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No 21-80
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of ..mos8_E.fuf[~--m--- ------------, deceosed,
Harold B. McLane. Deputy
To Riel<18ra C. P.AEler88~. Register of Wills for the County of Cumberlond,
in the Commonwealth ot Pennsylvanio.
IS .
Petitioner~ gre..the execut'(\-~m, _ _ named in the Last Will and
Testament of JfuJ~J:l~f.ned,------------- datedfub(Q.Ci~ II \(nq
Decedent was a citizen of the United States and a resident of
Caf11pr\1\\
of Pennsylvania.
Decedent died on 1l~a~ the ~ day of~cevY\ber- ,
A. D. 19~, in the County of (1JJN\bstiarA
~'{\"oA \lCl\.1.cl
~ her
Decedent has not been married and has not had children barn to ~
since the execution of the above described Will.
Decedent was possessed of persanal property to the value of
do 11.3.000 and of real estote to the volue of
~~,OOO as near as can be ascertained; said real
~ct~ fNen\l. e-
T€l'::Flslx1i~
Borough, Cumberland County, Commonwealth
, State of
estate situated as
Co.mpJ11' \\
follows 3\ \<( f\
~~tY1'<\'Y1
Ul-'t-'I y
Therefore, your petitionerlot-l respectfully applies for the probate
of the said Last Will and Testament and for/, L:t~ers Testaznt~~}hereo~.
Dated " >f f<-L 'VIL-e..c. C" . - CLt';/ -- ~
Name and oddress _t(l'\lA\efll E:. lo~e\ '
of Petitioner(s) 'fJ\ ~ . tIn.((jat2l Acre .
~
COMMONWEALTH OF PENNSYLVANIA t
COUNTY OF CUMBERLAND \ ss
yo.~Jem E. LD~s1.___-------
named in above application, being duly ~1J___-- according to
say(s) that the statements set forth in this petition are true to
best of _n.ef
law
the
knowledge ond belie;~ / (,' - l...,;) (J
~_ and subscribed before ;~;'-'4.J.f.d;d~JL!-/;;' - '/ t:.-L--'7,A
m~e, f'-~, ,P~~l1- , _19-~"O~- ,-,-------------------~----
I', ,,J .- - r<< _I .
J J'L.}..I' t ;.--:: f .--- ......~(J~' /'! J, -
_- Haroiu-I>.-MCL-a~-DeputY--'--
Rivl'C11 J C. Alld",. ,,61 '. Register
-,---------- ~
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I ~ Cl.
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Att;,rney
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Filed: January 22. 1980
d(/-8?' -3.':,- /0' ,) 2. - /
LAST '~IJ~ANIl TES1:A~ENT
OF
MARY E. IlAl\NEIJ
I, MARV E. HARNED. of r.amo Hill, r.umberland r.ollnty,l'cnnsvlvan1a, helM! nf
sound mind, memo""y nor! undp,rst~ndi.flr" dn nlnkr.., puhl:lsh non ~er.l"re this
mv Last- l~ill and 'fest"lment, heYehv ~evol..ing .1nrl -'
makino voirl all Formp.r ''111s by me at anv till',e heretofore malle,
ITE'\ 1 _ I direct that all mv legal dehts, funeral and asminiAtration
expenR8S, ;:md taxes due on account. of my neat.h, be naid from resinue. a<;
soon as practicable after mY death.
ITEM 11 _ I direct that my bndy be, buried on mv Int in the ~olnt
r.athprinp. r.empterv at Mnsc~~, ?ennsvlvania.
ITEM 111 _ I give devi se and benueath all of mv pronertv of whatever
nature and wberever situate, to my Aiste,r Kathleen E. 1.oyd.
Upon the death of mv said sister. the r-rinci.pal nf thi s trlU:;t Ahall he
ciAtrihutell to such of mv nieces, 'M,ary Lovd SbRely, Margaret Lovd r.ribhs,
Kathleen T.oyd and Ellen T.ovrl .lones, ,.;rho mat1 he livinp, ..t the time of mv
death. and to the issue then Hving of such of my niecp.s as TTiay then be
deall, per stirpes
I
'I,
ITEM lV _ T appoint my siAter Kathleen E. Lnyd, ExeclItrix of thiA mv
Lost Will and lest"ment, and di rect that it not be reouired to enter
b"hd or furnish s"reties in any lurisdiction
IN 'HTNESS WHEREOF, I have here,L'nto set mv hared and seal to this mv
l.ast Hill and TestRI1'p.nt, thls/2L dav nf h6-z:-r":o<"I1Q70.
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OATH OF SUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLVANIA! os:
COUNTY OF CUMBERLAND \
This......."".. ...,.. ...'"" ..~.7.t:h..,......,..",.."""""""", day of ",..".."""."," '!,a.!l~,a.~Y....,...""....""""", A, D,. 1 ft.!Q.....
Harold B. McLane Deputy
before me RioROrl11C ^ _~^"M". {{egister for the Probate of Wills and granting letters of Administration
in and for said County of Cumberland, in the Commonwealth of Pennsylvania, personally came ..............
Alma Y. wilson and Donald S. Marencic
................................................................................................................................................................................
the subscribing witnesses to the foregoing instrument of writing purporting to be the last Will and
Testament of ...........' .... ....., M.:~,:,~..~,:..,!:I,~r.~.~?..,.,.. ,.".,......, ,.",.."."",.......... Dated "..I!:~!?,~....~,!,.. .~,n~,........,
Camp Hill
late of ...,..' ....,..... ......,..".....".......... .......,..., ...',....'",.' ......,.."".",.."......, ....'", Cumberland County Pa" deceased
h b '1 sworn d' I d d they \/ere
w 0 emg du y .........................................., accor mg to aw, epose an say. that ,............................,..........
present, and saw and heard the testa..~!:,~.~....................,' ...........!1,a.~y..,!'!.,..,~!g!).!:l,4..............................,..
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 .......................!?,n~....................was of sound and disposing mind
memory and understanding, to the best of ......................!7J:1,~~,~...........,knowledge, observation and belief.
sworn d'
..............,................................ an subscnbed before
~ J;k..J
."t~",.,',..,..,.,-:;j.:..,......,...".."..,",...,...,.......,......
cA)md;t....~~."..."...".."...,.
~~1;~~."i~~';,~=~~,~?~Y
Fh.c1.~. J . .uJ.:.... ..,Lil, RegIster
..................................................................................
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA! ss:
COUNTY OF CUMBERLAND \
.........~~,~~~?.,.~t}~,.,...,',...".....,',..,',.,....,....,.,.",.,.,."".........."..",.....:,..."....,....,..,.....,..,..,..being duly
...s!.U!).'C,0........................., says that as nearly as can be ascertained the said decedent ,.........................
....,.......v.J0.-:f~"t,',..,..tmL(\~.."",.,..".,',..,,...,.,.",...",..".,..".".,...,.",......,....,...."..,.."...,.....,.......,.died on
....11J.~.~~~,.................... the ......,~~~..............day of .......tR,~~.<<\~.'::-,..........,..... A.D., 19.JQ
at or about ............itOO................... o'clock, AM,
.~~..1t.............................and subscribed this
..........yt............................ day of ,jcmUJ}J.~y
19, .SiO., before
:c.t~.~Y:~..
,.,/ JJ; ,
.~ 1"'- f
..;.,......:.... .. jS-:nL".'~).~"\'-:~:::~~""n.~,~~Y
R..J.......d E. ....d~h' ,Reglstcl-'_.
"
,--,y j- g().J~-
COM!oIlO!\'WEALTH OF PENNSYLVI\.N\;\.
UEPI\P.'i'MEtrr OF REVENUE
BUF-.EAU OF FIELD OPEPATI0NS
'I.'~
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J,::~jr.~LMiI'
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REV-401P. (8,78)
COUNTY 01:
Cumberland
RESIDENT DECEDF./lT
--_._.--~. .,",""-"...-,,-~.,,-._...,...~.,...,......-,..-_.~--_.__._---,....,.,.._-_.--:-...:..__._-,-..,...----'-,-------..- ----....--..-...---:----"
Thl" rt'l'l~', mll"l he c"I1'pil'II"\ If: dLI l~l :llld 1,1"11111 dl~I)~lt':ltl', \\ill~ ,,!I ,11:,II'IIl'll. ,\nl1 ,Ill" ,~,-.',\',:"r "I \hlls ,Ii the
I"""" .,,,,',.' ,1,','"d'''H ,"'.,d.''', \<.,,,,," i' 01",' ""I"" .,,,,,' """HI,. "",., ,I.,,,, ,., "..."i<, """,'" "" "'".""""" ,r"",,',1
I.y I~I! ~I" 'l,:\~ 'II I: l"IU'!W'.', l~...rl'l'''ll 'Iill "I ;1,.. lllhl'll!.l!n'" alld 1",.\.':1'" ,j:, ,\(1,'1 l'"d ,I
IMPORT AN T,
_..____..._ ,"H _... ".'
--------.'.-..'....--.".--.- ---.-' .,-....------..-.-,-----..----'
I:'J 'I ilE \1.'\1'TI;I: O!- !IlI' 1'.ST,\n.: n!:
I
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County"
I'XI,,('I''\'llH
,\I'I']PA\TI ill
,-_._.-------~' -.-..---' ----.-.---.-------'-
\<;T,',TE r-L\.\, :-l,\'~1 :-,;-' f' C!- 1"',,'
MARY E. HARNED
.\I)\ll~ISTR:\'1 Ult
Cumberland
Late of _____._..____. ---.---
Slot. .f ___P_ennsy,lvania
C.ont.f Dauphin
y ------,-,-,--------------
_Ka t:hl~~ll
J
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Exccu!tli'ix
E.
Loyd_
"lld ~.,.,.
x.1li.rt\ift~~--'
-rx ;:)1 IhCl c~l(lll" of 'l,~ ahcw,..no",,,'1 G..(:~d('nl nClnq duly \WNn, dcp.,'"
December 25 79
l>e..:ei.1enll!lcd_------------. 19' - fl,'!;IClele<l'lnglJ
"'d..~,l I l'"l ~~K~X'X
Ill)I ~i1I, [,,1':' "f ,..I.iell i:;; 1,C'",tonl1odwd. )
N,,,.,nd ,dd,... ,f n"'''''1 " ') _ JudJ_ S.hQ2Q._ smtt_h ,_~_s_CL'_, _ S~lIT\:l, CI-lfu'1BERLA1;N_ tL!1EDGER, P. C.
"h".o'h,,,,,d,,,,,,...,,,,,,.,,n,,I,,,, ~ 2931 North Front Street, Harrisburg, PA 17110
all corrClljlOndl"neCl :;;h<Juld \:." fl1<:1li"d. ) --------- ----- - ---~- --- - ~-~--~---- --- ---
ThalllS s"ch_Exe,Cl1.t::r!70,----- <1","'0"'" i, la",<I"" ",i!h lit<' alra,,', "r """ ..,..",' a"d [he !'["I,,"I" cooslillltiog
( l ,: E :_:u -;-,l r...;, I.)M' t,I15, r~ .\;:J ',.1
the assets lhcrcllf anJ theil' rair lllal'kcl value.
That at the lime or de~lh th~n: was 110 sar~ dl:p(l~it bo,\ l'l:gi:-.lercd ill del;edrnl' S Indi\iJllal
as agellt or lh:puty of iHItJlher. ur in l.h~t:edellt's illllivillu:d n:llnC. wilh ri~\Jt of :ll:t::::-.S b) i\1H'Lhcr;J
cx(;~pliot1 of the fobllving: -
I1<HIH:, ur jointly with, or
agenL ell deputy, with the
N'ME 'NO ADDRESS ~~~~";'~',O~=~~~;:;-;-N:;";~;.':;;,~~-"O:,,= i~-" "~~~~;~~,,c~'"'' "0. "F.,"o-I,;E;-~~<Ot'"H,p-~;JO,N-:;=
I N W,~'!~ t'.:::;;2.E~~-~;;":,~:;~~~"\.::.~,.-~~~~.~~~~.r...=.=J "-,"-h~L"~~'~ ,-~~.'~,~.-~~~;~,-~.)j,~:~,;..-,~!:_;:~,-,;~,',J~-,"I..-',i.J-t_~~~:)~7..r:s,L~7~EN T
,( v,,~~~o,,>/:'-" 0 .,_ U~- -"'J - -- -" ' - -
ea.JJ"F.JliL~I2.--,- ___________i_______-'u,---;t> //cLLlwl --j-------'---
, '
______..____._______.________.' -.----t'----~--.---. .-..-' -----.. -"- r
I i
--~~~-----=::-::,:_::-=:-~-~:~-~~=:'-:=r~----::--~-~:~~:::~=:-:::~=:~=L-=-~:::==~, '
---------
Thai Ihe contents or ,<lid safe den.",it hox or ho,es arc itemi"er! """" Se:"dulc,,_~lA _or Ihis '''turn,
with the exception of the follnwil1~~. for thl.: rt~ason~.. hcrcil'afll:1' ~et furth:
That Schedule A "",,,'llI',j h,,,"'" ,<I,d ,,,,,oIe p"rI here"r ,eh r"rtl, fdly .,01,1 .., d,,.ail all tb'.' real p,"perty
in Ihe Communwealth oll'ennsyhanta or which rleeedent died having an lu"'o' Ih"",,'ln, 1[ als" ,ets r"rlh the
1\10rlga~e enenmhranee, upon each pared "I' leal pr","'rIY al Il,e ':ak r'[ dealh. ,.',vi"g the al1l""nl 'Iill due at
death, nalOe of mortgagee. date. ,a" of illtereSl. a"d buok ..nd page "I' ,eeord the[n,f. II al:;" ,..." lorlh 10 the
eolllmns pro\'ided Ihen'lore tile asse",ed ,..Inali,,,, of e"eh of ,aid parcels. 110, e''.I<ualerl ",arket valne thereof
as of Jale of JCilth or dcct.:ul.:ut.
Tha' Schedule B allached hereto ,,,,d m,,,le pari hereof "" ,,,,tit fully ...,,1 j" ,kwii allp"'SOl",j property
whereso\'''' sltoated """",oj by 1\'" ,kceek,,1 at the tim.. ur ,k..lh: "il n",ney' left bv Ih" ,keer"'nl at the lime or
dealh. wherh,,, in ,,",,,,,,,,,,.,,'s o"r...rlia" p";",...io,,, ,,,..,,I,":, I"~ ,k...",;.,nt', ",,,,ii, i" banks ,,' dqlOSit, saviogs
hal''', Irll,1 .,,,,,;.,ai,', or oth,'r "'<li'"li,"'" wl,e[h", ,,,di,id,,a1\:', O[ in ,...:st I'" ,,,,', "ther p""'UI or pr"sOl"
giving also se!,aroldy th" ""en".,1 i",.""t ,1",""01, if ;ouy, d,,"o t" tit, 1",1 ,.,1'''''' ca, I',;or 10 ,lee"lenl's
dealh in II", ,,,,',"' of savin!ts h,""k., "",I :" II,,, .I,,'" "r ,;,.,.,,1"0(' d,..lh ,n "II ",' ,'r ,,;;',"" ,<II h"",b. l'o,lal
,tlvi1l!':'. "c.,,>'''y ,,,ni!i,,,,"" '" n..:, , " "1'.,,, """Ie:we ,,: ,,,",,hl",\:,'" ,,: :,,' ,:'''1',1 S[al,'S '" ':,e ,"'.
",dent' ;;11 "1.li",,[,"',;,, ""0:.1,,, Co" ,:,.",1. "r"e''-''''''''[ ",.,', ,,,- ,I. ;:,,,,,'.., ,", I..., I."", "I :h' ,nite,1 Sttlles.
or tiny ,tate, ,0 I'nlllieal suhdi,'ision [lierenf, or 01 tiny lo,erg" ....,,,nl" , wl"c, a" ""ne',1 tll th" lime or detllh:
all wearing app,oel. ,.:"dr':. ,;l.Trware. pi '"n,,"', h""ks, work" "I' "rl, h..",..;,,,id r"",il"[" h',,",,, "arritlges,
autom"hile', b"alS, ,,,,,I ''''\ aod all o,her 1",""",,,1 "ha",,;, ,,\ .\1""<."",,,, l.i,-,..1 '" ,,,[In,,'. lefl hldnTdent.
IU"ethe, "ilh thl' C,itly ,',:i",ate,1 markel v"I,,,, lIT,,,,,I: ,<II I'o"r!. ad '" .,,. tie'" I,,'id !n ,k""knl and "I' al\
e\ao'" d"e and ""j,,~ d""cJ"ot to' Ihe ,im" ,,[ ,i,';;'''. """ "II p",,,,,.,,,,,, ""'0'" ,,:h,', j,,,,,,,,,,e,,1S in writing
for the ptlymenl or money ,,\ "hid, eleced""t d,ed p".,essed. "I ,',h.,",,""'" ""Ii"". '.,,,10 i"I"",",.1 Ihe,e"u. if
any, giving tite race valne and eslimatd fair ma,kel vallie Ih..""f. aod tl ",,'h ,..,I,maled falf ""i1ket va\"e he
less than the lace vtlllle. i' .."ts f"rlh :',ie:'ly Ihe """""s \0)[ s""h ,kpn,,:..:1I'''' ,,. I" etlel< II..m: till ",nneys
payahle t" the e,tate from life in..or,,"C" p"I",i..'\ carried by ,I, "",;,.nl. "Ii "n""'[' "'111 "nd",",,.,,ent eon1ltlCI'
the procc<'ds of "I"eh were payahle 1Ip"n Ih,' d",,'h ..I lit,' ,k"...!""1. ,,11 tI",1 :h,. ""'I"""'''' .I'''l;, and di,,'dend,
,rue the reo" tI"d IIm""d a, "I ,he 01,;1, ,,\ ,k:lh, :"or,," tI"d ",:.",,,1 ,,,I"~"~'! ['., ",,,,, I.. lI,.: ,laic "Ie"""delll"
death "",) ,,[her ''''',''lm'",,1 "."utit'''' """,,01 h~ Ih,' ,,,".,.,\, "I "I II", "",,' ..! ,,,",,:Ie, ",:It Ii,,' '"ok", ""ju, thne.
or ,.It sut:h linlt'.
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pos:-;Ihln slIln.tllllll/1fl'd by j'llIlIllI'lnl ~Iil\' ,'i""'~ ". ,
th~.rt.ol' Il!i 01' till' ellll!' 01' 11.'nL'(. nil' ....,'11.'11111.. !,l~"
dnnth 1n 1I11~' f'll_I'III.tCll'l'sldp or \\l1.,lll"SS, 111111 In 'i'\] 1,011 'I
suitt sl'lu'dllll'1 t'IIlHlIl'lltl sl:III'1",11-nl' .,lll,w\llI', tlll'iI",,'I' j',.
.\ ('opy or t.hl' l'11_P/,!'"WI'!.ddl' 1I1',rl'l'tlll'P"1 (' I' "1'.'11. ',I 'L'
lo~'>lll,'r ',dlh Il stUll'11U'lll. sidling 1'01'111 till' .'Ii:II":' 1\')' '"
p('rtltlnll1g to till' bll~ill\l'SS liS 11lhY hI' l"'rll!!"J'! III 'II'
thl~I'f'lll !I1l1stlll~~;llbmltll'(I. If sl\Huld lll!>ll s.'1 "1':1, i1, t,.:;I\:"
I n till' ,'II ~1I' ot' .....,... l' \ t I t'~. t'! "I l'," '\I
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TI,,' Scl,pdule C nU",'I...d ,.""..,,, ",,,I """,. I"'" :,.."",1 ". Inr'"" ,,"'" "liS'"'' I." ..",,11 In'III\t)'
cOIII"III'''\ th"re\n IIII,\\n 1.11.' c"s.. "1'",,,,,,1','" ,,1'1"'''1'''''' ," ,'.' ,I ",,,,,.,,,.,,,,, ,,\lldn tWII y""rs 01' dee"IIPot's
de"tll, \n eontompluU"n 01' ,\<,,,,,,\,,"\', ,IPnlll, "" '"1'""': ,,, 'I," ,11',"1'" ,,,.,s..,.SIOll 0" .,",I")'m,,"t Id "I'
"fterdcnlll. ,uld 5cll('IIt,)0 ,."Is 1'01"11 1.11.' 11,,1.11"" '"'' I'"" ,,' ','11'1< 1'1'''1''''1:. ,",11,,01 tr'Ul"I'"rrpd, I.llc
rclnUonslllp 01' tile tl"UlsfO"",," I..' t!,e ,101'...1"111. il... ,.,- '1"'" ,,,..d.' ,11"1", ","",'1" 0\ h)' ,,,',d, 1.I"""I'"re.' 'HId
u\1 otller 1'0cts of u pHlllle"t n,"""r" r"",,,'dllll'. .,,,,,' ",,,.'.1."'" '" "". ,',,,.. ,,!, tl'""sl',,,.s IlIt",,,j,,,1 to
take el'fect In posS"S,IOII 0" en.loy",,,"t 01. ",. ,d"'" 0\. Ii., "'" ',- .,1'." """..1,..,1 1<1 tlte Scl....\II]" Il ""11)'
of' the de"ct. 1.1',,,1 "~I'I'.,,,,ellt nr 11th"" 11I'..."II"ell' """""111', II'" II'''''. 1',...." Is ,lIso SP' 1'0l'tlt III 5,ll'\
schcllllle" lIsl 01' '1111'''"1'''1'1.)', ,.",,\ "n'\ 1".",,,,,,1. ,i'" i" '.""..., ,,,,,,,,. ~,,,'s..,,,t d..c,'d,.ot'S d"lli.l, Ity
virtue oJ' the eXl'l'dse Il)' ctecoII...,t. c,U"". \IIdl\'\,h",'I'. ",- .I",,,Uy wJlIt ,,,",'1<"". <11' "IIY powel' oJ' "pI'Olllt-
mellt vest."dl"lIecI.ctellt, "Ither 1"lIlvldll"lly "I' .1010'\:.. '" U'" .'11. .1...'.1. "I' ":It,,r ,",tl...."e"t of ,",olhe,',
with Il cop)' oJ' Lhe 'nst!'lllnr,", cce"t.lll~ ,,,,,It pOWI'I' ""a,,,...d '0 1.1", s,,"l'dllle.
Thill Scl'<,du/,' 0 llt.t"eh"ll ,,,,,'<'1.0 "'"\ """II' 1'''1'' ,,,.....,,1' 'j"", I'..rth "'" n"me' ,,,,,I "ddr","o, 1lJ' ..1\
persons helleflctlllly In!.el'"5ted III this ..sLllle ,,' 1.1... ",,,,, "I' ",.",..1,,"" s ,\",,1.1<. tlte n"t"I''' oJ' LIt..lr 1'''5-
pective Int."l'ests, thl'll' re\<1t.lnll,ltip. If ,o'y, '0 "w ,1.',"'.1.'..1.. 1.,."'.0'11,,,1' wl'lt the ,,~os "I. the lIm" nJ'
deeectent's ,\elltlt of' II]] minors, UII,,"ltll"'" "",\1",,...1'1"'''1'1'''' 1'01' 'II''' ","\,,1' '\"C,,,\,,"t'S \\'111. [I. ,lIso
cont."lns "stllt...mell!. showl"~ whlclt oJ' Lite ,,,,"el'l,,,,,..I"" oa",,'" III ,'''' ".""..\0'''1.'5 will, If Il")'. dIed 1'1'10"
to lIeccdent. t.lte d"tes oJ' LIt..l" d.."tll, 11",1" Is''''''. ,"": ,I,.' ,.,'"II"o'.ltlp ,.:' s"clt Isslle 10 tllO h,,"nl'll'lIlI'Y'
Tltat. Sol.edu/" E Ilunchod Itel'eto lIlol ",,01,' " 1'''''' ''''1'...,'' ".." ,'",.11, 1111 p,'npel't)', l'eul ,m'\ I'el'-
5 OT'" I , ow"ed h)' the d..cedon I. .I 0 In 1.1)' w Il.h ,,"n' her IH' ":1,,,,,, I lid .111 :n" i \d,,,n,,i1>1 ". 5 t.nlldlng III Ihe 1I000"e
of the decedelll 111111 IIU\I'rs. pIllS the tlllte hlll\ 1'\""" "I' r.,,,,,"d "I' IIISt.rt'''''II1'' ,,\,\'eetln:\ the '.est.ltllr" of
real estllte hnl\ the date of' IICqll\sitlllO o\' 1"'1'''011''"''' 1'1", Ul" """",, IIdM""" Hlld relntlonshlp. \f ,my,
of co-owners to thl.' d.~cedent.
ThHt Sci>edu/e f- nttllchetl heret.o O1\ld m"tlo " 1'"1'\ hI""'" I' s.,t., flll'th \'1I11y Hod In IIo>tulI ,,\1 dobts
IIIItI ,\edllctlollS elnimetl fnr ,,,,,] "" IlI'hllJl' or thIs """,'d"II", ..,.""". l"..JII,\llIg fll,,',rHl e"p"",,es 1,,,ld,
1'lIm1l)' exea\ptlnll, whol'e Hpp]lCHhl", e",ts o\' '"1mlll\';"""'"'' ",' I.'''s ,.stll"" "nm'"OI f'ee' nnd flltllelury's
commissions pllld or to ~o p,dtl' enS\ ''"J",,"\o.tI fol' III,l'lll) I.""s",, 1."'111,"1(.11'" "I' ~ruvemllrkeI'S, IInd rell-
~lolIS services, III cOII"'q,,ell"o of' tI,.. d,,"t.h .\1' I.!,,' I.',""""'" ,J..I." "11" ,,1 ,,',II" 0"111,, nntl IIlIpaln "t U",,, nf
tle<lth; t<lxes nCCI'IIOI\ "hnr~ellhle 1'01' I"'rl,,d 1'1'101' '" ,}"""",,":' ,[.'",., '.""""1" t.hose a\lowed IHlller Section
G,,! of the IIIhel'It01\1Ce alltl ""tute T'" Ad)' 110;\"""'1' ,.)11< " ","""""", ,,\' "011"'''''") pled~ed \'01' ollllga-
tinns, If' "")" It \s a~reed t.h'" U", f'\,I"",,,r1 ,Ill pr""'''' 1'1'''111' "r s"lll dlll",,"\ ohl\C;aUon, lIpnn re-
'Illest, that If the ''''''''''\ lI"tllnlly 1"11'\ \11 ,,'11101.","11' 0' "": I"'''. ""mmlsSlnn or dellt Is leSS th<lll the
estlm<lWd a",,"mt c1ol!l\III~ ,,"11 HJlowed, tI,,,t. tIp, .",m" will '''' ""I'.,r' ".1 '" 'h.' "",glst.el' nf \\,1115, ,mtl U,ut.
thc Il",ollnt nf tH' "sse,,'''') C'U\ loe re'IS""'"'''' '" ".'"",..\..",.. ,il<'"..wl,L.
Th<lt tho totHls of' 11l" npprnprlHte cnlllmllS In ,;,'h.."ol,'S '\', "lI'. "". '1-:'. Hlld 'F' 'IS ,Ilreet.etl tllel'oln,
hll\'C! hcen cflrr1c{\ forwllt'll ftnli llrnperl~' rl'l-',1s1"rpt! In UP' ~'11!11;1)f1:"\..
Subscribed and sworn to before me this
I' ;'
d f _i; (
BY 0 {..",.,:'.,.
. (
;i~:,/(-
...,./~.~'
19((
/' ,)
"
// !
, ' (. ,--I .
(L:Z-, !()~Lc~r~:"-' ,:" .,.../i~,"rl~-
(}-~::e;:au\I...A{lmmtStJ"at-<)T) /
I
_..,.."t'
,,,),,,, ,
,,/'/
,..,/:..::/,:' ("\,,
......-.."....-'..
,:"
(SITee! Numb.,.)
Not,Jry Pllblic, r:,-'url~i:l Cr:',:':~y. Pen;,5j'h'.111ia
My CfJ:ill~.d':~,:~)ll [xr-ircs J~_:.UMY lO. 1983
BI'l'oP~ sl!.;lIin~ urf\rlllvit lUll!.;" ';101'
In with tlptllils or t.hl' lI'ur'l "~O'l',".
(,--
.,; : 1\', i, 'lr',r! schl'dllll':-' lilll1t'Xpd ar'~
",'
or Town and State)
,,;1 \'!
'n
~IlTE:
f'tIIl'll
.'11'\ iI,
,'i,L;,'
'I"
I';
iTJl'111,J., 1'i1r'\' 'IIvl \In\ i~l,~d s('('llrlti.>s,
t1111t the
.\lSt) m:l\.:e
S'~'~lIl"llh'S of closf' nr flll11tl)' cOl'l'p,'/lIl"Jo" <ll'\ll \;II,'r.~1
dlltll /11111 sUtl.l'[T1puts rl'ltlll rPll HlIII..r '1..> \ '1'.'')' f'llpli it!,II'''' 1"'\:'
CI'rUt!1I thllt ('ulumn #1 III tILl' "~\11IUIl;:I'yn I." h''''1I JlI'''',,,"I'1
III ,Ill.' "'lu\',II'lll"I'slli\l \)r l1uslll'>SS,
\111' III ':':\'h,',llll." nil" 1l1'P IIl.tru'hl..,I.
i:,l" \ ,'d I"~; ,,\1(1\,.--<1\ rjl(.ted.
R'EV,,4!l1 (8"711)
.
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "Boo
PER SOHAL PROPERTY
----
INSTRUCTIONS: This Sehedllle mllsl disclose i1l1lullgihle alld illlallgihle perslllllll properly oWlled illdividllally hy the
deeedellt, III the lillle of his dealh. 1',"perlY oWlled hl' Ihe ,!ceedelll joilllly wilh IlI\olher or 1I1hers IIIl1sl IH' listed
1I111le, Sehedllle "E". IlIlaogihle p.rsollal properlY, litled illlhe oame lIf Ihe deeedelll, hilI payahle ill ,Ieilth III alllllher
or IIlhers, illclllding hlllllllllimiled III I'.o.n. \I.S. Savillgs BlIllds alld telllillive Ifllsl ilCC'HlIlls, IIIl1st he (;sIC<!, de"pile
the fuet that they ure nnt of the adlllilliSlered estate.
Tallgible persollall~operlY shollld he listed finl (e.g. jewel,y, wearillg appilrel, hOllsehllld go"ds, alld
furnishings, hOllks, puintings, llulol1\ohiles, tmills, etc.)
IlIlllllgihle 11erslllllll prllperly, slleh liS hOllds, Irellsury certificates, eilsh 1I11 halld alld ill hilllk, sllleks,
IIIl1rtgllges, 1I0tes, logelher "ilh lIeerued illtere",lIr dividellds, slllaries or wilges, illsllrance payahle to the estale 01'
fidllei,,,y in sllid eapllcity, plI'tllership illteresls, illteresl ill IIny IIl1dist,ilHlled esla'e lIf "r income frolll llny property
held ill Iruslllllder Ihe will or i1greelllelltof IInnlher, even 'hollgh located nlllside of Ihe Slille, al Ihe lime of <\(',i1lh,
should be listed in this schedule.
,-~-
Item I'IEM UNIT ESTIMATED IIEI',IRTMENT
Nu. List and describe fully VALUE MARKET VALUATION
VALUE (Do not write in
this space)
1- Automobile - 1979 Fairmont
Title No. A31773771 2,500.00
Insert this tutal opposile HPersunal property", ScheJule "B" in XX 2,500.00 .2,.'iC 0,0 C
the l'As Reported" column Oil the la~t p.lgc of this return. -Y'(<
,H~V"4~J (8"761
COl\t\HJNWEALTII (IF PENNSYLVANI/\
TRANSFER INIIEIlITANC'E TAX
RESIIlENT DECEIlENT
I.
;~ ~~~ ~)
.)!fqP'~", ~.,
;","\iT!~il:,'\ ~
'itl,.\~j'rf,~qf,:' ".'
:'~.'L v~f"~l~}../'
SClII'IlULF "Il"
BI':~~I;!'ICi:\((II':;
,- - -_._--,----
- - - SUI~\'IV~ATF -- -- ~---- -
BENEFICIARIES ANIl AIlIlRf,sSES RELATIONSIIII'
(State fullnul1Ics lInd nddrcsscs of 1111 who (If slep..dlildrcn or INTEREST OF
have an intcrcst, vcsted, contingent or othcr.. illcgilimllte childrcn DECEDENT OF BENI~FICI'\RY
wisc, in cstate) arl~ involved, sl~1 STATE YES IlWTII IN ESTATE
forth this fnet.) OR NO
Kathleen E. T.mTli ~, y.ec 0/11/22 sole heir
-
I
'I
- I -t
u I
-
Deponent further says that 011 the above"named bcneficiorics orc living at this time cxcept below:
HAME ~~T~ O~- DEATH -,---- RESIDENCE
None
"
OVl.....
~-f. ....
~... :u:
~. =
'C ~ E
.... I:) ::3
E- -
_ '" 0
~ E U
10"
'"'u:;,
s.... IU
o ~ -
u::l 5
" E '"
" "
:::! "
SlIMMARY
Real Properly
Personal Property -----
Transfers
(Sell. (lA")
(Sl:h. "W')
(Seh, He' ')
Gross Taxable ESll.ltc,_
;. '0
" Z "
~ IJ.I ~
" :;; ~
'" "
IJ.I (::I U
<I'J " ...J
- ~ 0 <(
-<: 1iJ '"
e<: u.. ,~ :;;:
c.. 0 ~ = '"
c.. "" 0 "-
OJ -<: OJu.; g , "-
-" IJ.I -";. ;:;. <(
ci ;. ;.-<: ~ ...... "
;:::: = 0
z .!: '-I-- ~ =
;. Otn ~ Q) " :z:
u.. IJ.I ~ "- <(
II: 0 ~ c ...
.~ '"
e<: u -= 0
- IJ.I "-
"
~ i- 0 UJ
- ~ U '"
'" .... "
:S :.: 0 =
~
:;;; 0 ::'
- a " 0 0
:::"0 ;:; 0 a
::.=< 0 0
...l U U
(j)
(A1' Reported)
$ 15...21)JL.J) 0
$ 2.500.00
$ 00.00
,
$
$3/,/00.UU
(2)
(As Determined)
$
$
$
$
$
$
RCV.484 CX~ (J.tlO)
INHERITANCE TAX SUMMARY SHEET
(I3UREA~_IJ~~ ONL~)
File Number
n ?1-80~OO:>5
Estale Nome
Nary E. Burned
Dole of Death
Deccmbc,' 25.1979_
Social Securi ty Number
REPORT OF INHERITANCE TAX APPRAISER
Ii' th., undersigned duly appointed Inheritance Tax Approiser in ond for the County of ._ Cumberland
Pennsylvania, do rospectfully report thot I hove approised the real and personal property as reported in the foregoing
return at tho values set forth opposite each item in the 105t column to tho right in Schedules llA", "B", liCit, Clnd liE"
Dated: --Al.lgus.L2.8. 1980
,)/,(I"~/J / 'ffIr"ltHJ )
INHERITANCE TAX APPRAISER
__ ______.n"'
INVENTORY,_ VA_~~~_ AS APPRAISEO lCODE
Real Property (Schedule A) 7. 200 00 00+
Personol Property (Schedule B) 2 coo 00 10+
Joint-Held Prope~ty (Schedule E)
ADJUSTMENTS
(HARRISBURG USE ONLY)
REMAINDER APPRAISEMENT CODE
92+
TOTAL GRDSS ASSETS
:;; 2lH
N 30+
38.295 25_
40- 93-
Transf,us (Schedule C)
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Voluotlon of life estates or
annuities. . . . I . _ . I . . . . .
RATE
FACTOR
PRINCIPLE
VALUE
CODE
FOR USE OF REGiSTER ONLY
COOE
COMPUTATION OF TAX
5
5
5
5
Taxon$-
6%
T ax on $
15%
Tax on $
Tax on $
Exemptions
Total Estate ,____
TOTAL TAX
1
T ax on $
INTEREST FROM
BALANCE
TO
5
5
5
Less Crodits
DATE OF PAYMENT
AMOUNT r'AID
---
DISCOUNT
INTEREST
TAX CRE~
S ·
>
S
=
$
;
BALANCE 5
INTEREST FROM ______ TO -------- >
BALAN.CE DUE S
>'t
~ ~ p:: .-j
~ < ~
z ~ ~ ~
0 >-
~ '0
<I'J M "
;:> M ~
. 'n rl
...:I ril :I1 H
< .
- >< ~ '"
U Z ~ a E 0 C\J ....
- 0 <:l ~ M '"'
I:.. 0<. t> t.l C\J
I:.. -
0 ~ g
~ t:.
I:..
;. 0 <I'J 0 0
<I'J <I'J >- ;. 0
- ~
z 8 ~ f- ~ Z Z
...l 0 - d p:: z ~ ~
~ Cl ~
...l Z Z ;:> U L? Z
- ~ <I'J ~ 8 0 -<
~ ~ Cl ~ :l
OF
Cumberland
COUNT"
';'J / -:i{)..] C
STATEMENT OF DEBTS
AND DEDUCTIONS
i'lid': /!/J i,' ( ? /i"'< '
DEDUCTIONS ALLOWED IN
.,.'
OFrlCE OF nC"
REGmTr.n or- WILLS
D^l[~rpnOVED
/", !'-
" 'f
$/~ '1'3.3, /po
,,,,,t; /!:~J9.
Form ncC'.lO
""
TH[ 5UM or
AND M.ENT Of" nut COMMONW"A.LTU
DATC OF FILING APPRAISEMEtlT
LATF. or
6 to OAT' OF OE.Iro.nl
Camp Hill
ESTATE OF
December 25, 1979
ntMARKlI
"Mourn
38 16
90 00
150 00
93 00
33 00
60 6
OATI':
NO, 0'
VOlJC~""
N^Mr;: OF PAYEE
Caretti, Inc. (Blue Cross-
Group Ins.)
Debt owed to
Paul Harned (Debt owed to
Pa. Power and Light Compan
Register of Wills
Bell Tele hone Com an
Even in Sentinel (advertis'ng)
Pealer's Flowers (charge a count balance)
21
27
24 00
Aetna Car Insurance
93 28
J k
Jill Children's Sto e
Hess' De artment Store
Schleisner' s
Smnmons Communications
Truman Horner (Refuse ick up) 11 85
Riverton Water 27 62
,
Hol S idt Hos ital
Thomas Aldous, M.D.
Neurological Surgery
De
Cam Hill Ambulance 5
Holy Spirit Radiology 16
Finance America 305
COMMONWEALTH OF PENNSYLVANIA }sa:
COUNTY OF Dauphin
I, Kathleen E. Loyd
MY KNOWL!OGE AND BEL.IEF, TH!!: FOREGOING 18 A JUST AND TRU E SfATEMENT or DEOTS
'1 1:' '
ADMINISTRATION sUBMITTED TO THE ESTATE OF 1 ary L.. Harned
INHERITANCE TAX PURPOSE8,
HtREBY CERTI"Y, THAT. TO THE DEIT OF
FUNERAL [.)CPENGED AND EXPF.NIIE.!1 01"'
';, ,,(
SWORN AND IlUBSCRIBED I!i:FORE M[ THIS .";
/~I.'" f ,10 .u..:...
/// ""- ." .
'-~ . ( ~,\', )fo-
OtCEAeE~, "9 DEDUCTlON~ ,.OR
), ' ,I (
~~~/~iL,-_,1-:: '..J.!<-c.w
CAY Of' ' I'"
(L,5,)
Notaty Publi- D" ~'!'I C
'-, <.1I1,.. n ollnf, P"nn" I I
:~y C"'-',-,:,:,-:" . ".' " <,;, ~y ",:.In a
.....11,._..",,1. .../1 I~"" I I'll l'
. ,~...-, rj 0,1983
fllrm RCi'lO
, ,.,.
DEDUCTIONS ALLOWED IN
..
OFTICE OF TMli
nF.OlflTfn or WILLI;
Cumberland
STATEMENT OF DEBTS
AND DEDUCTIONS
Tll!: SUM OF
, .
nAT[. API'1l0VEO
or
COUHTV
AND AGCNT 01" TH" COMMONW'ALTlt
Hru"hr 0' Willi. AUI'~1
ESTATE OF
Mary E. Harned
LAlli or
t"lATC OF FILINO AI'f'lR"'SF.Mli:NT
DAn; 0'" DeATH
o"n:
NO. 01"
YOUCH"lIl
NAMIi: OF PAVEE
nEM"RKS
"MOUNl
CONTINUED
Harrisbur
Beachley's
Postage
X-Ray
Car Radio
2 154
55
14B
12
95
96
75
25
316
18
123
29
10
1,635
n ral
2 Days Motel Room for Out- f-Town Flli1eral
Meals for two days
Travel Expenses
n Schiro M.D.
Cumberland County Law Book
Monroe Calculator Co.
De t. of Transportation (A tomobile Title Transfer)
Recorder of Deeds - Cumber and County
Executrix Fee - Kathleen E Loyd
C amberlain Hed er P.C.
Dau hin De osit Bank & Tru t Co. - mort a e on house
Register of Wills - Filin of Inventory and Debts
an e s
8 641
6
Total:
17,433 60
COMMONWEALTH OF PENNSYLVANIA
}..,
COUNTY OF
I.
MV KNOWL~OGE AND BELIEF, TH~ FOREGOING IS A JUST AND TRU!!:
AOMINI6TRATION SUBMlnEO TO THE ESTATE OF
INHEfllTANCE TAX PURPOSE',
HEREBV CERTIFY, THA,-, TO THE BE8r OF
STATEMENT orr DEBTS, FUNERAL UPENEiEG ANP EXPENfttS 01"
DtClAeifJ, ". DEDUCTIONS I"OR
IL. Eo )
SWORN AND 8UBseRIBED BEFORE Jot!: THIS
DAY 0"
'0-
RECAPITULATION
Apl,misod valuo or Potao""l Proporty .......,........,.................................................... ,..2,,50,0...00
Appmisod valuo or real o.~'IO ................,.........................................,.................... ,.3.5..,20.0...0.0
Tot'l\ sppmiscrl valuo ....."..,.........,..,..,........."......,',......,',....,..............,............... ,3,7.,.7.00,..00
AFFIDAVIT OF PERSONAL REPRESENTATIVE
County 01 Dauphin s.:
.....,.. .......... .Kat:.\11 ~~J:\. .E., ,. ,Loy. d.""",..,.."..".."". "",.""."...,....... .............................,..,....
Execut L'LA
t\dministrat
,krcascd. beinl( duly......l?w.9..r.n.........................,,,........,," "...... .rcordinl( to law. depose and .ay that the
item~ appearing in the Inventory inc!\1dr all of the personal assets wherever situate and all of the
real estate in the Commonw('alth of Pennsylvania of said decedent; that the valuation plated opposite
(.:trh item of said In\'.entory n'lHt'~l"tlts its fair value as of the- date of the decedent's death; and that
dl'cedcllt owned no real estate 1l111Sidc the Commonw'~alth of I't'nnsyl\'ania except that which appean
in n. Tllt'ltlllrandum at the co<l,d the Inn"ntory.
of lhe ; <(;11< or ................,....k!!;l);Y....I;;.'"...1:!!;l);.I},~9........."..................................,..
....................................... anll sllbsrrih<d \
If }' ?I'<'( d 1
le ore nle t \I~.......l."............."......... av 0
....AI;i........................... ^;l' 19t../...,
..."...'/~b..L.~,~W."'=.....".,...
E"::i) ,
~/ '"",.
"....(..(.i..'i.ji...t..~&d,~.... L.....~. ..,;!bq/\....
./" Exocutor . Admlnhtrator /
"..,..."..........,..,....'..'..'..Add~..............,..............".......
Notary Public. Dauphin County. Pennsylvania
My CommissIon Expires January 10, 19R3
INSTRUCTIONS
1. An InTontory mUlIl be nlod within throe roootba u.f1.6r I.lplXllnlllwnt of penonal ropronntAtln.
2. A flupplemontal Inventory must be riled wltbln thirty dIlylS ot dl!l('o,ery of addlUonalllllell.
:t AddiUonal IlhcetB may bo attached ft.' to perBonalty or r{lalty.
t. See ArUC'le IV. F1duclnrlen Act of 19409.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
~I- X () j ..-
COUNTY FILE NO: ..J i_)
i j
I -, ....01
y
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t. (l_~~~"( ''v '.~, _,' . t~~J^_ r~/-
G ~:; T':1 - iJ, ' ft ,/ \\ (~)
al.3/'11 -'7'Ji,,-t. \JiJO;''''::xJ"JJ\",I(z. jl?!1
Appraised Value of Estate:
Real Estate
_0) /1
$
+
Personal Property
Jointly Held Property/Transfers
+
s
Total Gross Estate
Total Approved Oeductions
$
Clear Value of Estate
less: Approved Charitable Exemptions
Clear Value of Estate Subje':;t to Tax
$
Amount TaKable @ 6% Rate
$
Amount TaKeble @ 15% Rate
*'
DATE li)OL 1/ r i, ,Y'I)
ESTATEjY~E ',~!:..: o,^,d-
FILE NO. ~~.J ?~) -3-.5
COUNTY C} 1-"('( 0 n1Y ~. :~\
DATE OF DEATH I -,(.;
tax due
$
tax due
1.. J TOl~L PENNSYLV~NIA INHERITANCE TAX DUE
,~.u~;; t-<)'f'I \? - ~ - YO). / ~,' '!6'0)
(, 0,'1:, 1::5,:;')
.. '* .. * '* .. A H e percent CJ1scount totarlng $
will be granted if the Inheritance Tax is paid by
$3/ ;:;,9 '~9
, r
3.5. 5 ~
3/ (,LI/-N
less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
L.i?d (- - y()
$ :s /,;),q :?J'i + $
s
+
+
Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Ta). from
to date of payment. Interest due if paid by
TAX CREDIT
= $:.2UCi d.5
d (( ,..
=
=
is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
$
-, /.-
....,"""' J:.,~
~.
rJJ
Assessed by: . / " , , .' d/' )
See Information on Reverse Side Ag.ntlorth,.ComrncrWlII~ .- I
\ /, /.;:; -'
! 9/ (.._.- ..
,
'../
lNFORMATION_
To insurc propor cr~dit to your account, tI,U name 01 the estatO and Ille number 5tl(Juld l.J(j clunrly print.
cd on the check or money ordl!l.
This assessment is made in accordanco with Snclion 708 01 the Inh~riHlnf.p. illld Estnle Tnl< Act of
1961 (72 P,S, \ 2485,7081,
To the extent that inheritance tax is paid withm three /3) monthS after the death of the decedent. a
discount of five {51 percent is allowed (72 P,S, ~ 2485- 716)
Inheritance Tax. other than i::JX on iJ futuro interust, is due ill tho date of the decedent's denth and becomes
delinquent at the expiration of nino (9) months oher the decec1ent's d&ath (72 P.S. ~ 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, 5 2485- 712), Calculate interest from the delinquent date shown
on the face 01 this form to the date of actual payment using the loliowlng interest table'
--------------------- -----,----- ------- ------ --- - - ---- ..------------ -- - - --- --
1 month ,005 4 months ,D20 7 months ,035 10 months ,05D
2 months ,010 5 months ,025 B months ,040 11 months ,055
3 months ,015 6 months ,D30 9 months ,045 12 months ,060
, days ,00017 11 days ,00186 21 days ,00352
2 days ,00034 12 days ,QD203 22 days ,00369
3 days ,00051 13 days ,00220 23 doys ,00386
4 days ,00068 14 dayS ,OD237 24 days ,D04D3
5 days ,00085 15 days ,00250 25 days ,0042D
6 days ,OOlD1 16 days ,OD267 26 days ,00437
7 days ,00118 17 days ,00284 27 days ,DD454
8 days ,00135 18 days ,D0301 28 days ,00471
9 days ,00152 19 da'ls ,00318 29 days ,OD488
1 D days ,00169 20 day~ ,00335 3D days ,OD5DD
-- --------- --- - - ----.. - -..- - - - -- -- - -- -_. - - ---- - - - --- --- - - - - - --------- - -----
Any party in Interest, including tile Commonwealth <Iud the lJersoniJl represent3tive. not satisfied with
tho assessment may object thereto Within sixty lfiOl dilYS after receiPt of Ihis Notice ilS provided by Section
1001 of tho Inheritance and Esta1e Tax Act of 1961 (72 !',S ~ 2485,W011
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
'*
'J"
,,/.,
DATE , , (;
rw (.,
ESTATE "1 \".
,
.") il,t FILE NO. ',,/ /~.- )
L,
/ r,
COUNTY \,.~,~,)/y.... Xl 0"
J (I ,/"',j
COUNTY FILE NO:
TO: L..J J ~ (J,r.,N
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DATE OF DEATH )llI,,', .;~ f-.,
! ,)
1'1;
Appraised Value of Estate:
Real Estate
G
+
Personal Property
+
Jointly Held Property/Transfers
G
Total Gross Estate
Total Approved Deductions
G
Clear Value of Estate
less: Approved Charitable Exemptions
G
Clear Value of Estate Subject to Tax
Amount Taxable @ 6% Rate
G
tax due
G
tax due
Amount Taxable @ '5% Rate
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
G
;;;-5 ~ ~
_ I:;) ~
1ft .. 'II .. 1ft .. A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
$ ..~..0 f,; c}.
I;;:;. -- (; KO
$ ~5,~c.2 +
$
s
=
+
=
+
=
--
Interest Bl.:crues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by____
is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
$
_,;:- rj...
._~):J (";7\
Sl'e InlormAtlon on Reverse SIde
Assessed by: /
Agent lor the Comma
."
,
11th
( ( [ ,J
INFORMATION
To insure proper crodit to your account, the narno of tho ostolO ami fild number should Iw Clt:3rly print-
ed on the check or money ordor.
This assessment is made in accordanco with Section 708 of tho Inheritanr.o and E~la!O Tnx Act of
1961 (72 P,S, 9 2485- 7D81,
To lhe eKtenl that inheritance lax is paid within thtoe 13) months after the dealh 01 the decedent, a
discount of five (51 percent is allowed 172 P,S, 9 2485- 7161,
Inheritance Tax. other than tax on a future interost, is due at the date of the decedent's death and becomes
delinquent at the expiration of nine (9) months after the decedont's death (72 P.S. S 2485.711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer lokes effect in possession rmd
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 the date of actual payment using tile following interest table:
------------ --------- ---------- --- ---- --------- - - --- - ..-- -- ------ -- - - - - - -- --
1 month ,005 4 months ,020 7 months ,035 10 months ,05D
2 months ,D1D 5 months ,025 8 months ,D40 11 months ,055
3 months ,D15 6 months ,030 9 months ,045 12 months ,06D
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 uays ,00237 24 days ,OD4D3
5 days ,00085 1 r days ,00250 25 days ,00420
6 days ,00101 16 days ,00267 26 days ,00437
7 days ,00118 17 uays ,OD284 27 days ,D0454
8 days ,00135 18 days ,OD301 28 days ,00471
9 days ,00152 19 days ,00318 29 days ,00488
lD days ,00169 2D days ,00335 30 days ,D05oo
- - --- ------ ---------- --- -- ------- -- - - - - -- -- - --- --- - - - - - --.------ --- ---
,)
Any party in interest, including the Commonwealth and the personal representative. not satisfied with
the assessment may object thereto within sixty (60) days titter receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961172 P,S, 9 2485-10011,
Make check or money order payable to:
"Register of Wills. Agent"
Mail to the address listed below: