
~. ~s :
COUNlY OF CUMBERLAND I
y..,....~.... ...~."'!f. !:.'?!:.<!c...~ E).!. ?.t.. ..9. r E ~.o.!C... ~.~1.1l?~ i..~...D..c. r.Cl.S. i..~.}~ [[.): .1:....C\ ':.~. .xr.~l. ~ .t:...c. ?~........ ....... being duly
.................~.~f.'?n"..................... says that as nearly as can bc ascertained the said decedent ............................................
................................I: .r;. ~.!:l. ..y.... ... ]::.1m.R.r........................................................... ...................................... ........ ...... died on
.f.~.~.c.l.0.Y..................... thc ...............2~11............... day of ...........?(J':."."'l'c:.~:.......................... A. D., 19??.....
at or about ................................................ o'dock, .... M,
...................~.~~~.~.......................... and subscribed this
................................~.9..~~............ day of ........!:l.~.~l!.~l?er
19,..?~.., before
~~JtP~.Jl)~:zi.~.h-~c::............
..;fJ..~&.~~A.....d,4A~::&:10{.
"v " 7""
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENN5YLVANIA~
55:
COUNTY OF CUMBERLAND
Before me, the Register for the Probate of Wills and granting of Letters of Administration in and for the
County of Cumberland, personally came ...H.,..S.,..S.~J'.r?t.']....T.r.".,:.L....9.1:.1).<; .'J}:...!).D..l\I).l.~.~...D..(,l'.~.'}.~.t....R.".n.1.',..!l n d
Trust Co.
who, being duly ........f!.;!:>.!:.n..........., do ~.~........ depose and say that as ..............!~.::;g.<;)!.~.9y........................................
of the last Will and Testament of .............p..Q.~.!)....y........~;.\,!!.?.r...................................................................... deceased
...............h.\'....................... 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.
sworn
and subscribed
................................
........................~~~~~.~.~...~.~............ A, D., 19.?~....
...lffAl~....A~mm
before me.
............................................................................................
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DECREE
Be it remembered that onlhe .........~.~~......... day of ...................D..~~~:m.?~.~.................., A. 0" 19.7.~..., there
was probated and recorded the last Will and Testament of ..........P.~!l.~.LY......J::bne.r..............................................,
late of .........1!.I?p.~.;...~.P:~.n....r.9.WI:\fi.~.i.p..............................., Cumberland County, Pennsylvania, Deceased. Letters
.......................~.e..~.:.~e.~~.~':.~............ were granted to .. .[).,,!J.~J:1~.n...O'~~!5.i..t....B.~!l.It...~...r..~.!!t:..9.!?~l?~.n.y...
Witness my hand and official seal the day and year afore.s~i~.f, .', _) .' .
L~~,:t:~J...b....J)y..,.:~~.\,':"..................Df~?s~f...
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
55:
_Thomas W. Walker, Vi_c.e .president & Trust-Officer-Eii:,; Tre13idi"n-i-Tfiusr~ff1cer
boing duly ...-"-",,,..rn .. . according to law, doposos and says that ho ~up'.!!. n...... e.po_s_ t.. .an -..
Trus t Company, Execu tor of tho Est.to 01 ....P_"'.arl__'L'-E_b..l).e~-_...._..._-_..___...__
lalo of Nt. Allet). Drive, NechanicsbuU>.._. __._, Cumborland County, Pa., docoasod and that the
within is an invontory madc by Dauphin Deposit Bank &..J't:ust Co.._. tho said___.Executar-----
of tho ontiro cstato of said dccodont, consisting of .11 tho porsonal proporly and roal ostato, .xcopt roal ostato ouhido
Iho Commonwoalth 01 Ponnsylvania. and that tho ligures opposito oach itom of tho Invontory represent it's fair valuo
.s of tho dato of docodenl's dealh.
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Ellocutor . Administrator
Vice President - Trust Officer
Sworn to
and subscribed beforo me,
October 15,
,J
, ~
E!izi1l~et" J. CC:1k". N"Jhrv PliMic
My Comminion h..im r.pril lb. 19R4
tl."i1buU;l. P,. O~uph:n (ollnty
\
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..~ LJ Jlarke.LS_t.r.eeL_____.
Har~ l~b..u rg,. .p_"-nnM.l.v.ania _1.7..1.0.5.
Addr"u
9th
-..------- -------------_.__._~. -.--------- -------"
November 1979
Date 01 Ooath ____..
Day
t...1onth
YUt
INSTRUCTIOt~S
I. An inventory must be filed within three months after appointment of personal repres.entative.
2. A supplemont inventory must be filed within thirty days of discovcry of additional assets,
3. Additional sheets may be attachod as to personalty or realty
4. See Article IV, riduciaries Act 011949.
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PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of 19GI provides that the following persons shall prepare and file
a return:
a. The personal representative of the estate of the decedent ilS to proper~1 of the decedent administered by him
and such additional property which is or may be subject to Inheritilnce Tax of which he/she shall have or
aCQui re knowledge;
b. The transferee of property upon the transfer of which Inheritance Tax is or may be imposed by the 1961 Statute,
including a trustee of property transferred in trust, provided lIwt no separate return need be made by the transferee
of property included in the return of a personal representative.
2. PLACE FOR FILING
The return is to be filed in duplicate with the Register of Wills of the county wherein the decedent resided.
3. TIME FOR FILING
The return is due nine months after the decedent's death, unless an extension for filing has been applied for 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 personally liable. . .to a penalty of 25% of the tax 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 at 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 against any real property in tile 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 line not exceeding
$1,000 or undergo imprisonment not exceeding one year or both.
QUESTIONS CONCEI1NING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any material pari of his estate without receiving
valuable and ade~uatp. consideration? (Answer "Yes" or "No".) NO
2. Did decedent, within two years of death, transfer property from himself! herself to himself/herself and another party
or parties (includinr~ a spouse) io joint ownership? (Answer "Yes" or "No".) --1!9.-
3. If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following
information:
a. Age of decedent at time of transfer.
b. Copy of death certificate.
c. Affidavit bl' Ihe altending physician indicating the state of decedent's health at time of transfer.
d. All other information supporting nontaxabilily of transfer.
4. Did decedCllt, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consideration
therefor which was to 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 return to transferor 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 death?
5. Did decedent in his/her lifetime make any transfer without receiving a valuable and adequate consideration therefor
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 transferred? (Answer "Yes" or "No".) ~
b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(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 transferee'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 revoke, or which could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".) NO
9. If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Yes" or "No".)
R,EV.45411.eO)
COMMONWEALTH OF PENNSYLVANIA
tlEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "E"
JOINTLY OWNED PROPEI1TY
'*
(Instructions on RWf1rS(! Sidc)
Estate of
Pear 1 V. Ebner
p
TOTAL E VALUE OF DEPARTMENT
ITEM R
DESCRIPTION MARKET c~ DECEDENT'S VALUATION
NO. VALUE N INTEREST (Official Use Only)
T
II NONE "
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TOTAL THIS PAGE I1I!:IMO ""AI
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INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
,
Schedule "E" must include all property, real and personal. owned by the decedent jointly with another
party or parties as joint tenants with rinht 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". Incl'Jde 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.
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INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
File Number ____21.7.79-07)1________________
Dote of Death
November 9, 19'79
[i] Original
o Supplemental
o Remainder
Estate Nome _....._._.l'earL1l._.EbneL......_
Social Securi ly Number
m-2.6-)986
REPORT OF INHERITANCE TAX APPRAISER
f, the undersiQned duly appointed Inheritance Tax Appraiser in and for the County of Cumberland
Pennsylvania, do respoctfully report that I have appraised the real and personal property as reported in the foregoing
return at the valuos sot forth opposite- each item in the last column to the right in Schodules "All, liB", ue", and "E"
Dated:
JAnUAry 8, lq81
..fI'tI...'r;" ;-!Pr"),,.rJ)
INHERITANCE TAX APPRAISER
INVENTORY
VALUE AS APPRAISED
ADJUSTMENTS
caaE (HARRISBURG USE ONLY)
REMAINDER APPRAISEMENT CODE
Real Property (Schedule A)
$
N
00+
92+
Personal Property (Sehedule B)
Jolnt.Held Property (Schedule E)
Transfers (Schedule C)
'0+
N
None
20+
30+
TOT AL GROSS ASSETS
.. 2lf,no.. 05_.
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Estate
o Annuity
40-
93-
RATE
FACTOR
PRINCIPLE
VALUE
CODE
FOR USE OF REGISTER ONL Y
T ox on $
CODE
COMPUTATION OF TAX
$
$
S
$
$
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T ox on S
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Tox on $
TaJ( on S
T OJ( on S
Exemptions
Total Estnlc
TOTAL T4X
INTEREST FROM
BALANCE
TO
$
$
$
Less Crlldlls
DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST
S + $ S =
+ =
BALANCE S
INTEREST FROM TO __ S
BALANCE DUE S
TAX CREDIT
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IN TilE ORPHANS' COURT OF CUlmERI.ANIJ COUNTY , PENNSYLVANIA
IN THE HATTER OF TilE ESTATE OF PEARL V. EBNER
LATE OF UPPER ALLEN TOWNSHIP
CUllBERLANIJ COUNTY, PENNSYLVANIA
IJECEASED
PROPOSED SCHEIJULE OF DISTRIBUTION
llalance for distribution as shOlm by First and Final Account
Hrs. llenjamin Hiller - 25.00% of the residue in accordance
wi th Item V (b) of the Ilill consisting of:
Hrs. Deverle Frund - 8.3333% of the residue in accordance
with Item V (c) of the Will consisting of:
Hrs. llenjamin Root - 8.3333% of the residue in accordance
with Item V (c) of the Will consisting of:
Hrs. Robert Cornman - 8.3333% of the residue in accordance
with Item V (c) of the Will consisting of:
Hrs. William Westbury - 8.3333% of the residue in accordance
with Item V (c) of the Will consisting of:
Hiss Hary R. Ebner - 8.3333% of the residue in accordance
with Item V (c) of the Will consisting of:
Hr. Gilbert C. Ebner - 8.3333% of the residue in accordance
wi th Item V (c) of the mIl consisting of:
Hr. George Ehner - 8.3333% of the residue In accordance
with Item V (c) of the Ilill consisting of:
Hr. William Ebner - 8.3333% of the residue In accordance
with Item V (c) of the Will consIsting of:
Hr. Charles n. Ebner - 8.3333% of the residue In accordance
with Item V (c) of the Will consistinp, of:
um ',,)7 I"c~ ,J.t;)
I
W,l158.86
$ 5,114.72
1,704.91
1,704.91
1,704.91
1,704.91
1,704.90
1,704.90
1,704.90
1,704.90
1,704.90
$ 20.458.86
HI~Vo"'jti EX I 130/10)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
----- ,...;;;'"~,..~"~,:,...;:;~::..,,-..
Pearl V. Ebncr
Claimant
Claimant's Address
ITEM DATE NAME OF PA YE E
NO.
1. Dec. 5 Cumberland Count Re ister
of Hills
2. Dec. 10 Mess iah Village
3. Dee .10 Me ers - Hall Funeral Home
4. Dee.31 Cumberland Law Journal
5. J an. 22 Patriot News Comapny
6. Au .18 Brae
Relationship to Decedent
REMARKS
AMOUNT
__1_ Letters Testament~
~2 short Certificates
Institutional Care
$
..EY.n.eral F'.xppn~(-q:~
Advertising Executor's Notice
& Proof of Publication
18.00
Advertisin Executor's Notice &
Proof of Publication
55.02
'-'
,'-
~: ..
RESERVE TO PAY TH
Trust Company
Executor Fee
-
1,238.50
.::,
Reserve to File Accoun
c;,
0:>
TOTAL THIS PAGE
I hereby certify that to the best of my knowledge and belief the fore~oing is a just alld true statement of debts, funeral
expenses and e><penses of administration submitted ~p the eslate as deductions for Inheritance Tax purposes.
~~~~~~nJ:~~~;~i /~~n~~7I~:.t Company, Executor of the
Slr~NATUI<F OF ATTOHNFY/FlDUCIAPY DATE
$
6,260.97
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED II. THE SUM OF S ~";( lu{}' 7'1
V!,~!~ f':;:L:',~I), j~l .1:\i;~~; : frl(TI~
AT
/(;-
PERCENT.
/'~'/) .,,/ /)
~ t!"'-
_ .' A-L IUJ~I~S";.f I~
/-y-y/
IlJ\Tl
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 the cost of administration,
attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone or 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 filed. 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.
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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 ciaimed 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 column 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.
INFORMATION
To insure proper credit to your account. the namo of the estate and tilo numbor should he Clcilrly print-
ed on the check or money order.
This 6ssessment is made in accordance wilh SOClioll 708 of tho Inheritance and Estate Tax Act of
1961 (72 P.S. ~ 2485.7081.
To the extent that inheritance tax is paid within thffJO 13) months after the death of tho decedent, a
discount of five 151 percent is allowed 172 P.S. ~ 2485.7161.
Inheritance Tax, other than tax on a future interest, is due at the date of the decedent's death and becomes
delinquent at the expiration of nine (91 months after the decedent's death (72 P,S. Ij 2485-711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. S 2485.7121. Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using tho following interest table:
----------------------------------------------- - - --- ---- --.------ ---- -- -----
1 month .005 4 months .020 7 months .035 '0 months .050
2 months .010 5 months .025 8 months .040 11 months .055
3 months .0\5 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 lli days .00267 26 days .00437
7 days .OC)118 17 days .00284 27 days .00464
8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 days .00318 29 days .00488
10days .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 (60) days alter receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961 (72 P.S. ~ 2486.10011.
Make check or money order payable to:
"Register of Wills. Agent"
Mail to the address listed below:
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
*'
COUNTY FILE NO:
I
1::\
\7 "1 . \) I;)
DATE
\ 1(/
\\' I ,', /
'J; 'vI '(
," ~.., I, " (1
\ IJ ( .,j"")1 .'
., ., )
. /
TO: ..A",~ I,v ,A\:-I H,
0.) I :i'f'iy''\.lo...t.,1 ,11'1':.)
'-4.1 VJ\ll-" 0~l\'r l . \~.
ESTATE
.J - 'I
I, ".J (
" .,
FILE NO.
.) I 11 (1 ,/ J ,l
( 1 I
COUNTY ,) ,lA,'Y' \ J ~-, it.
~..
, r
DATE OF DEATH '. tV')
,J
} 0 '79'
/ "/, U 'i
Appraised Value of Estate:
Real Estate
$
Personal Property
+
Jointly Held Property/Transfers
+
$
Total Gross Estate
Total Approved Oeductions
Clear Value of Estate
$
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$
Amount Taxable @ 6% Rate
$
tax due
$
Amount Taxable @ '5% Rate
tax due
/v.".-1:'o""j
I TOTAL PEN~SYL~AN~A INHE,RIT~N:E TAX DUE
~' ,...... (9 0'.) /" . I; "')
(. IJ).<< {I,' ''\
percent discount -' totaHng $
Tax is paid by
$
J.. t) '7(" :>'(.., f-
'71.1. 0(,
~
;;"&-':;0 I{~
.. '* '* * .. * A five
will be granted if the Inheritance
/ olA j
less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
J..If. :5'/
$ J~'r,/) U~ + $
$
= $;:; :{ t,f\ l/ d
, .
+
=
+
=
Interest accrues at tho rate of six (61 percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
is
'--1 . '-"J ~ ~
''1,'' r ")
$ Ii ( \'.Iv' '. \1
\
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
,
'I"']
Assessedby: V) 0.)
See Information on Reverse Side Aglntlophl omrnonwealth
: f,.',\J."
\ ' " ; .w....Jt: 1
.J \\
INFORMATION
To insure proper credit to your account. the rltlmo 01 tho estate and filo number should lie clcml'f print-
ed on the check or money order.
This assessment is made in accordance with Seeliol1 708 of the Inherltnncp. Clnd Esti1lO Tax Act of
1961 (72 P.S. 9 2485.7081.
To the 6xtent that inheritance tax is paid within Ihrl10 (3) months after tho death of the decedent, a
discount of five (5) percent is allowed (72 P.S. ~ 2485.716).
Inheritance Tax. other than to)( on a future interest. is due at the datu 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 tho transfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. !l 2485.712). Calculate into rest from the delinquent date shown
on the face of this form to Ihe date 01 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, not satisfied with
the assessment may object thereto within sixty (60) days after receipt of this Notice as pro....ided by Section
1001 of the Inheritance and Estate Tax Act of 1961 (72 P.S. ~ 2485-1001).
Make check or money o"ler payable to:
"Register of Wills, Agont"
Mail to the address listed below: