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No, 21-80,
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of
"" ,J,,-,..:--L..--,.:-" :.:_'C:."~-j _.." .-..-,....---, deceased,
Harold B. McLane, Deputy
To fli8"'8.rS e, ,"'.~QQH;9r;:l, Register of Wills far the County af Cumberland,
in the Commonwealth at Pennsylvania,
IS
Petitioner(s) are the execuL:.c. _ nomed In the Last Will and
Testomentof ''',:,,,,,,,,: (:' ,/,. .',", dated "'''' ",' .",,'1
. ,. .' '-'-'---~r--~----------- / .,._~
Decedent was a citizen of the United States and a resident of
Township
,,( . i ' ." Borough, Cumberland County, Commonwealth
af Pennsylvania,
Decedent died on
, "
.... ~ ,
. .'" I
the _/.) 'I ,j
A. D, 191.:!.-, in the County of
(' , ,
I L ,..._/e."I. . I
, " " _ at the oge af ') I years.
Aas has ner
Decedent has not been married and has not had children born to him
since the execution af the above described Will.
Decedent was possessed of personal property to the value of
'1/(1 1.-1 i and af real estote to the value of
), ,.
as near as can be ascertained; said real
estate situated as fallows
. ;-1.",' r:"'"
apply
Therefore, yaur petitioner(s) respectfully aw'i,;,c for the probate
of the said Last Will and Testament and for Letters Testamentary thereon.
Dated
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Name and address ,I
of Petitianer(s)
;,jtVlr 0. S:~v~
(1./ ~. L<,,,~ ';d. JtU:Ut"-"''':~VlI4 11011
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COMMONWEALTH OF PENNSYLVANIA ~
ss
COUNTY OF CUMBERLAND
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named in above application, being duly _.__."'-'''---"______.m according to law
say(s) that the statements set forth in this petition are true to the
best of
f ._,
_ knowledge and belief.. --
and subscribed before__,_LJc~1f&"- [l~~-fl-
__j:iLt_lLit-L.1LidlWyjL~
I
. .1,.,,'
. ,
January 4 80
~e, f. -J'{;-, ----,---.----T-- 19.___
~' 1"'\' -\ j\)' " ,
:JI/'''' '~'" '.':> ,1 . /{'y \ \'
--<tuotcf's-; Mcr;-M1I!~ I--'D!put .....n
n;,..Ila, J [, Al\d~I.161 " Kegi~ter
-+-- ",-,---,,~,,-----"----'----~
h'Jl~
Filed;
.:.:t1-.f.::>..S'
9,
1980
Attorney,
.' / . '
"li"" ....,.
,l
LAST/ilLL J\t;lJ TE:,TAMr:l\T
OF
HhHPER 0, SWARTLEY
I, HARPER 0, SWARTLEY, single, of fl,echanicsburg R. D.,
County of Cumberland, and State of Pennsyl VC),nia, being of sound
mind and memory, do hereby make this my Las t \Hll and Tes tament,
revoking and making void all wills, codicils, and other testa-
mentary dispositions, by me at any time heretofore made.
First, I direct my Executors to pay all of my just
debts, the expenses of my last illness, and interment, of
suitably marking my place of interment, and the costs of admin-
istration as promptly after my decease as may be convenient.
All the rest, residue and remainder of my estate,
real and personal property, of whutever nature and wherever
situate, I give, devise and bequeath unto my son, Harper O.
Swartley, Jr., and my dauf':hter, Shirley E. Hershman, share and
share alike. In case either child shall fail to survive me,
leaving issue surviving me, such issue shall take the share which
such child, if living, would have taken; in default of such issue,
then to my other child or his or her issue as above provided.
Lastly, I make, nominate and appoint mv said son,
Harper O. Swartley, Jr., and my said daughter, Shirley E.
Hershman, to be the Co_Executors of chis my Last Will and Testa-
ment.
'1'11; s document I1Ol[; been prep',reo :Jnr! executed in tripl i-
cate and each of the three eopi es sl1;,}1 be consider'Jo an orif"inal.
Furthermore, the disappearance of one copy shall not be construed
-1-
87
OATH OF SUBSCRIBING WITNESS
COMMONWEALTH OF PI';NNSYLVANIA / os:
COUNTY OF ClJMlmHLAND \
\
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Th' / d f" AD 1 ,\'
IS....... ........................ .......................... ............... ay 0 ..... ....'.. ,I'..:.:.:. ~. :.. :~l.......................... ........... . " 9.L!~.."
Harold B, McLane, Deputy !
before me 1+;.1.... d IS. :.m!-.. "II, He~ister fill' the l~~obate of Wills and ~ranling letters of Administration
in and for said County of Cumherland, in the COI~monwealth of Pennsylvania, personally came ........,....,
,'~'_ ') \1' "J J I'" .., i'l "
......... ~.-... ~>...,.... ".'.\ /. ;-.::..\ :'.~.. ~'A... "..... ~.::.~. <-,. ~ ~ :'.:......... y......\...:... ~', ;/, ~.;'. ~ ~.~..........................................................................
,
t.he subscribing witnesses to the filregoinf.( instrument of writing purporting to be the last Will and
I ./ .' \,
'-')1 / I I e \'. '., ,<'.
) / .' " \ '. ,'- , ,.'" _ , , . ,', I, " r. . ..~: r, .', \ ' '.' ' r /
Testament, of ..,..,...., .." ,..,/',1,,'....,"'.."..'.."'.."'..'.... ..\f....".."..".."" ......"..".."" Dated ........ .J...,......"'" ....;......,.."
. ' l
late of ,....' ,....\..1"",.".........."':,(" I.', ;".....,........",..,.............."...,' ,..',.."........",,'" Cumber} and County Pa" deceased
who being duly ..,..,c..'..,..".."..............,........, according to law, depose and say, that ..l!.,<....",,~'..,.,.............,......,
r
present, and saw and heard the testa!.~"...:...............".........., ...:.r...I.:.jj..'........':.:.....l::...;;.,.;\1...::./............................
sign, seal, publish, pronounce and declare the said instrument of writing as and for h..,(,:,........, Testament
and Last Will, and at the time of so doing ....,........!;"......,........................,was of sound and disposing mind
memory and understanding, to the best of ......,',:(,~:;,I...,..............,..,......knowledge, observation and belief,
,
......./i",\~,','...;t...................., and subscribed before
....... ) ,/~~-~)~ :
" _ < "'- r~, ,,"-'.." ( ~ r,
"'{}j,,;''!''X''''l;';:;;:::!J{''''''''''''''''''''''''''","','
jj,'......",."",.,.."J!.,..",../K"""""""""""",..""",.
l/l1. ~G" \/ I
,..f.\ <,a,l..\l"<~,, \f\Y:;;,,;,tr~h\.r;'.,..........., !?,~P'~,~y."
I\iduud E. ~\ud...I."'v.!, Register
..................................................................................
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA t ss:
COUNTY OF CUMBERLAND \
, 1.;;;.\ '.;;' .r.. ,/ ".J ' -'
V I, \.~" ,ot ,,) /.;_AJ~~) if '/e..". "'{' ","''- . '. ':"" , ",,:.{.ll_, \.. being duly
. ............... ........ ..... .......~..... :~4;~...................."""""""",,,,,,,,,, ............... ................................ t.,..:.,...........
...................,..,\,;",\:,'~"'............. say~ that as nearly as can be ascertained the said decedent. ..........................
.;r~,". " (, .J ",,( {' dl'ed on
...................~.......r.<.................-.......... ..~..,.....................................................................................................
, . r '"
J(. ~r:" _/ . th . ,,!" d' f .' ".. .'" A D 19 '17
.::....................';(....................... e ................................ ay 0 .....;........~..;.................................... .., ..c. .,
at or about ......;:,;?;..';,!........,................ o'clock, ....M,
c
..,.....,..:o;-?:";",,,......:..,,..........,,..,..,and subscribed this
..........................,:::,::'......,....".. day of ,...l,'.'..:;:..;........,
,
19, ,{..v.., before
j"{"l"'C2~,,,sillJt*m
'" ~,.~~l;\!.l.~t,&, ,:.rf."" J'y):,:,:.:j;::: :,,:-: ";,, ~,7,P'~,~y'",
R:~J.~.d E. A...:L......., Register
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PI~NNSYLV ANlA }
COUNTY OF CUMBERLAND SS:
Before me, the Hegister fill' the Prohate of Wills and granting of LeUers of Administration in and for
.,' ..".. ,/ / I', ( .'
the County of Cumherland, personally carne .,....',;,;..y".....'..', ,,!,',.,~dl,'1"i'!~,r.. ,.::" 1..,,:-.(,,1"'( ..,:Y/,:\.,l/'''''.'',,,,,,,,,....
i
who, being duly .....,;i"....,~:i;.,....,.... do ......,... depose and say that as,..,:'....{:..':".....1,,:.l...,....,..,..............................,
of the last Will and 1'estament of ,.,',:.::..::'.',:~[r!.:i',.,,':::,..;,,.r.;,,',,...":!.(,,..I'"",.....",..",...."",..,.."",........",deceased
, :
......ai.I....,........ 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, ,..,,.,;:/,.,,,,,........1:..... and subscribed
before me.
......r..'~~'~~~'~'y...~..,.................., A, D" 19~~........
":1Jkw.~.f~f2-,Sq,s...i~~;;\'>.~...,,:,,:,?~,~~~.y.,
R:""L:Ud E. :"&I.-aLJOn, Register
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DECREE
, 9th January 80
Be It remembered that on the ........................ day of ..,........,....,..............................,' A, D" 19 ........, there
was probated and recorded the Jast Will and Testament of ....,a.~,r.~~,r...?,:..,~~~,:.~~~X..........,........,........,'
Shireroanstown " '
late of ................,..,................"........,..,..............,',..,......, Cumberland County, Pennsylvania, Deceased, Letters
Testaroentary Harper O. Swartley, Jr. and
..,............,.............,....,................,.., were granted to ...shi'r!~V..E';..'Rer'Sli1l'\i!iti"...,............"'.............,..,......
Witness my hand and official seal the day and year aforesaid,
.:" ~y. j(,~J1,k ,.Y.~ (:,'1:',"'...1..., ,~,7.p.~.~y.
Riahnnl ") llr"''''IRe~ist.cr.
COMMONWEALTH Of PENNSYLVANIA
COUNTY OF CUMBERLAND
55:
HARPER 0, SWAIl'l'I,EY, ,m.& SlItHLEY E, HEIlSmlAN
_ ..... _ ___..___ n__ ___un
being duly ___,___>;WOl'n __ according to law, doposes and says Ihallhe y___:u'o--l.ho-,--- -- ---- ""-
_,,__"" ,____GCl:-EXr;CU'l'ORS of Ihe Eslale of _,!!^-I~~~\l._Q.,-fi\.v-~Ii!'~!:!:._--,---,-,,-
lale of 1?1 S IO('lISI- 51- 5hi1'C,,"1l1SlO\\11, ----'-' Cumberland Counly, Pa" deceased and that the
'Ih" ' I d b IImVer 0, S\I'<\1'lley, ,J1', & Shirlr,y E, lIel'silman 'd Co_Fxpculors
WI In IS an Inven ory ma 0 Y ,-- '--, the '01 --"",'..::----,,- -'-- --"-
of Ihe enlire eshle of said decedenl, consisling of alllho personal prop.rly and real oslate, except real estale ouhide
Ihe Commonweallh of Pennsylvania, and Ihallhe figures opposite each item of Ihe Invenlory represenl ii's fair value
as of Ih dale of decedenl's dealh ,
/c, 19f1_
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~;..-A A~ r;:('(. L~~
,/ SHAROII-6RUS~, Ii,' ,'I [. ",
1\1Y r.:orllnll"~I: Ii l\ - ;j. . I .. .' '".
Hillll~b;r~t(J.' '. -
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mlrp~W.ry: 'sW!['lit - 0: .Jr,
Y,4MS\' tl/'-f~l'~l"~
1~Y J~. J ers 1l1lal1
ro_F:X(;lCutor
)~Lf3-,-lR~ust' i?t, , ::;iliremansto,\VI1' PL_1l0~1
Add""
Date of Death ___ ~@.______-____-..__-_.Jl~l!lbe!:....
79
Month
Y~1r
D,y
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal repre,entativo!"P
c;m
2, A supplement inventory musl be filed within thirty days of discovery of additional asseh, ii1~
il'1l,
3, Additional sheels may be altached as to personalty or really i!!~~
4, See Article IV, Fiduciaries Act of 1949. ~;:2:
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Inventory of the real and porsonal estate of
HARPER 0, SWAlnThY
--------..--.-..- ..-. .__.~_._._.__.
.'---'- .~._.._-- .----.-.---
_._----_...__.,_.-~- ------_.~..._. ._~.-- --..
COMMONWEALTH NA'rIONAL BANK
(Checking Account)
BELL TELEPHONE COMPANY
(Refund)
AETNA CASUALTY INSURANCE COMPANY
(Refund)
(No Real Esto,te)
TOTAL INVENTORY
deceased.
..--.-------- ---
---I
$37,39 ,17
$ 2 .10
$ 6 ,10
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$37,48~.37
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EIN~SYLYJl.~IH~jjJflIJAN9E TlIX GENERAL INFQ_RMAT!O~
1. PERSONS RESPONSIBLE FOR I1ETURN
------------_..~-_._-_.-
Sectiun 701 01 the Inherilance and Estate Tax Actol 1961 providr:s thai till: following persons ~,h;i11 prepilre and lile
~ return:
il, The persooolrepresentative ollhe estille ollhe dewtent as 10 properly 01 the decpdent adrninistered by Il\m
and such adrlitionol propr:rty which rs ormoy be sublectto Intieritonce Tox 01 whicti he/she shall have or
ocqui re knowledge;
b, The lrilnsferee of property upon the trilnsfer 01 which Inheritonce Tilx is ormilY he imposed by the 1961 Stotute,
incfuding 0 (ruolen 01 properly 1';lIlslc/led in tlUSt, plovidedthotno sepilrate return need be rnilde by the trilns(eree
of properly included In the relurn 01 il pelsouillreprescntiltivc.
2, PLACE FOR FILING
The return is 10 be filed in duplicote with the Register of Wills ollhe county wherein the decedent resided,
3, TIME FOR FILING
The return is due nine monllls ilfler the decedent's deillll, unless an extension for filing hos been applied (or and
granted by the Secretory of Revenue within the nine-month period,
4, FAILURE TO FILE RETURN
Section 791 of the 1961 Stillute provides thai" . , .ony person who willfully lails to file a relurn or olher report
required of him, , ,sholl be personally liable, , .to a penally o( 25% o( the lax ultirnately toundto be due or $1,000
whichever is the lesser to be reco'lered by lIle Deportment 01 Revenue as debts ollike omount ore recoverable by
law,"
5, TAX RATES
inheritance Tax is payable ot the rate of 6% on transfers to lineat descendants, such oS lather, mother, husband, wife,
son, daughter, grandchildren, grondporenl, son-in-law and daughter-in-law and at the rale of 15% as to all others,
6, PAYMENT OF TAX
The tax assessed on lhe transfer of properly reporled in the return is due 9 monllrs after lhe decedent's deatlr, interest
al the rate of 6% per annurn accrues thereafter until payment is made, All payments received are firsl 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 10 the Register of Wills of tire counly wherein the decedent resided and are
received subject to Ihe final determination of tire Department of Revenue,
7, FAILURE TO PAY
The taxes imposed, together willi ony interest lhereon, are a lien upon real properly, which lien remains in effecl until
the taxes and interest have been poid in lull. The taxes may be sued for agoinst any real property in tire decedent's
estate or againslany properly belonging to 0 transferee tioble for the lax,
8, FILlNGOF FALSE RETURN
Any person who willfully makes a false retulil or report required o( Irim shall, in accordance witlr Section 793 of the
1961 Slalute, be gullly 01 a misdemeanor and, on conviction tlrereof, slrall be sentenced to pay a tine not exceeding
$1,000 or undergo imprisonment not exceeding one year or bolli,
NOTE: Compensation poid to ,111 estate represenlative; nalllely, an execlltor 01 adrllinistliltol, for services performed
in administering an estate is reportable for Pennsyl'lania Income Tax purposes, TillS taxable iricome item shollld be
reported on form PA_40_llIdividllallncome Tax Return.
INSTRUCTIONS FOR COMPLETING SCHEDULE "A"
Schedule" A" should include 0 detoiled description of 0\1 reol property locoted in Pennsylvanio
and held solely by the decedent or held jointly with another individual (s) as tenants in cammon. List the
decedent's percentage of ownership and the estimated market value of the decedent's interest, (Property held
os joint tenants with the right of survivorship or tenants by entireties should be reported on Schedule "E".)
All real estate located in Pennsylvanio should be described by lot and block number, street
address, number of acres and general description of land and buildings, Also, include the book and page
i number in which the deed is recorded and the exact title as indicated on the deed. If the properly has been
i sold, attach a copy of the settlement sheet. If the property is subject to a mortgage encumbrance, include
I the name of the mertgagee, dote, rate of interest and the outstanding bolance on the date of death and
I attoch a statement from the mortgagor verifying the outstanding balance,
I Property taxes and interest on mortgoges as of the date of death, assessments and other
I encumbrances should be listed an Schedule IOF", Do not deduct them on Schedule "A",
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REV.4!i 1 EX+ (3-801
COMfj10NWEAL TH OF PENNSYLVANIA
. DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*'
(InstfIJctiolls all Rr.v(!rse Side)
HARPER 0, SWARTLEY
Estate of
,~-
ESTIMATED DEPARTMENT
ITEM DESCRIPTION UNIT MARKET VALUATION
NO, VALUE VALUE (OFFICIAL USE ONL Yi
-
COMMONWEALTH NATIONAL BANK $37 , 398 . 17
(Checking Account)
BELL TELEPHONE COMPANY $ 26.10
(Refund)
AETNA CASUALTY INSURANCE COMPANY $ 64.10
(Refund)
TOTAL THIS PAGE $37,488.37 .31. 'f ?f, :31
~
QUESTIONS CONCERNING PROPERlY TI;I\NSfEllS
"------
1. Did decedenl, wilhin two ye,Hs of deillll, In,IIH: ;IIIY tl;lnslelnl :,IIY 11I;;lel, II 11,'11 olllls e~;I;,lt: wilhollt receiving
valuable and adequate consideralion? 'I\n~;vlo:l "\'1::;" III "No",1 _,l'l_Q.,.
2, Did decedent, withinlwo yeilrs of dealh, trilllsli:1 plllp'''11' flrl:l,II"W;t:11 I\I~I",,:III! Ili,,'~.,:11 '1Ir,,~.,'11 ilnd :motller piuly
or pilrlies{II1cluding il sponse) in 10\111 owtlel~,lllp'! [^n~,wt:1 "'Ie:," "I "NIl".1 NO_
3, If the answer to Olle or Iwo :iI~JVP I'; "'I,"'" ;llld II", 11.'11',1',1 , .lIt: CI.IIII\I:d i I Iii' 110111'"1111", provide 1111) lallowing
inforrnillion:
il, Age 01 decedent ilt lime of Ililn"li:r, ._'_-
b, Copy 01 deillll cerliliciltr..
c, A{fidilvil by the ilttendillg physiclilll incllc,llinr: till: sLilt: 01 1!i:et:dl:111". 111';11111 .II Ii III 0.: :){ llilw:lr.r,
d, All olher informilliun supporllng nontilxilllillly olll.lII'.I\:1.
4, Did decedent, in his/her lifelime, malie any Ic,lIlsfel 01 fllOfluily witll()"IIl;(,!iV/ilI~.1 viduallle 01 illi(){/lIil!O cOIISldUl;]lio/l
therefor wllich was 10 [;Ike effecllll possl:SSiOIIIlI'~lIllIYIIII~111 011 or iillllr IlIc/lwr clt:.1th'l iI\II~:wl:r "Yes" 01 "No".) NO_
a, WilS there allY possibility thallhe properly lrilllslelrcdlllir~htlelllllllo Ililllslt~<lJr or hi~,.'hel U~;I,lte 01 be subjecl
to his/her power of dlSpositioll? (Allswel "YI~s" or "No",1 NO_
b, Wlwt was the IransfelCe's ill~e illlillle of dliWlclli',; deil1h? --1iQ_
5. Did decedent in his/her lifelillle lIIake ilny Iransllll withoutlecelvlllg ,1 V.1illilhll! ilnil iiderl'llll" cOllsiduIC11ion therefor
under which trmlSferOl expressly or illllJliedly ri'sr:rves 10/ hls,llelli!r! 01 IIO,! pl'llod which does inlilcl end belore his/Iler
death:
a. The possession or enjoYlllellt of Ollhe righlto IncolIllI from IIle propelty tr<lllslellelP (Answer "Ye:;" 01 "No",) NO
b, The right to deslgllilte the persons wllo Shilll possess 01 CIlJOY till, plOperly Irilllslerrorf or incollle tllerelrolll?
(Answer "Yes" or "No",) ~~
6, If the answer to five h. olhove is "Yes," stilte wheilwr tllP. lil~hl WIIS reserved In decedent illone or others,
7, Did decedent in his/her lifelillle make iltrilnsfel, the considerollion lor wllich W,l'; trilnsleree's prOlllise to pay income
to or for the beneli lor cme of llolnsferor? (Answel "Yes" or "No".1 _NO
8. Did decedent, at any tillie, tlil/lsler property, lhe hmeficiill enJoYlllent of wllich was suhiect to change, because of
a reserved power to illter, ollllend, or revoke, or which coold reverl to dlicedcolondellerllls of lrilnsfer 01 by operation of
law? (Answer "Yes" or "No",) _NO
9, If the answer to eight ilbove is "Yes," was the powel 10 ill tel, ilmerltl 01 revoke the interest 01 the beneficiary reserved
in the decedent alone or the decedent and others" (An,wcr "Yes" or "No" ,'----.-
REV.454 EX+ (3.eO)
COMMONWEALTH OF PENNSYLVANIA
, ,OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "E"
JOINTL V OWNED PROPERTY
*
(lnstflletlons on Reve,se Side)
Estate of
HARPER O. SWARTLEY
- ..-
ITEM TOTAL \ VALUE OF DEPARTMENT
DESCRIPTION MARKET DECEDENT'S VALUATION
NO, VALUE INTEREST (Official Use Only)
T
--+--._-"-------- . ..
--.-----------.--.--.
NONE
,
TOTAL THIS PAGE N, i:,V,".
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by tile decedent jointly with another
party or parties as joint tenants with right of survivorship, Botll tangible and intangible property are to be
included, List real estate first.
1. Describe all real property as indicated in tile instructions for Schedule "A", Describe all personal property
as indicated in the instructions for Schedule "B", Include the nmne, 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.
C '"0 0 n ;V ~ ;V :;:
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REY..6. EXt (woo)
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
[!] Original
o Supplemental
o Remainder
File Number _ 21-8_0..._~008_
Estate Name __~~!,p~r_, D. HS_wart,],~L
Date of Death
12-29-79
Social Security Number ___1!_~:~1..~~85_,__u _____
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly uppointed Inheritance Tax Appraiser in and far the County of Cumberland
Pennsylvania, do respectfully report that I 'have appraised the reol and personal property as reported in the foregoing
return at the values set forth opposite each item in the 105t column to the right in Schedules "AU, liB", "e", and liEU
Dated:
April 1, 1981
8'l' 1 - 1)
- U\u/ 1r/~ll:!.ilyfl
INHERITANCE TAX APPRAISER
---.-
-----~_.- .-
INVENTORY
VALUE AS APPRAISED caDE
.~-~-_..-,.,_. -_."-_._,._------~
S None 00+
37 488 37 10+
_HQ@ 20+
None 30+
---
37,488 3]
ADJUSTMENTS
(HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE
Real Property (Schedule A)
Personal Property (Schedule B)
Jalnt.Held Property (Schedule E)
92+
Transfers (Schedule C)
TOTAL GROSS ASSETS
Leu Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
40-
93-
-_._.._--_._-~_._.._- ---
..-._---------_.-._~ -
o Life Estate
o Annuity
RATE
FACTOR
PRINCIPLE
VALUE
CODE
._, '__0'_ ____.___........___..~__._.._..__ __u... --_ - ..
-~----~-,_._._-_._._.._-----~--_.- .---
FOR USE OF REGiSTER ONL Y
fQQg
COMPUTATION OF TAX
$
$
$
$
TalC an .$
6"
"
TalC on S
15~~
T ox on S
Tax on S
Tall on S
$
Ellcmpllons
T alaI Eslolo -----------
TOTAL TAX
INTEREST FROM
OALANCE
TO
S
$
$
Less Credit'>
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
,\
\
S
,
$
--...---
BALANCE
$
INTEREH f1WM ,____._~__ TO __ ~
>>
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GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxabie 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 hOl/sehold as the decedent. The family exemption is
allowable only against assets which pass by a will or by the Pennsylvania Intestate Laws.
C ." Cl n > tTl ~ ~
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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 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 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.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL "OnCE OF
INHERITANCE TAX
ASSESSMENT
*
DATE
I
1/ if
/ .
/..r ~/,.,
/t!
TO:
, I (-
" ,/ (' I I' I""
, /.'.' J( ,~~ (.'/---
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Of
l
FILE NO,
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;". '7 ]
/.,' /. ,(I _ ,/ "'
" ,: l-) 11.;5.I.! id/I ,: ,.;L_
COUNTY FILE NO:
.. /,
I,
ESTATE
COUNTY
"1' ( ,
",J" ,:/1
~/
:/,1-
, 'I;, , ,,'/
" ";~
DATE OF DEATH
I, /',
/1./il.)It.f/.~-(" ./
Appraised Value of Estate:
Real Estate
$ .-------
',' ,'/ ..' r".,r~ ".)
+ ~~~,:I i,;'<i' ,.:'
Personal Property
--,-------_.----
+
Jointly Held Property/Transfers
$ ~" / ,/ ('J' ~;"J
.' ,I
Total Gross Estate
Total Approved Deductions
/' .',' ~,- "J.. I
_ ,I /.-' / ',:' -./ ~-1 I"
"'/ ... ,'... 'I'
$ ,,', j/,./'
Clear Value of Estate
...-.-.----
less: Approved Charitable Exemptions
$ ",' /
;",' ?~' ;i'/'-;
",'./ -'
Clear Value of Estate Subject to Tax
Amount Taxable @ 6% Rate
'j
$ ,;/
:: /.:::~, / 7
tax due
$ /f,.:I '/ 3l
,
tax due
Amount Taxable @ 15% Rate
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
$ It :; r; ,3 r.;
I
* * * * * * A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
;C ",t' /'J
J '_',.' .'.' " ~
J v" ' v'
AMOUNT PAlO DISCOUNT INTEREST TAX CREDIT
$ ///.'- ,) ('?; + $ 1./ / .\ S = S /'/,:/;! /(1
i /-....(.. /1.' l (; v
+ =
+ =
--
less Credits:
DATE OF PAYMENT
Interest accrues at the rate of six (6) percent per
on the unpaid balance of Inheritance TDx from_
to date of payment. Interest due if paid by
annum
BALANCE OF PENNSYLVANIA INHERITANCE TAX OUE
'r' .' /)/ 1/ .
i/l '::::J.j ~~",.:..(..<,j(/
" '(1' .,,,,~,,r'.-:--
Assessed by '// It i'i' (--'x~.~( -ca./
5," ",,,m'OO' 0' Re"'" 5,,, Ageo' ,o,\"~~~m,'; o;nj'" lth,~ /
/) " I t..,;.-l:I.
!/
is
$
!fifORMATlO~
To insure proper credit 10 your account, the llilllHl ul tho estate <Iod Itle nurnbN should hI' c1lJiltly print.
ed on tho check or money order.
This assessmont is made in nccordanco with Sc,-llon 708 of H1/~ Inheritance nod ESHlte Ta)( Act of
1961172 P,S, 9 2485.7081,
To rhe extenl that inheritance Ifill. is piud within thH!I) (3) months after the death 01 the decedent, a
discount of five (5} percent is allowed (72 P.S. 5 2485.716).
Inheritnnce Tax., other than lax on a luture inlcrest, is due <It ttle daW olthe rJecodent's death and becomes
delinquent at the expiration of nine (9) months after the decedent's deilth (72 P,S. S 2485.711). Inheritance
Tax on a future interest is pi:lyable within three (3) months alter the trllnsfcr Itlkes nUeel III possession and
enjoyment and is dclinquenl therci3!tN (72 P.S. 9 2485.712). Calculate interest from tile delinquent date shown
on the face of this form to the date of actual payment USing the following inloresllilble
-------------------- - ---------- --- ----- -------- -- - - ---.- --- -- --------- -- - - - -- --
1 month ,005 4 lTlonthS ,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 rnonths .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 di1Ys ,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 3D days ,00500
- - - -- - ----- ------~---- -.-- - - - - -- - - - -- - - - --- - - - --- - --- - - - - --------- ------
Any party in interest. including tl1e Cornmonwl!nlth and the personal representative. not satisfied with
the assessment may object thereto within Slxt"{ (GO) days after reeeipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of '961 (72 P S. s 2485- 1 0011
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below: