HomeMy WebLinkAbout80-00014
No, 21-80
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of ___ ___HO)'-'LL~-BRl1JlA\<.ER ___ __ -- - --------------, deceased.
~arold B. McLane, Deputy
To Rlel.a. U E. .'\fo\~,g@f-I, Register of Wills for the County of Cumberland,
in the Commonwealth of Pennsylvania,
IS
Petitianer(e) EIEI! the executr_~J{- __ named in the Lost Will and
Testament of __HO.Y.LL~-_J3R1JJ3AKElL----d __ _____ -- doted _nSgp.J;-eJ.llb.e.r---3.CL. 1965
Decedent was a citizen of the United States and a resident of
Township
SQuth Middlgton 801 ~"9\.-., Cumberland County, Commonwealth
of Pennsylvania.
Decedent died on ----1'~ay .. the ___.Jil;j1 day oL Dec;;eI1t~L--,
A. D. 19.-TI-, in the County of Cumberland
State of
-~------,
Pennsyl vania at the age of 75 years.
_ bas E
Decedent has not been married and has not had children born to him
since the execution of the above described Will.
Decedent was possessed of personal property to the value of
Unestimated and of real estate to the value of
None as near as can be ascertained; said real
estate situated as follows None
~
Therefore, your petitioner{e-) respectfully applies for the probate
of the said Last Will and Testament and for Letters Testamentary thereon.
Dated January 7, 1980
Name and address -{ /'("L'~/ /' 6{4tC-/:.'<''-'
of Petitioner(1I)
Juris E Brubaker
R D. 1,
Boiling spJings, PA 17007
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY OF CUMBERLAND \ ss
DORIS E. BRUBAKER
-.------...----------
named in above application, being duly __.5.wurn---- according to law
say(s) that the statements set forth in this petition ore true to the
best of
her
knowledge and belief.
--Swo= t"
_ and subscribed before
if /'
" / v '.,' 't '---....
/,' . ( ,_/. f-/- 0-
../-~~..._:.:...._-,,:--~-
~ ~/c
January'l 7 1980
me, ----,-----------------------
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Ri.J-__J [~A11tl~RlM.Register
Harold B. HcLane
Deputy Regis ter
1980
--.------------.
..-..-----
-
. .1
, I I
Attorney: Hilliam F. Hartson, Esquire
Hilliam F. lIar ton , P. C.
WILLIAM F. MARTSON
ATTORNtV AT LAW
C:;ARl.ISLE. PA.
L^~~I'-~:I.Il,.!.:._"^N 1~'l"S'I:!>HI'CNL_
1, 1I0YT 1. BRUB^KER, of" R.D. Itl, BoiJ.inf; Springs,
Pennsylv1.lnin, being or sound and disposing mind nn(1 memory,
do hp.reby make, publish antI cle,clar('. this to be my Ll1st will
and T('stament, hereby revokini; any and n1.1. former Wi lIs or
Codicils by 01" mack.
1.
I give, dc.visc. and bequentb nll of my estnte, both real
and pc.rsonlll pr0pert:y, unto my wi [(', DORIS E. BRUB^KER,
absolutely, and I hereby appoint: my said wife ns Executrix
of my estnte.
2.
In the event my wiEe shall predec"asc or fail to survive
me, then 1. give, devise and be.quen th all of my estate in the
follOl"ing mann"r and under the following conditions:
(a) I hereby give said estate in equal shares unto my
daughters, DORIS E. BRUI>M(ER, (Born Nny 15, 191f5), and N^NCY
K. BRUBAKER, (Born September) 8, 19118), absoJ.utely.
(b) If "ither of my said dnughters shall elaim the
family exemption n s prov ided by 1 aI~, then the other daughter
shall get n like I1mount fr"" of any inl1<'ri.tance tax prior to
the division of my said estnte.
(c) I \wT('by appoint ^LETH/\ KING as Guardian of the
persons of my chi 1 ell"Cn nnel THE IIARRISBURG NATIONAL B^NK ANn
TRUST CONPANY fl. Glwrd!8l\ o/' tbe esLntc of nny minor child.
(d) T herehy ap!'oinl F.DI,^RD 1-1. CRONEH, 620 North Hanover
Strc"t, Cnrlisl(', Pn., os Executor o/' my cstnte, however, if
the said 110ris IC, Brubnl-:('r sh;,],l hovC' attaincd the ag(' of 21
ycars nt thc timc "I' mv clc.1t'h. th('n T oDpoint th" sa id Doris E.
Brubaker as a co-executor "ith E,!I,ard \:I. Croner.
.
OATH OF SUBSCRIBING WITNESS
COMMONWI<:ALTH OF PI<:NNSYLVANIA I ss:
COUN'rY OF CUMBlmLAND \
This.......................... ........~~~..,..."..."....,........,...,. day of ......,..January",.,........,. ....",..........,....... A. D., 19.~Q...,
before me R'!jf.r<J~, .~: I McL~.I)re'~iR~P.W)~.Ythe Prohate of Wills and ~rantin~ letters of Administration
in and for said County of Cumberland, in the Commonwealth of Pennsylvania, personally came ..............
... ..,..... ...... ..... ....... .Ruth.. R.... Mook ..and.. J,oy.c.e..H" ..l:1\lm1?,~h..,................,..,., ..... ,.. ... ,..,. ....... ... ... ...... ...... ......
the subscribing witnesses to the fore~oin~ instrument of writin~ purporting to be the last Will and
Testament of .......... Hay..t. .L.... .Br.ubaker...............,......... ......."..",...,....,...,. Da tcd .~~P. !;~!1\1?~I" ~9.1.. .J.~~.5
late of ...........s.outh..Middle.tan,..Tow.nsb.ip.....,........................ .,......... Cumberland County Pa., deceased
who being duly .......swo.r:n......................... according to law, depose and say, that ....,t;:.I:\~y...W~.r.~......,........
present, and saw and heard the testa..tor............,..........., ....,......HQY.h..1......~;t;),\1?,!'!~!:~;t;.............................
sign, seal, publish, pronounce and declare the said instrument of writing as and for h;i..~............ 'l'estament
and Last Will, and at the time of so doing .............he.........,..,..,...............was of sound and disposing mind
memory and understanding, to the best of ....their:...............................knowledge, observation and belief.
sworn '
............................................... and subscl'lbed before
f1td,~.:...,:.::~.~::::::::::::::::
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'nO 1 , T:'l A 1 ftl I Register
Harold B. McLane, Deputy
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND \
......... ...... ........ ........ ....,.... ....... ....., .... .DORIS...E... ..BRUBAKER,.. ,............",........ ...... .... ,.,..... ..... ........... being duly
.......................61'7.0.[.\............. says that as nearly as can be ascertained the said decedent ..........................
...................................... .I;\9XJ... J:..:... ~,R.Y~A~~.R....,...,.,................, ,.......,...".,.....,.........,.,..."......................d ied on
......................'J:uesday........... the,....,..J+.hP...............day of ,.....p.,~~~1?~.~.~,........................... A.D., 19..??.,
at or about ........S.:.4t:1......................... o'clock, .~.M.
.......................sW,orn..t.o..........,and subscribl'd this
....................?~~...................... day of ....J.i\p.\!gy......
19, .80..., beforl'
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f... ,-::~~(,:;, ,.::,.... C..,. ...... :-?~......~... ~::~:.:.-:::..,............
., ~ ~J.(\i utLI'.L...JJ:.) ,~"..J (.,~.:,......"..." J).~P~,t.y
U.' , y~ A 1 I Hegi:-;tcr
Harold B. McLane, Deputy Register
OATH OF PERSONAL REPRESENTATIVE
COMMONWI';ALTII OF I'ENN:~YLVi\NIi\ }
COUNTY OF CUMIII';J{\,i\NIl SS:
Befol'!' me. till' He~istel' for the Pl'ohate of Wills and ~ranLin~ of Letters of Administration in and f()1'
the County of Cumberland. personally came .DD.RIS",E..,,,HRUnAKER,,,,,,,,,,,,,,,,,,,,,,,,.,,'"''''''''''''''''''''''''''....
who, being duly "".S.wo.r:n"",,,,,,,,. do es""" depose and say that as..""E:l!:ec.utr.ix"",,,,,,,..,,,,.,,,,,,....,,.......
oflhe last Will and TestamentoI' ,,,,,,,,HO,Y.T,,.L,_,,.RRliRAXF.R,,,........,,....,,,,..,,..,,...,,...........,,............deceased
......she............ will well and truly administer the ~oods 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. ............s.wo.r:n..... and subscrihed
before me.
January 7 80
........................................................ A. D., 19............
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........ {}t.d.. (. ,...l'::!.~.'::.(.j.9.,~.Q....,...................
R:...L.uJ B. ~.~.AJ........~U, Register
Harold B. McLane, Deputy
Jj. e &""J 40-
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DECREE
, lOth . Jamary 80
Be It remembered that on the .."........,.."...,... day of ""........".."............,,,....,,.......... A, D.. 19........, there
was probated and recorded the last Will and Testam!'ntof .......~.Cl'f.1:...,~.~,..~.~.~~.~~~.~......................"........,
, . South Middleton Township . ...' l... ,,'. .....,..'
late of ......,..."........,......................".""."."'".,,"",..,"",,. CumbcI1.1I1d Count.y.l el1I1S) l\ .1n1.1, Dece,lsed. Letters
..............,..........?:'!:!,~~.~~,r:l:~i'!-,r.y,. wen' ~ralltl'd to ",.""" .,,'.. .,"',I)(),x:~,s,',E.,~,.,B.,r.\lb..~~~,r.".. ",,,...,,...........,....
Witnesi< my hand al1,l ollieial seal till' da\' and war aron'said,
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I ; / I., ,'). Deputy
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~~~ll<1'~~~~, H...~ist...l',
C9MMONWEAL TH OF PENNSYL VANIA
OEPARTMENT Of REVENUE
BUREAU Of COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
INHEmTANCE TAX RETURN
FOR INSOLVENT ESTATES ONLY
OF RESIDENT DECEDENTS
(2.1- 80- It\-)
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RCC.lO'3 (3-731
COUNTY OF _C.llffiRCrr:lf;lJ1-cL-.----
This return must be completed in dotoll and fllod in duplicato, with tllll Rogistuf of Wills in tho Counly whore Ihl! decudon! rllsidod within nino
months after dOlO of death, unless on Q)llcnsion is gronted uy tho Secrulery of Revunuo,
Will ,~-,1'
~\M,..Ntl.
;<"
l'lltCL I. --DDRl5-E._BRUBl\.KER--.----.. "1P.._D.._l..Boiling .Springs.._.Pa-
INAM!-:I I.(IIJI{! 'i',1 17007
""""'.
being duly sworn aCl:uruing to law, ocpnSl's allll say." IhaI9\l: is Ihe _.-.Exec.utrix..-------
~ 1 >: ( c., ^ I '1.1" \ I (, ^ 1 I I . L I (. \
nl the eslale III __Ho.yt_..L. _ Brubaker_,
laic III_S.QUt:h_.Middleton TO\Yl1Ship
I Cl TY, UOIlOL'(oIt, 011 T()Wr~<;HI!'1
deceased, ami thut the whole of the estate of said dCl:cdcnl. \\'ho dil:d Oil December 4, 1979
lOATI:1
eoosisled of Ihe assels Iislerl helo\\' aod Ihal all"'l'ahle dehls aod dcrluelioos excceded Ihe lair olilrkcl I'aloc or 1111' assels a ",I
no Pellllsylvania Transfer Inhcrililllce Tax is dUl:.
Sworn ond subscribod before me
/1111 II" I' "
1\'0_- day "f l...<0'~ \ 19_19--
'v' -.f!r/.. '-./(~:. elL
to /1 '
_j~ZK)_( .. ,::>~~c1.<-,L:~'-:- Executrix_
lSIGNATUREI Il'lTLEI
i",
ASSETS
Estimated
Market
Value
Deportment
Y~'ia"
CAUTION
(00 ntlt wrile
in this s ca)
Type of As'5~'t: .F/\ ';
Raal E'loti;1IP,.~,s. "
p roperty ~,~ oi,n.,_ly
Hald Prap', ar'';
Transfars
'< .:
i~ ,,:.1;,
r~(AtfOChadditiOn(l~ifncCC5sary)
Description of A55cl
REAL ESTATE:
PERSONAL
PROPERTY:
NONE
NOTE:
1. 100 shs., Pittsburgh & West Virginia
Railroad, Non-Assessable shares of
Beneficial Interest, registered l/n/o
decedent. at 5.l87Y"rer share $
20 shs., General Motors Corp., $5.00
Series Preferred. registered l/n/o
decedent, at $52.0~per share
3, 1973 volkswagen Sedan, Vehicle No.
1332688971, Title No. B249033ll
Allot er property, both real and personal,
was 0 ed by decedent and Doris E. Brubaker,
as Te ants by the Entireties
518.75/
2.
1,040.00/
800.00
TOTALS
$2,358.75
1t'1.1 n. 15"
.
REPORT OF INHERITANCE TAX API'R,\ISER
I, the undersigned duly appointed Inherilane", Tax Appraiser in and ror the above Connty dn respeclfully reporl Ihal I hal'e
appraised the real and persuoal prnpcrly as reported in Ihe fnrego;ng schedule al the I'aloes set lorlh npposile each ilem in
the last column 10 the right. ..;//,,~ I ~~
Daled: April--2-4 1980 IINHEr",'A~f'S^PPR^rSERI-----
,
Nome of Payee DEBTS AND DEDUCTIONS Amount AmOIl"l ApPloved
Nature of Claim Claimed by RogishH
1. Doris E. Brubaker Family Exemption $2,000.00
2. Hoffman-Roth
Funeral Home Funeral Expense 2.390.00
3. Letort Evangelical
Church Cemetery Lot 400.00
4. Belvedere Medical
Corporation Account Payable 510.00
TOTALS
I
----1-----
$5,300.00 I b'3{J-C,M)
REPORT OF I'IIE RF(;\STER OF WILLS
I. the undersigned dull' elected Register or Wills in and for Ihc ahllve Cllunll. JII respeellully reportlhall h:Ol'e allll\\'ed
deduelions in Ihe amllunls set lorlh in the ahnve sch,.Jnle as cI:oimerl. exeepl where I have se! fmlh a gre:OI,'r "' Ie>,er :01l1,"nt!
in the last L:ulumn to Ihe right. whkh grealer or lesscr i1l1\OIlIlI Icprl'scnts the slim allowed as a dcduc1ioJl
\late III App,""al: .))) /ttL/.- / J\, / q rO. " 1,1, .. <-(.~..J
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WILLIAM r. MARTSON
ATTORNEY AT LAW
CARLISLE. po....
LAST WIl~.0ND TESTM1ENT
I, HOYT L. BRUBAKER, of R.D. ,n, Boiling Springs,
Pennsylvanin, being of sound and disposing mind and memory,
do hereby make, publish and declare this to be my Lnst will
and Testament, hereby revoking any and all former Wills or
Codicils by me made.
1.
I give, devise and bequeath all of my estate, both real
and personal property, unto my wife, DORIS E. BRUBAKER,
absolutely, and I hereby appoint my s,d,d wife as Executrix
of my estate.
2.
In the event my ",ife shall predecease or fail to survive
me, then I give, devise and bequC'.ath all of my estate in the
following manner and under the following conditions:
(a) I hereby give said estate in equal shares unto my
daughters, DORIS E. BRUBAKER, (BornHny 15,1945), and NANCY
K. BRUBAKER, (Born September 18, 1948), absolutely.
(b) If either of my said daughters shall claim the
family exemption as provided by laVl, then the oth€.r daughter
shall get a like Amount free of any inheritance tax prior to
the division of my said estate.
(c) T herC',by appoint ALETHA KING as Gunrdian of the
persons of my children and THE HAilltISBURG NATIONAL BANK AND
TRUST CONPANY as Guardian of the estate of any minor child.
(d) I hereby appoint EDWARD H. CRONER, 620 North Hanover
Street, Carlisle, Pa., as Executor of my estate, hOVlever, if
the said Doris E. Brubaker shall hnve attained the age of 21
years at the time of my death, then I a ppoint the sa id Doris E.
Brubaker as a co-executor with E(h~ard W. Croner.
[) r ! /.;~.,: I "i
',' 1,/oll!.'!,1 FUli 1\l'iD Co:m:tH
I" i ,':M'\[',:' ,r('I,if-,III!:"
,.,...C!oILl,i;U Illilll. Nt,ME
OF ^ RESIDENT DECEDalT
~~~~,
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COI.\MU~l'(:r-I' I'; "
I3UI,~ [AU "f '.\ 1,
APf:.~..!s.j\J.I1:..:I' I": 'II,!:! i'i ;\II'I,IC/ TE)
TO THE ,'f::r,id", ,'0,;,,1.' '),Y,~RT,I',!:riT OF I;TVENUE.
r\"~:'licl.;~"):' I', 'd,"fly JlllJ(:C fOJ CO'i;;cnllo tne Irnllsfcr of the following securities of 0 Pennsylvania
Corporaiio!l :,; a ~J(lt~("lU: :~(JI1king A':,sociu\ion lauded i!l Pennsylvania:
DA TE._AoriL.23, _19110
(oL350 3hs. i,,! Pittsburgh & Wes,t Virginia Rail:t:o_acL (cLJiEmeficia1 Interest
(NOTE: I: ,;e.<.I<",,, ''''."I<',OS ;,,,,or ii' lill, rob 0.0, eilher 1110 number 01 shores 01 slack or the /oce amount 0/
regiskr,-,! ;'Jil,hl,'" :" (bl, Iii ':tHO"~', c{ 'il.:.' ,llinfl company and in (c) th~ class of stock or the stated il1tcrest rate
and :i1nilnii)' :.1(11(: of !-:ql:.,tcrcd I~I~.,_;:;.I
ISSUEG ON (See other side). (]II': !,,,in~,, TOTAL MARKET VALUE OF SJ,.,_8].2..,~_____
I ~\ ,;" ;
05 of the dotl' oj {I,.,;!; I.' ;',(0 dec..'lk,',I.
HOYT L...BRUBAKER..-------., an.Jlecernber 4, 1979
(Nornu of Df.lcl.!dc/ll) (Dote of death)
who 1'10', lok of
R.D. 1
Boil iug.. Springfl,._.C;l1IlIQe1;;L11,l1..!l.
(r,>.:t OHic'.') (County)
PA 17007
~ S ! r , ' .: I ," 1 d 1" l 'I n n (: r1
(Statc)
The securit'", "'" "',: "I'",.,: 0' foilows: ,Hoyt L. Brubaker, &_Doris..E._Br,ubaker...J.t~..T.eIL...-
(Nom', or nnllle.. in which ccrtificotc!; arc rogistcrt.d)
AF.'.l'ttNi~i"I"!t~""Pi Doris E. ,Brubaker, R. D._1, Boiling. SpringB._.EA_.J.IO_~
EXECUTOR I (" ",,' (Add",,,)
ilArd: OF APPLlCAtIT.. .William._L....Mar.t.a.o.n. p .C.
COU~lTf flU:: IU,\dEf, 21-80-14.._ ADDRESS OF APPLICANT _l~lL.-~gh_s.treetF'
( r'i11 i. ~/1> 17013
BUREAU FiU: t<IJ!WE~i , , ,.. SIGNATURE OF APPLICANT _L.t!.1~LtlLL! II Om"
,i' YOU FAil. TO 1'.'UPi::,LY FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NOT BE
CO~iSI[Jcl<[[; C,OMPl.HE AI~D WILL BE KETURNED TO YOU FOR COMPLETION.
r:C':I,;,:li<\~Et., 'TH OF PENNSYLVANIA - DEPARTMENT OF REVENUE.,
CONSDn TO TRMlSFER SEClIRITIES vh' '.. ',I J{/'
-.- ..------- DATEu.f<j 1-L!.Lj"'('
I h:~lo:?h/ (i)ns.>:rl to the fl\";'lsler oj lhL Clbov(,> sccuri1ies now r0gistercd in the name of the afar/said '
Dcceclr:.ni ane! we:'! 2 :';:-, fdll",:J ot a c('rlilicofC certifyinfl10 I'he payment of the transfer inheritance tax to which
Ihe proper!;, ,i: ooid ,/"",!" 0" 1 "'. mode subject pur ,"ant to the provisions of the Act 0/ June 20, 1919, P.L. 521,
as amcnded and i'~ (~Ac1 d JU\l" 15, 1961, P.L. 373, (l~ Gll1cnded. This is also in accordance with the provisions
0/ the Act ,,' A"r'l ) 1'12'1, r',L, 3~1
11'; c...~'1~:,~,d If: rl(Hl"fel 'h,: flt'fcin described property operates only in reference to the estate of the
C1bovc~n(Jr~1Cd G0cf:lp)il.
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J., ','_1""-/ 'A-
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Signed (or the Secretory of Revenue
By_.AI/( L'I_I~,' ,Lt~,'j 'j/,'-
(Sian:JGro) ..' . ,
" /_ I' /,,'
, /./ ", ;(. __L'u:.L',', CJ.""L{iLh ~(..
--'CiT'ill-~)"- - (County)
Date ~ert1f1cl1tc No~ Sh~~~
--
6/15/73 tiC 29917 100
10/20/67 PC 2114 100
1/15170 tiC 24205 100
6/15/73 NO 7016 50
.',' c,."
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,,' I'{ iU i'IO~~ 1'01< AriD CmJSEHT
1<1 r!,' '.1",1 1':1, ~;f'J-LIRITII"
,d,',,:~ f EllUl ", l}if: Iltd,',!:
OF ^ RESIDE~IT DECEDENT
W.~."
,.~lt
AtT~:.I('/d I,: (,",:, r i," :'!U:[: I~i m!I'L1CnE)
TO THE PUII'I~':: V,\~II,IIl[c'Mn/'\ENT OF I<EVEtILlE:
'\;11,1;,:-,:1:1, I j,r'I'.:llV 111l1dr} fDI (OlI.)t'tll to thc transfer of the following securities of 0 Pennsylvania
Corpuroliol1 or (1 (:',11 ..nul ;:i~'nkinu ^".socteJ1ion located in PCl1nsylvonio:
DATE._A!?!,.:!,l 23-> ...1.9~O
(a) 100 shs .:,dPittsburgh & \oles t Virginia Railroad,__ (c)J1e.n.e.ficJ.a.l Interest
(NOTE; In lk ,Cll;!if1~J ~;('cuf;tiI'S ("11 ~-,r ill (0), ub (ve, either the number of shares of stock or the face amount of
fl~~i.,tef(;d ~,(!;,.!~;, ill (b}, lhe [,JL:e rd 'il': :~~;,:"il\q compuny ond :11 (c) the closs of stock or the stated interest rote
and nlotu,.it;., (;'Jtc iJ! rr:(;I:=:,icrcd b(Jnd~>.\
ISSU[D or, _October 20, 196,7,nd :"'v;"o n TOT AI.. MARKET VALUE OF s~Jil,,12.
os of the dOll" to! rlt'{llh 01 the d':ccdl.:J11r. HQYT_L_'__~'RJJ.l}AK~R______.._,__.____., on December 4. 1979
(r),,',.\
(tlumt! 01 l)l'c"dcnf)
(Dllte of death)
whawaslaleoiR., D"l,
Boiling Spr~ngs_._~':!ffib~r~and.
PA 17007
: I',! r"~'l U:ld f~u:nb,'r)
(ro~f Office)
(County)
(Stele)
The securiti~~ :,"" r{>(";i~::I.{I~d n',., follow=;:
,HOYTr.. _BF-!IDAK!::B___.____ .
(NllflW ,'Jr nomos in which certificates ore rogisterod)
Doris E. Brubaker I ,R.. D_.J ._.BgJlj;J;lg -.Springs ,]LJ.1Q07
lNUi11' 1 (Address)
~IAME OF APPLICANT ....WHlJ.!!l!L.F. Marts.Q!L P. C.
COUNl Y I iLE ~;U,\\BE:, 21-80-:1,~_.._ ADDRESS OF APPLlCANL_1Q.J~....Hieh...ill;.. Carlisle. Pa.
, 'I) )/1 /7,/=p013
BUREAU FILE NI!MBER._ ._, .u_ SIGNA TURf: OF APPLlCANLJWJ<U,,\\ '1/;/ I oJ') I,
NOTICE: IF YOU FAIL TO PROPERL Y FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
^9Mtffi:;'fRr:'i'er:,
EXECUTOR )
COMN,ONVlE'ALTIi OF PENHSYLVANIA ,- DEPARTMENT OF REVENUE
~O.NS~!:l:r:rO Tf3.J\!'1S.FE.R ~ECU.!~.l.II E S DA TE'~ ht-
I hc:eoy CC'fi:~2\,. to the fr'ansfc:r 01' the Jbo'/E- sccurities now registered in the name of the afo said
Dccedcnl und,."";,,o d" lilil19 af a ccrlificute ccrlifying to the payment al Ihe Iransler inheritance lax to which
the prapert)' of s,,;,I Der.dcnt '" :r,ndo subiect p'lfsunnt tn the pravisions al the Act of June 20, 1919, P.L. 521,
as urnend",1 end lh" Act r:i Juno 15,1961, P,L, 373, as amended. This is also in accordance with the provisions
af the Act of April \' 192\', P,I... 343.
Thi', r:nnc.,.":'.. to Tr,l"sb Iho herein de"cribod praperly aperoles anly in reference ta the estate of the
nhove~ncm(,d DPoc:eil,.':',t.
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Signed for, the Secretary al Revenue
,. . . ,,' / '"7".'. /
By~---!.LLc,_':/,'.~_J!)1 ,'(',-c._,j
(Sic;no,ore)
j // ,/-:~' /, / < / < ,;A.,_
/ Ly.t(!., ~.. 'ic:::';;.L' - ,-t.~L_."
!I'IIon"tATION
To insuro propor crmJll to your nccomll, tlHl namo of tllO l!SIaI'~ ilnd Iiltl nlJrnbm r;l~ould bt! clearly prllll.
cd on tho chuck or monoy order.
ThiS Assossmont is madll If' nccOIdilnco with Soctlon 108 of thl! lnl1crlwncc and Estate Tux Act of
1961 (72 p,s, 9 2485.7081,
To the extent that intwriranca 101:0: is lJillO WJlhlTl Ihrl!(~ (3) flWrllhs afwr tho death of tile decedent, a
discount of llvo (51 percunl IS allowed (72 P.S ~ 2485 71 G).
lntleriwncc Tax, otller thiln tax on a future interest, is tJ1.m at the date of II)!} decedent'!) death and becomes
delinquent al the expirntion 01 nlno (9) months aftr,r IIw dnceden"5 death 17') P,S j 2485-71 H tntwntance
Tall. on II future interest is pllyahlp. within three (3) months after the lransler takes clluc! In lJossession ond
enjoyment and is dollnquonlthoroafter (72 P.S. ~ 2485.712!. Cillclllalc Intef(~st from the dchnQlltHll date shown
on tho face of this form 10 the dale of aCllHtI payment uSlIlg tho followlfllllntnrest table:
-------~-~-- --------- ------ --- - ----. ---- - - - ---- -- -- -- --_. - - ---.----- -- - - - -- --
1 month ,005 4 months 020 7 rnonths 035 10 months ,050
2 months ,010 5 months ,025 8 months 040 11 months ,055
3 monlhs ,015 G montlls ,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 dnys 00250 25 days ,00420
6 days ,00101 1G 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 clays ,00318 29 days ,00488
10 days ,00169 20 days 00335 30 days ,00500
..- --------- --- ---------- ---- - - -- - ..- -- -. --- -- - --- - -- - - - - - -~------- -----"
Any party in interest, including the Commonwealth ilnd tl18 personal representalive, not satisfied with
the assessment may object thereto within sixty (60) days "fIef receipt 01 this NotIce as provided uy Section
1001 of tl,e Inhentance and Estate Tax Act of 1961 (72 PS. G 2t1U[).1001j
Make check or money order payable to:
"Register of Wills, Agent"
Mail to tho address listed below: