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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
55:
Mervin O. Foge IS::lnger
being duly ..,_.~L... ....... ...." .ccording to I.w, deposes .nd s.ys th.t heAdm.il1,istra,t:PY..s>Lt.bc. Est!lt...!L.of
Mary G.. Black deceased formerly widol' and J' B 81 k
-S.ole....heu-of.James....B. ,Biack..,.... .. . ' 0 Ihe Est.te of ---'!Jl]91L~..,jl..c------,-
I.Ie of _'" Hopewell Township .. .. .._. _ ___., Cumberland County, Pa., deceased and that Ih.
'th" . r. d b him th .~ Administrator of the
WI .n ~ ~!lt~V('d" f.\: F'f "!ll.." "d .. , ..' ""-'''1'. .a- - 'a"- l"b e sr''J'D-- -- -
of th. ~~lire esta e o~ s.i;paeceie9,~..con~f.lfi,~cc\hlf?if~I~~r;>c;n~'llpi'J~.~Py .~~ r~JiesUte~ .xc~ll'ffJh.P.vJCoKuhid.
the Commonwe.lth of Pennsylv.ni., .nd th.tthe figures opposite e.ch item of the Inventory represent it's fair y.lue
.s of the date of docedent's de.th.
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Medin O. ][il>XOI)(C\l(1MIolJa>>lt~K' Fogelsanger
Sworn
__ and subscribed before me,
" .l14..~esLKillg_Strc..\l,L_..---,
Shippensburg, Pennsylvania 17257
Addr."
O.te of Oe.lh ______U_____....:!________J..une
Oay Month
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1971
Year
INSTRUCTIONS
I. An inyentory must be filed within three months .fter .ppointment of personal r.p,'esentative,
2, A supplement inventory must be filed within thirty d.ys of discovery of addition.1 asseh.
3. Addition.1 sheeh m.y b. .tt.ched .s to person.lty or realty
4. See Article IV, Fiduci.ries Act of 1949.
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" NO LET~'ERS II
REV.455 (1.80)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAK
RESIOENT OECEOENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
_~'~'__'_.__'___~7'="'~~c....;.,:",----
Estate of James B. Black Date 01 Death June 17, 1971
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
File No.!...).! /.
Claimant
Relationship to Decedent
Claimant's Address
ITEM OATE NAME OF PAYEE REMARKS AMOUNT
NO.
G. Irv1l1 Van Scyoc, Funeral Expense 725.00
Funeral Hone
~ES:rp()!:1~M~l 0); ..Land FHe Appra1.~~rbn~~a!;anent ot q.nn
, enns varu.a Debts am Oed c 1.
~E?Xt8rOolE1l~~~~' ~G.
~c~61geg~~~6ff~1~.W~~~k 44.00
Robert J. YOCLUU, Attorney Professional Services Rerrlered 125.00
.
TOTAL THIS PAGE I 903.00
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral
eKpenses and eKpenses of administration submitted to the est ale as deductions for Inheritance Tax purposes.
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I Mervin O. F~e1san~er6 Administrator of th~ /:~ /
" .~O:>lwClt...e u[ l' he~. 16 h., J.t:\..l;;;O.i:)ed., LUJ..ILIC1.Ol:FICIAL USE ONLY
;ndow arrl sole l.r, of James B. Black
5/11/81
DATE
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S
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PERCENT.
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DATE
GEN~E&..!.NHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred bV the decedent prior to his/her death are deductible against his/her taKable 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 eKpenses including the cost of a burial lot, tombstone or grave marker.
All debts being claimed against an estate are subject to the approval 01 the Register of Wills with whom the
Inheritance Tax Return is filed, Evidence to support the decedent's or the estate's liabilitv 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 eKemption. 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.
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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 eKemption" 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 pavee.
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 bv the person who has assumed the responsibility for paying the debts.
INFORMATION
To insure proper credit to your account, the narnn 01 tho tislate i1nd filn nurnhlH should be clenrly pont.
cd on the check or money order.
This assessment is made in occordnnce with Section 708 of thn Inheritance and Estnto Tax Act of
1961 (72 P,S, 9 2485.708),
To the extent that inheritance lax is paId within three (3\ lnonth5 aftor the death of tile decedent, a
discount of five (5) percent is allowed ("12 P.S. 9 2485-716).
Inheritance Tax, othl!f than tax on a future interest, IS due ill tile dilt~ of tile decedent's death ofld becomes
delinquent at the expilolion of nine (9l months aher tlw decedcnt'5 dClJlh (72 P.S. 8 2485.711), Inheritance
Tax on a future io1tcrest is pnyable within three (31 months after the trnnsler takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. 9 2485.712). Calculate interest from the delinquent date shown
on the face of this form to 1110 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 .00468
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 (60l days after receipt of thiS Notice as provided by Section
1001 of the Inheritance and Estate Tax Acl of 1961 (72 P.S. ~. 2-185- 1 001l.
Make check or money order payable to:
"Register of Wills, Agenl"
Mail to the address listed below: