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21.80
PETITION FOR LETTERS OF ADMINISTRATION
IN TilE ESTATE OF ..RQ.I)(;WLJ'A...H.ln~f.:t\IUL.... IlE('EASIW.
To ",Ha.r.Q.l.c1...U .... ,t-lrr.f..aJ:\c".. ,D.eputy...
Hcg-iKlcr of \\'ills 1'01' the ('ollllt,\' oj' ('uIl11ll'l'lallll. ill Itw ('OIl11ll01l\\'l'ulth /II' j1(,IlIl:"ylv:Lllia.
The Petition "I' ...r;.lJ.l!fl...r.....JJ.Ul~:t;ul'd.......................... . ..................... .......................................
................................ ......................... ,.esl)(,,'1 rlll1~' sh,,""[ h I hal ...1~().IJqy~...I.'.,...n.\l.r.gf\r.9................................
r 1 f TIIII'II.,hip I I
was a reHident "I' ....UP.p(~~'... :1'.01" .o.r.ll................:4~ . {'lIl11l",,'land {'''nnl~'. State or 'ennsy-
vania, and a Citi,.en or United SlateH. and deparled Ihh lift' illll'slal(' illlhe {'tIllllly "I' .~J!l11.1.<R.\~),.;;1.I]I:J...
........."........................,.... and State of ..l~el1tlsy.l.v.a.n.-i[,\...,.... ............,,,..............,...,... ..............................
on ...~l!!.U!;!.y...................... the ............~.~tI.l................. da~' of .... ....Or..t.ob.'"r:......................... A. Il.. I!I....?Q...
al the age of .."~~,,..,," seal's,
That the Haid ......R.9.11.'!,r.);...f!.,...I).\1f.g<;1r.(1...........
d(~l'tlast!d. left :-illl'\'ivillg' the follo\ving"
named widow OJ. hu:-\uand, heil's alld !lext to kill. 111 wit:
Name
1("lal illllship
lle:;idenct.!
.!'.~~...r,...)).\-!!:'.gi!.r..~.............
...\~.ifq... ....... ...........
...('l()~.......................
...('l().~..................................
...Daught.er.. .............. .......
)J, A ...\1.... .~.,.. .N.I'w.V.:\ll.\;.,...PI.I..l7.?.\ll
)J,... ..n.. ...~.,.. .N.I'w.v.ill.\;.,...PA ..17.2.lJ1
li 03 Springhouse Road
C.,m\ll.. H i .1.1..,... p.A......17. 0.11...............
)J,..... .0... ..J.,. ..N.I'wy.ill\;.,... PA. ....l72!ll
.R.9.R!!.F.!;,..);......)).W;.g~r..9..,. ..Y..r...... .........
q~!:\~...b...~.\1F.g~ 1:.9... ........ ....... ............
.(;J:\~X'.y,l..E.....l\);\thQn.y.... ........ ...........
.........................................".,..........,......,.
. . . . . , . . . . . . . , , , . , . . . , . . . . . , , . . , . , . , . , , . . , , ,
."..,...,........,..".........................................
........................................"..........,....,,..,..
......................",..............,....
,...,..,....................,................................,..
.....................................................,.,....,,,.
.........."".....,.....,...,....,...,.....
.,....,....."...,..,............,..............................
........................,..............,......,.......,.......,.
......,........".................,.........
,...,......."..,.............,',...............................
....................................,....,........,...,....,,..,
. . , . . . , . . . . . . . . . . . . . . , , . , . . . , . . . . . . , . , , . . , , .
.,.""...."."...."..,....,.",...,..".."..,.,....,........
That those above namet! inclllde all of 11ll' next of kin. so fal' as kno\\'n.
The ~mid decedent \\'a~ pO~Sp~s(~(l of personal property to the estimated \'alue or $..1.Ul~st.iroate,d""..
and of Real I';state. less illl'lImh,'ance. to the "stimatet! ,."IlIe of $......none.................. as neal' as can he
ascertained.
That the said Real Estate in so fal' as is known is Ioeated in .....N/A....................................................
...........,...,.,....."...,.................."..,...,'"....",."......,..".",.,.,..".,."....,...,.,...,.."..".",.,.,.,.".....".".,..,.,.,',..,..".,........",..........
Therefore. your petitionerW;l )'cspectfully allpl~'(h~s) fOJ' Leitel's of Administration in the above
named estate.
Dated .............J<;1)).\!;).ry.....2.?,.
A. Il.. 1\1...80..
.1/ \'-. --:;) ,
...... .....-:'((:1:1:,.1.-:.1."'... f:. ,':,~,~~,'-:':'.. a.k~":l.';!~"""
...~ ;tJn<;1. .1',.. . !lqrg<;1r.9. ......... ....... .... ...... ......................
Signature ant! Addn'"
of Pt.titiollt'I'(:':)
R. D. 3, Box 157-B
........,......",......,..........,....".........,.,,.,..........".............
.. N. ~\~:' ~. ~ i.e.,.. .I~c:!~n..~.y. .1.v. ~1~.i~...... ~ ~? ~~.l...............
COMMONWEALTH OF I'E;\;\:-;\'L\' A;\IA \
\. ss'
COUNTY OF CmlBEHLANIl i" .
.................................... E lma. .1:.. . Bur.l-!;a l~d.
in the aho\'e application \)(~ill~ duly........... ..$.W9TP..."... . .
...,..............................,
... named
... :H'('OI'ding" to law. say tIlat the facts S(~t
forth in the aho\'e application art' tnw to tl11' Ill'S! of ..hq~'1.
....""..,......~.~~~.'F.!)........ and sUhSCI'i\H.'d 'I
I
,
I
I).. 1\1..80... I
.,-' knowlt'dl!e and, l,clit,'f. '
C' I' J /'
.. ~.....,.. ,G"~;'" r }.'.l>::, .(t........ r:.... \'-;rJ.,; ,f. .i.','~l./L...C .~J_..~
............. ..V..
before me,
........(~.......Ja\llJJlI:y..H~~HH.HH A.
..ct. {,Ll.Ll]..;~yn.:.>ic.'><.,,:..
H !)El!?\1t y
lkgbtt'l'
, 07
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Filet!: ...~all\Jar~( 25~H 19BO
At\"""'~: Rl1elba15.,!r,}leCalelJ.."'. P.i.c.1<qr
(un'l')
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RCC.JJ (4.1,))
c:2 / -S()-. 5;L
CO\'~\(JNWE.\LTII OF PENNSYI.VANIA
IlEP.\RnIENT OF HEVENUE
11\~I(Hl! OF ('OUNn' COU.FCTIflNS
*
' .
..~ -I",' .
COUNTY OF
C\JNIlEIU1\NIl
RESIDENT DECEDENT
IMPORT ANT,
-lhlS Il"lllrlll11l1s1 he \'ompkll.'\\ in dl'ta;l amI flklllll dllplit.:llll'. wilh all <Illlll:ht'\I. Wlllllhe ItCL~lslCt of Wilh of the
('''lIl1ty "",',e deeedr'rlt "',,.!cd. H,'\lrlll ".I",' ,,;''''rI 1I11\l' "'''lit I" alt" da\l' "I .1"'11". rllIl.." rIrI eX\l",,"rI' i, ~\llllled
hy Ihl' Sn'tl'WIY 0\ 1{I'\lL'lIW', !Sl'l'liI11l711.\ (If lhl'lnlll'lililfl\\' j\lld Lstalc Tll~ Al:1 uf 19f1l.1
IN Till' \I,\TIYH Ill' Till' I'STXIT Ill'
ROBERT [,. BlJRG^RD
ISTl\Tl:. FUI.L NM,\E OF DFCFl)Ej.j'il
} ,\I'I'IIIWIlIlI'
lili: ~"\H"n
AI)\lIi'lISTRXl'llR
Lata 01 ___..J:_\Jl'1BEllIf-\ND d
PENNSyr.v^N IA
State of __------------------.
COllnty
~~} '"
ELM^ r. BIJRGMD
Adllli I\i S I ril lor -- --;~~~I~-.~I-_;h-~.-ob~.~~:-~~ ;~~d 'd.cc ed~~; "b~;;~'d~l~-- ~:'~r'~,-doPOsCS---- '.~~d soy S
County 01 __.crJMBJ.RI~l'll2----
".~'t'f!t/M'
Decedent died October
lMONTHI
Home and address of attorney or }
other authorlted represontotive to whol\1
all correspondence should be maild,
28,
. l(J~J~Mttl...j,""'l"'\)"+"18........t.l.l.,...epr~i-c",-h..nel'ete-aHlKhd'}
'yEA.ki '--,"tosIOIC
IUhyl
SNE['BAKER, ~leCALEB " ~~ICKER
Ltli. West ~lail1 Street_, ~1eehaniesburp;, Pennsylvania
17055
Thai a' ,u<h Administratrix depuncnt i, i'amiliar wilh Ih< alTair' uf said e"ale rind Ihe pruperty ennslillllin~
I EX E CU TO R-/,OMIN 15 l' f~ A TO pl
the asscts thercof and their fair market valuc.
That atthc timc uf dcath Ihe,e was nu ,afe rlepu,it hu.\ rcgi'lcred in deeedenl" individual name. or juintly with. ur
as agenl rlr dePllty nf another. or ill rle<edenl's iodividualname. with ri~hl of ae,'ess hy another as a~enl or depuly. with Ihe
exce\Hioll nf the following.: -
NAME AND '~OORES~ OF -SAN:-OR OTHE~-'~~~~~U=~~.N-:-=-:O:'~--."--T~~<; Sf.!"!: DFP~SI;' BO~ RENTED
II. WHICH DECEDENT RENTED ,\ S~Fr:: DEPOSIT E'\0X IN N",,.,I::: OR NAMES OF
_ _ u.' _ _,_ ,_=,-",-=.==-=--=,",---~., ----=~==-"- ---- -. -,.- -- . -
----T
__--- I
=t=
RELATlor.SHIP OF JOINT
HOLDERS TO DECEDENT
That the contents of said safe deposit hox or hoxes are itemized under Schedules
with the exceptiollof the following, for the reasons hcreinafter set forth:
of this return,
ThaI Schedule A aJlached herelo aod m,ute pan hereof ,"ts forlh fully and in delai I all the real properlY
in the Commonwealth of Pennsylvania of whidl decedent died having an interest therein. 11 also sets forth the
morlga~e encllmbrallc", up"n cadI parcd of ,eal property at the date of dealh. givin~ Ihe amounl still due at
dcalh, name of mortgagce, date. rale of intCH"t. and book and page of re<ord thereof. 11 also sels forth in the
columns 11rovided therefore the a>>essed valnation of each of ,aid parcels. the eslimaled markol value thereof
as of date of dcath of decedent.
That Schedule B attached heretn and made pari hCl'eof scls fo!'th fully and in detail all personal property
wheresover sitLlated owned hy Ihe decerlent at Ih< lime of death; all moneys lefl hy the de<edenl atlhe lime of
dealh. whelher in decedent', imlllerliale po>>e>>ion. Slandin~ to decedent's ",edil in hanks of deposit, savin~s
hanks, trusl companies, or Ilther institutions, whcther inJi,'idually. or ill trust for any other person or persons
giving aho ,"paralely Ihe a<",,,erl in:erc,t thereon. if any, rlown to the la,t interesl day prior 10 decedent's
dealh in the ca," of ,aving' hallk>. anrl to the date of decedent's rlealh in a\l other ",!>es: all honds. postal
savin~'. treasury cenifieat", or notes aod olher eviden<e of indebledne>> of Ihe Uniled Slales 10 Ihe de-
eedenl; all obligatiuns. whether hI' ,Ialute or a~rcemenl they arc d",ignated as t,,, free. of Ihe United Slates,
or any 'laic, or puliti<al snhdivi,ion Ihereof. or of allY forei~n <",miry. which arc owned allhe time of death;
all wearing app,.rel. .jewelry. ,ilverware. pi<t",e,. hoob. "ork, of an. hOllsehohl furniture. hor,"s. carria~es.
aulomohiles. hoal'. allrl any anrl all other per,ollal challel, of "ha"oe\e[, kinrl or nature. left hy de<edent.
togelhcr with the fairly ",Iilllalerl markel valne thereof: :ill honds a ",I n"'rtgages hdd by decedenl and nf all
claim' dLle and owing dr'cerlent at Ihc time of rlealh. and all plomi>>"'y noles or other in'trumenls in writin~
for the payment of nHotey of wlllch dccedent died 1'0 s>e>>c:I. of whaISOe\'er natllre. wilh interest Ihereon. if
any. giving the face vallie alld ",tirl,a,":! fair m,"kel value therc"f. anrl if such estimated fair markel value be
less than the face \'allle. it sets forth hridly tIll.' reasons fur SUdl dl'prcciation as to each itcm; all moneys
payable to the "'talc from life in,,,,ance policics carr;ed by decedellt; a\l allnLlity and endowment conlract'
the proceeds of whidt were payahle upon Ihe death uf the deeedenl: all and the eorporalC slocks and dividends
due Ihereon and unpairl ,I> of the datc of d".lIh. \"",d, and a",rllerl interest thereon to the dale of de<edcttl's
death ,\ltd othcr il1\'cslmcl1t sl'curitics owner.! hy the decedent ilt till' til1ll' of death. with Ihe market \'alue there.
Ill' at such time.
11\ tl\l' ('/lSf' or spe\lrit.I(~S or 1~lllS" 0\' 1'1l"1l1~ c'O"PIII'lIlloI1S, till' vllllP'S 1'I'IIlll.\pd Itl'" liS 1'111' IlS
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slltll St'hI'111I\l', f111llllt,t/ll SlllU'lllPfl1S slln.....1111~ IllI'Hssnls IIl1cl 1111hllllll'''; or slllrl t'o-pllrIW!I'slLlp or hIlSllll'SS'
.\ "01'1' 01' ",,' ..o_p"rl",','sloll' '0("""""'01.. III' "r"I," ""1.",,,,'01 ".'".." 1'"..," 1.1,.. ""'111'" 01' 1.1,,' "".""""",",)
I"~!"'''''' wll.l>" sl"IO',,'O'III s.."III/'. 1',,"'" "". e!1II1'1I..1..,' 01' '.1,,' ,,,,,I,,..,,. lis 10..,,1.11111, ",,,I ",..II 01111'" 1',,,,l.s
1"'rl."'IIIII~ 10 "'" ,,,,,Ill"" liS "'''I' ,,,' 1""'1111"111 '0" 1',,1.. ",,,I .Ills! "l'l'rllls,,1 01' "'" ."..",,1,,"" s 11I1...r..sl.
11I00,...III,,,,"II>"Sll',,oI,,...I. It sl'''III'' "Iso sd 1'0rl.I1 \11 ,,,.,,,,,,,,, 1'0,'111, lo~O'''",r willi 1.1,,' 1',,11' mllrk..1 ,,,I"..
tlLt'reot', nllY 0(.1,1'1' prnl""'t.y OWlll'iI Clr hpqllPllll1pcl hy t,llI! l!f'I't't!t'l1t III tilt' limp CI" dPlIt.ll,
Till" SC/!f'du!I' C nlt.nf:hnd !1prp.l.o 1\1ll! IT]lulf' JlllrL 111'1'1'01' spts fort.h It trIll' ItIlSw('r t.o eu.eh inquiry
".",1,,111...1 t,,..r.o\" ,,",11111.1,.. ..ns..ol'l.r,,"sl','rsol'p,'ol,,'rI.Y'. "0',,1 0" ,,,.rsOIlloI. "III,ln two yenl's 01' ,,",c...\<mt's
".."tl>, III "oll"''''l'lnl.lon 01' .1...".oI.."I.'S .k"II1, 01' 1,,1.,'nole.1 to ,.,\,,, ..I'!"'''' I" 1'0"'0',,10" nr "n.loym..nl. nt 01'
nl'ter 11""1.11, ,,01.1 s..l>O'oI"I.' s""s 1'0..1.11 ",,' 1II""r,, ",,,I vnl".. 01' s".." 1"'01"''''1'. ,,, wl>nm l.rnnsf'O'rr",I, UlOO
rel"t.lnnsl> I I' nf' 1.1>0' I"''''S f'e,'''O's 10 ,"e .lecO'oI,,,, I., 11<" I'rol'or Un"OI I." sl,,"',. 1",,'..1 v..d I<y' ""cl> I.r""s1'"re" "od
,,11 ol.I<er f'1I"I.S of' " 1'''1'1..1,,,,,,1. oOlt",'e r"~lIroll"~ s"ll\ I.r""sl'ers. I" II..' ""s" o\' I.,.""sl'ors I "l.e"oIell 1.0
tnke "I'f'oo I. I II 1'0ss"Os I 0" nr "".1 oYllle" I "I. or ,,1'1."" 01.1''''1<, U",,'e Is" I so ,,1.t.lld...oI to 1.110 s..hell"l.. " ..onY
01' tl>e .I..ed, I.rusl n~r..enlO"l. 0" ol\1Or lllsl.run...nl. ere"""~ U", "'usl. "1<""" Is "Iso SO'1. fort.I< 10 sllld
seh",I"I,," list 01' "II I'rol'orl.y, re,,' ""III,,',,"onlll, wllh lIs VIII".., whl"" I""'so's "I. oIO'collo"t.'s 110"1.1< hI'
virtue 01' t.I<" exercise I>y de"",I,'"I.. oll.I<er Indlvld""lly, or.lolnt.ly wil.li IInol.h..r. or ''''y I'nwel' nl' API'olot."
me"l. vest.odlndeceolenl., eiU,,,r Indlvldn"lly 0" .Inlnt.ly, I>ytl<" will, 01....01, or ,,1.11..1' Insl.r"m..nl 01' ""ot.hOr,
with n (~opy of ttw iostrullIl'nt. erf!lltln~ such IHlwllr f1ttnchr>d 1.0 till' s(~1l1't1..1f'.
TI<at Scl>l'dulc D "Ullcl,..11 I<.."oto "",I mild" 1'''1'1. ''''''1'''1' s"t.s 1'0rl.I< "", ,,,lIno'S "",\ Illlllross"o of 0111
persons l>enel'lelnlly Int.e,'est.ed III tl>ls eSI."l.e "I. '"I' 1..111I001' 11..1...01.",,' s 01 ,," tl< , I.l>e ,,,,t.ure of' tl<elr res-
I,ect.!ve Inlerest.S, lI<elr r<<I"l..1onsl111'. I I' "oy, to l.I1e decedolll., to,~..II<er wil.l> tl<e Il~es ,", l.I<e t.lme 01'
oIecedenl's Ile"th of 1111 minors, "nnult.nnt.s "nd l>en"l'l..illrl"s I'or lire 1I11<1or Ilecodelll.'s WIll. It 01150
cont"lns Il 51.01''''''0'111. sl>owlng wl<lcl> 01' 1.1", I>enef'lei"rlos ,,,,med In t.he <1.."".\onl.'s w111, If' Ilny, diodl'rlor
to deeedenl., l.I<e dllt.eS of their deOlI.I>, t.l>elr ISSUl>, "ndl.ho ;,el"l.Iollsl>ll' 01' sllel< \sslle to Ihe l>enof'lclllry.
TI<llt S.foedule E "1.1."el<e,1 heret.o ""01 "".10' " pOlrt. h"reol' sets I'lIdl< ,,11 property, relll onll per-
sonol, owneol I>y the decedent .10111111' wllh ""o'hor or ol.l>ers, Inel",'ln~ Inl.ll,,~lhle, st."n,Jln)'; In t.he II""e
of the dec..dm,1 ",,,I ot.l>ers, plus 1.1>0' .I"t.e Ilnol pl"cO 01' reeord 01' I"S\ rUllleol.s o\'t'ecl.lo~ t.l>e vcsl1.turo of'
real est."t.o Ilnll t.he dllle of' oe'llllsHloo of pel'son"lty, pIllS t.he 01l"O'. "dllress 01,,01 rel"Uonsl>lp, II' Ilny',
of co-owners to the decedent..
Thill. Scfoedule F Iltt"cl<ed hereto "nol ",nole II I'"rl ,,,,,',,of' s..ls f'o,'U, 1'1111)' IInll In <let.llll 1111 <lel>l.s
"nd deoluellons clalllle<l for ,mol on l>O'hal!' of' 1.l>ls 010'''1'010111.', "sl"l.e, \Oclllllln~ I'lIneral oxponses plllol;
I'llmllyexeml'llon, where "1'1,11,,"1>11'; eosl.s of n,lmlnlslrlll.lon 01' Ihis ,,,I.lll.<<: coonse1 fees anol 1~loIlcillry' 5
eonunlss1ons pn1<1 or I.n ho 100dd: oosl. oXl'onclO',1 for 10111' lid 1."OISt.S, t.oml>sl.nn..s nr ~r"v"mllrkors, "nIl rei 1-
glous servleos, in consell',,,nc,, of' t.1>" <10'111.1> of' U,,' olcc"oIenl: II"hl.s IInll O'1n1ms owln~ "nol OInpalol nt t.lmo nl'
do"tl>; Illxes "e..rllo<l ehllr~e"l>le for 1,..rlool prIor 1.0 ,lecl>oIO'n t.' s .1"" I.h (exe"pl I.hoso ,1\ 10weol unolor Re..llon
651 of' th" Inl>erlt"n.." llnol EsI.III.. T"x AcU: l.o~"l.h"l' wil.li " sl<"..III,'nl. of' oolll1l.el'al pleol~..,1 f'or ohl1gll-
tlons, il' IIny. It 15 ,,~r""11 that. t.1>.. f'111oel1l1'Y will I",e,,'nl. l'rool' o\' ,11101 0'10111I1'.1 ohI1:,at.illns uI'on re-
quost, U,"t. ll' 11>.. IImOUllt. "ol.unlly 1',,11\ In sot.l.le"","1. of 11111' f''''', O'1""lIIlssloll or 1\0'1>1. 1s I"ss t.l>lln t.ho
OSllmnl.",1 Ilmount e1111,"ln~ nil' I lI11owe.I, I.l>nl 1.1>1' sollie will 1>0' r"l'or,,'o\ to II". 1\..~lsl.<'r 01' \\'IlIs, ",,01 I.\!fil.
the nm01mt of t.1l,\( IIssessl~t1 ellTl he rt'lIssessf>i\ ill Il.::cot'f\:mcl-' therl'wl t.ll.
Thllt the t.ouds of ,he IIpproprl"l.e cnlllmns In R"h...llIl.'s ",\", "II". "1'". "1'", ",,,I "I'" os .1Iroct.e,1 l.\1Oreln,
hnv(! heen (,lIrrIed forwnrtl !ll1fl tll'nrf~rl~' rl~l-!;lsterl'(1 In t.he Hnnunlu'y.
//,~. ,
day of C1"<"'C
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" IU ,j':rr t, II J ' , '" , C
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i,!;'I:,. ;,:1.. :j:' Cdt':::'!
\" "':'~;l; PPWi;, ti'i ',~ 1f1:~/ ,
SOTE: 1I""or" S I ""l nv. II l'fI oIll\' It mllkO' SlIre 01 11 Iolllnk SI'''O:''s 111 II'" "l't'I olav II "nol so:hO'0\1I1 ,., a<H,O'xO'.1 llr..
1'111,..1 In wl,h 0\"1.,,1 Is "r II'" woro' "Son.'", """ In ..IISO' II'" IIRS"IS In<'1l101e ","'" "n" lInllsl",' s..ellrll.l..s,
sel>lIrll.l.'s of' 01"'" or f"lIIlly ""f1,oratl"O' or "n 1nl<'c,'st 111 I"'~' ""_I',"'lo,'o:sl1l\, "I' Iollsll"'SS, I.hlll. ,'",
0I1Ot" nll.1 Slll"'II...n's re'I"lr"" "nol..r '1'0 l'''rOl~''''I'I1 lll.o"" rO'1allll," ,,, Sl'i'''''oJp "II" "r.' III.t.a.,I>..II. .\1 so mllke
cHtllln I.l>nl. O'oll1l11n ,I In 1.10" "SlIo.""ry' lias I>",'n prol'O'rly 0:1"'1'10'1,..1 'IS "1".v,'"'"r.,,,le.l.
Subscriood and sworn to hefore me thiB
.............. (O~'I
l!L~Q.
~_~/G'j ;-:;; ~
Ic( ~~:~(:;;Ad;';i~is;,;::;;,;)'2(f~('~'{:"""
R. D. ~. ,Ilo~..]:??:ll.........m. m...............
(Street Numb.".)
Ne\~vj He, Pennsylvunia
(City 01" Town and State)
172111
RCC.J4l4.7~1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
*'
Real property in PeRnsylyania, with statement of mortgage encumbrances upon eoch parcel at death of dece.
dent. Property held by the decedent os tenant in common with another or other, should be identified
os to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held os joint tenants with right of surYiarship or tenancy by entireties should be reported on Schedule "E.")
Tho rool property located In tho Commonwealth of Pennsylvania .hould bo (1) (2) 13\
delcrlbed by lot and block number, .treot and stroet number, together with DEPARTMENT
a general description of the property, with 0 roference to the record of tho ASSESSED VALUE VALUA TION
conveyance by which the decodent took title; If (I farm stote number of a. FOR YEAR OF ESTIMA TED CAUTION
crel; also Itatement of mortgage oncumbrancas upon each parcel at death DECEDENT'S MARKET YALUE (Do not write
of decedent. Toxes, ossellment., accrued Interest on mortgoges, etc.,are DEA TH In thll lpoC.)
to bo listed on Schedule uF" and must not b. doducted from this schedule.
NONE
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the lost page of Ihis return.
No'n.v
REV..4Ilt !6..n)
4tJ1dA
~
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PER SOHAL PROPERTY
---.---
INSTRlICTIONS: This Sl.:hedllle I11l1st t1i~cl()se alllllll~ihlc and intllllgihle persllllul prupcrly tl\\'IH~d individually hy the
dccedent, III thc lime or his dealh. Pruperly oWlH~t1 hy Ihe den-,dclIl juintly with illlother or 1I1hcIS 1ll~~I--~hted-
under Sdledule "F". Inlilng.ihlcpcuiUnal properly, titled ill the lIilllle of the decedent, hut Pilyahk at death tll i1l1ulher
or olher!., illc1udill~ hutll(lt limited 10 I',O.U, Il.S. Sa\'ill~s Blllllh. and Il'lltilti\'l' trust ilL'COllllls, lllusllll' lish:t1, despite
the r;l\~t Ihal they arc 11IIt or the adlllilli...;Il-'rcd cstale.
Tan~ihlc lH:rsollill prollerly shHuhl hc Iislctll'irsl (c.g.jewclry, wl~ilring. lippard, hllUSl:hllltl !.!-IUlds, alld
furnishings, hooks, paintings, aut0Il10hi\l~s, hoats, ell:.)
Inlllngihlc personal prllpcrlY, slIl.:h as !lollds, treasury certificates, t.:a:-.h IlII haud "lilt ill hank, stlld,~"
U101'tgagL's, noles, tUJ;l:ther wilh aCl.:rtIed inlerest 01' dividends, salaries or wages, illsurallc{~ payahle tll the estate pr
fiduciary ;n said capacity, partnership inlcrcsls, interest III any t1lHtislrihuled estatc of lit' illl.:lIlm~ frl)111 any property
held ill Inlst under Ihe will or agrel:ml.:nl of al\olhl~r, C\'CIl though locatcd \lul:..;ide of thl.: Slale, ill the tillw Ill' death,
sllllulJ he lisll.:d in this sdll:dule.
-
Item !'IMI IINIT ESTlMATHl DEP,lllnIENT
No. Lisl ilnd describe fully VALliE W,RKET VAI.IIATION
VAl.lIE (1)" lIul write in
litis sll:ll;e)
l. Ford Galaxie Automobile, 1973 Node 1 $ 875.0l
'P-7."f15" I) ~.,5()5.:~ .>-S"'f1~-,-Si-'
2 . 1162 Shares, ConUl1011 , ~Iob:il Corporat ion ( 16.9062' ,)
I-~
) 1/. /.)(.ij Yb
.
1')',/ 1-; Vi. h1
InserL this tolal oppositc "'Personal Properly", ScheJule "U" in X X $ 65,380.0 i)I/.y-ti~;;/e-
the uAs Ih~porlcd" colullIn till the last page or this rcturn.
R.EV.453 (8-701
':1.
~ ~,,*,~
~;;Jl;
"'if"""'" .
""qT. ,',.
",'L:~~"':. ~11\,
.1,/"", .'(-:1""':]'
.~...( {~."';" p7i',~-,1
CO~\\IONWEALTII OF PENNSYLV^NIA
TII^NSFEIl INHEIlIT^NCE TAX
Ilr,~IDENT DECEDENT
Sll\l':lllll.l' "I)"
- ._---~ ---. ---". .----.--,,--..'--..--- _._---~_.-.. .- -----.----" ,---_._~--_..-
------ p ---------..------..
BENEFI<.'1t\RIFS AND t\l)nH..."'~ES HFI.ATIO~SllIP
(Stutc full names Olml iulurcssc~ of all wllo Of strp..dllldfcn or SI1R\'I\'F1) Il,\'!-F. INTI.:I{E~T OF
hllve tin interest, vcstl'll, contingent Of other" illcgitimatc childrell 11E('1~1)1'~Nl 01; 1\1'~~I'.l;I('II\HY
wise, in estate) arc in\'ol\'l'd, !.l'{ S'L\TI.. Yb"i I\JRTII IN FSrATI':
forth Ihi~ fact.) OR NO
EINA F. BURGARD WIFE YE8._ ~Intc~.!:[lte_~l1are ;_
- ------
R. D. 3, Box l57-ll ~20,00l1.00 pIlls one-
- 1-__---------- ---------- _______--t lie, If (-i:;J-o-j'-t-hle
Ne\~vil1e , PennsylvanJa balnnce o\' the EST.aJ;..Q..
-
ROllERT L. BURGARD, JR. SON YES Intestate share; one-
-- 6fx:r:h o~ rile lJa lance
R. D. 3 o. the Estate
Newville, pennsy I van J a -
-
Gene L. Burgard SON YES Intestate share; one-
- slxtll ot tile ba lance
l~O3 Springhouse Road
Camp Hill, Pennsylvania of the Estate
--
CHERYL E. ANTHONY DMlGllTER YES Intes.tate share; one-
- I
R. D. 3 sixth of the balance
Newville, Pennsylvania l of the Estate
- -r -
I
- -- \ \ -
-
---
--
- ------ ---
-- - - -
- -
- ---'--'- ---- -- --
-- \--------------. ---- --. ---
- --,------ -- - ==1--
- _:::- - --- __L-- _--.:.:=-:- -. - -
III 'NFl'!(, 1,\\, U :.s
--------- ---.-.--------..---- ,.---------,----------
-- -----"
,....,"' '"~., ,.':~;: ." ,.. ,~...:.~ I'?~:'~:;~r ::'~' .,..~;~~,,~~-=~
_J_.__________ -------
I
.-1-------------
_L---
I
---
--
~-,--------,----,---~--_..------
----~_.
---.---
-_._---~-
~
3~::
g:t :u:
~. c
'E ~ e
's ~ .=
"'0 c. 8
15..
oU:O
...... ~
~ ~ -
u ~ ~
~ e 8.
~ ~
!8 ~
SUMMARY
Real property
Personal Properly
Trunsfcrs
(Seh. "A")
(Sell."B")
(Sch, oe' ')
Gross Taxl1hlc Estate
r- .."
~ Z u
co 1.\.1 "-
" ::;; c
.... u
1.\.1 u
tI'J u ..J
- Q <0:
<<: on
Q: "" .~ <
0. 0 c '"
0. c a.
" <<: ,,1.\.1 ;. a.
.<: 1.\.1 "<::r- ;., <0:
<5 r- r-<: "-
:E: c 0
Z .;: r- ..... r- c :z:
0 l/l ~
"" 1.\.1 0.. <0:
0 ~ I-
IC '"
.S Q: -= 0
~ 1.\.1 a.
" .
~ r- u w
~ ~ '"
'" r- 0 "
'" <<: ~ c
- .s :;; 0 :::' 0
u 0 E
:::"0 ;; 0 E
~~ 0 c
..J U U
(II
(As Rl~pllfICd)
>.
'!;
>
$
>
>
.
(2)
(/\s Determined)
>
>
>
$
>
$
REV.484 EX~ (3.UQ)
INHERITANCE TAX SUMMARY SHEET
(~lJB_~t-t,JLJ~E .of'.l,=-V)
Fi I e Number ______.'~~_8_0-0_?_.s.z_
Estate Nome --
l:obert K. nl1rp~~yd
Date of Death ____
1G/28179
Social Security Number
REPORT OF INHERITANCE TAX APPRAISER
I, the undenigned duly appointed Inheritance Tax Appraiser in and for fhe County of __Cumberland
Pennsylvania, do rr.spectfuf1y report thot I hove appraised the reol and pc-rsonal property as reP~rtc(nn the foregoing
return at the values set forth opposite each item in the last column to the right in Schedules "A", HB", "e", and IIE"
Dot.d:
May-1.., 1980
(j' , , #.~. -' I )
,. 1'~!(ld/ ;,/!,/'r,1U,
INHER1TANCL TAX APPHAISr::r~
I~VE~TORY
-~:LUE AS APPR-A~SEO--=-~oo~1
AOJUSTMEt-lTS
(HARRISBURG USE O~LY)
REMAI~OER APPRAISEMENT
COOE
Real Property (Schedule A)
Personol Property (Schedul. 8)
Joint-Held Property (Schedule E)
Transfer. (Schedule C)
I N c \ 00+ 92+
,
56 .<287- - 88- -tOt
None J 21)+
TOT AL GROSS ASSETS
Kone 30+ I
___ .~6,:~7_88;\. I"
==-~~_~~:~~~,~J=~,
I
93-
Less D.bts ond Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
FOR USE OF REGISTER O~L Y
Tax on $
~
PRI~CIPLE VALUE CODE
--
I
COMPUTATION OF TAX
$
S
$
$
~
Voluotlon of life estates or
annultl... . .. . . . . . ... "'
RATE
FACTOR
6'.
"
T ax on S
15% .
Tax on $
Tax on $
Tox on $
Exemptions
Toto\ Estote
TOTAL TAX
INTEREST FROM
BALA~CE
TO
$
$ -------
I
Less Credits
DATE OF PAYMEHT
AMOU~T PAlO
DISCOUNT
I~TEREST
TAX CREDIT
s
+ S
s
=
s
+
----...
BALANce
s ________________
I~TEREST FROM
BALA~CE ~UE
TO _._ ,.._~ ~
,
.
p.
.-1 '0 ~
~ ~
''(I ~ p:: ~ ~ '0
<: ~
\) ~ 0
:z: ~ ~ ::l ""'
0 :>- '" .>l ,,,
~ 'Cl '"
III . c::
'\ l/l :~ ~ d
..,.\..,' ::> '"' .....
~ ~
V\ ...l ~ ~ OJ
..: OJ OJ 1l
... .D 0. ..;t
....... U :z: 0 0. ::l 0 '"
... 0 '" ::> u ..... '" N
(\- ""
"" -
I) 0 ~
~ "" 0
\J.,
~ 0 l/l 0 Z ci
l/l ~ Ul :>- ~ ci
-
:z: 8 ~ ~ ~ z z
:j 0 - ci 5 :.: ~ ~
z ::E z 0 U I..? Z
... ~ l/l ~ 0 0 ..: ::l
~ ~ u 0 Po
" .-~.
RE~.IlOO EX" 1""1
i
...
a
...
~
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ut ID
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ua.
.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENU!
aU.IAU o. IXAMINATION
P.O.IOXB327
HARRISBURG, PA 17105
/0 - c71 L/- ..2-
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
FILE NUMBER
21-ll0-52
201-03-5356
01.
04.
o 2. Supplemental Return
o Ao. Futuro Interelt Compromise
o 3. Remainder Return
o 5. Federal E.tate Tax
Return Required
_ 8. Total Number of lafo deposit box.,
z
o
~
..
::l
a.
::E
o
u
~
..
(20)
(20A)
(208)
DECEDENT'S NAME lLAST, FIRST, AND MIDDLE IHIlIA~
DECEDENt'S ADDRESS
R. D. 3, nux 157-B
Newville. Pennsylvania
Cumberland
17055
ZIP
n
~M
S::,:,'
it:.::
I" ,
_.C)
;:::..,~
05
-""
;0'"
p,rT1
c,n
_0
UI~'
"1r:,
I"'"
;'7,'0
,,~,
BURGARD
SOCIAL SECURITY NUMBER
Robert
L.
'-
=-
z:
I
U1
DATE OF DEATH
Oetober 2ll, 1979
Co,,,"
,:"'J.
,-"'.'
d. b
.55. 31m. 06
U1
;0
6,260.02
'19.120.04
'19.120.04
2,9Lj7.20
2~947.20
2,9'17.36
0.16
+
19. If line 18 is greater than line 17, enler the difference on line 19. This b Ihe OVERPAYMENT.
A. o Chock here if you ore requesting a refund of your overpayment.
20. If line 17 is gr.ater thon line 1 B, enter the difference on line 20. This is tha BALANCE DUE.
A. Enler the interest on the balance due on line 20A.
8. Enter ,he tatai allin. 20 and 20A on line 208.
Mak. Ch.ck Pavabl. 10: R.gl.t.r af Will., Ag.nt
.... BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH....
Und.r p.nalti.. 01 p.rjury, I dodar. that I have examin.d ,his r.turn. including accompanying sch.dui.. and .'a..m.nh. and to th. b..t 01 my knowl.dg. ond b.Ii.I,
it i. tru., corr. and compl.t.. 1 d.dar. tho' oil real.,'a'. has be.n r.port.d attru. mark.. volu.. O.c1aration of pr.par.r ather than th. p.rsonal r.pr...n'a.iv. i.
basedo~~.~i) .!rnationof:", iC~P~PD~,.)ho.anYknowled~', R. D: 3, 130x lS~:13 "-;, ,- !
I __ ';--;.[__,'.-/ :<,(_/Ne"v~Jle. PA 112lil ;--a., ') I.t
IONATUR 0 ER ON RES'ON,"'E' RILING RElU N ADDRESS DATF
Snelb (_' ',_ cG ) El.icl ..r Iili West ~lain Street I;
"n . '~~:;'J.r' -'.2~'cr.4.,~t>--- HC'chanicsiJU1'r PA 17{JS~ //1/ I/r; rll
SlONA RE Of 'REPA THER THAN REPRESENTATIVE ADDRESS - I OATE
Original Return
Lif. Estate
06. Decedent died testate 07. Detedent maintained a living trust
(Artach co of Will (Artach co altru.t)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECfED TO:
NAME ADDRESS
Snelbal(er, McCaleb & Elicker
Lj'l West Main Street
P. O. Bo)( 318
~lechanicsburg PA
STATE
TELEPHONE NUMBER
717-697-8528
CITY
z
o
3
:>
..
ii:
~
...
IX
1. Real E.tate (Schedule A) ( 1)
2. Stack. and 8and. (Schedule 8) ( 2)
3. Cla.ely Held StacklPartnenhip Intere.I (Schedule C) (3)
4. Mortgage. and Note. Receivabl. (Schedule D) ( 4)
5. Ca.h, Oank Depa.ih & Mi.cellaneau. Penanal Prap.rty( 5)
(Scnedule E)
6. Join.ly Owned Prap.rty (Schedule F)
7. Tran.fen (Schedule G) (Sch.dule L)
8. Total Gra.. A..et. (total line, \.7)
9. Funeral Expenses, Administrative Costs, Miscellaneous ( 9)
Expen.e. (Schedule H)
10. Debt., Mortgage Uabilitie,. lion. (Schedule i) (10)
11. T alai Deductions (ta'alline. 9 & 10)
12. Ne. Yalue 01 E.tate (line B minus line 11)
13. Charitabl. and Gavernmen.al Bequell. (Schedule J)
104. Net Value subiect to lax (line 12 minus line 13)
15. Amount of line 1 A taxable at 6% role
(include value. Iram Schedule K or Sch.dule M)
16. Amount of Iin. 14 .axable at 15% rate (16)
(Indude value. from Schedul. K or Schedule M)
17. Principal tax due (add tax from line \5 plus tOK from line 16)
Interest
( 6)
(7)
( 8)
S,8ll8.00
372.02
(15)
q9 .120. 01;
(11)
(12)
(13)
(14)
X .06 =
)( .15 =
tl7j
Discount
]'17.36
Amount Paid
2.800.00
18. Total Prior pay';'e"ts:
(18)
(19)