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~'RE v., IV (a"78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMErlT OF REVENUE
BUREAU OF FIELD OPERATIONS
TRANSFER INHERITANCE TAX OIVISION
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES .);:l
OF RESIDENT DECEDENTS
COUNTY OF ~~Wu:I,-t.i:.w..f--_----
Thl. .e'u,n mu.' b. comple..d In dotoll ond Hied In duplIco'o, with ,h. Rogi..o, 01 Will, in 'h. Coun'Y wh..o .1.0 ducudun. .u.ided w;ohln nine
months ohor dalo of death, unless on Ulan,ion is granted by thCl Secretary of Revenue,
Will ) ,- I
Admn. Nu. ,. I - ~ .
-{(',/
"ll)~
"I' 26 Valley -p~_G..a_rlisle~-,--
I All{)rH.:S:.:.l
C. Lee Warner
I,
\t~AMEI
Misc.
being duly sworn Ilccording IU law, depuses ami SOlys thai he i~ the
Legatee (Fathe.;.) _~_______- ---------
(EXec., I.OM.. l.EGATl':E, tTC,)
laic "I' South Middleton Township
ICITY, I:iOROU5H--;OR"T'"O'WNSHiiij------.- --...-.-.---
or the estate uf
John L. Warner
deceased, and that the whnle of the estale nf said decedent, whll died nn .._.g~!y--~I..--:L~?~-----,,---n---u------------
lOAT!:::l
consisted of the assets listed belllw and that allnwahle dehls and deduct inns esceeded the [air lIIarket \'alue "I' the asselS and
nn Pennsylvania Transfer tnhcrilil1\ce Tax is due,
L_&~':--~1'd!~L&~------
(SIGNATUREI
l TITLE)
Sworn and subsc:ribed be foro me
.h. fi"fil doy ol-)u i.- 19~
I";':_l.~,i,.~l I~. ~n (I /~,.." J "', '
./ . I J.
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'/
Deportmlll1t
Valuation
CAUTION
(Do not writo
in this spGcel
Estimated
Mark..,t
Value
Type of Auet:
Real Estote, Pers.
Property, Jointly
Held Prop. or
Transfers
ASSETS
(Attach additiono~;;;;if necessary)
Description of Asset
{'b..u......R..J
rEu1", dy
Account at commonwealth National Bank
No. TC0214
164.59
It, ,/,5'7
REPORT OF INIIERITANCE TAX APPRAISER -<t~1C
I. the undersigned duly appointed Inheritance Tax Appraiser in and fur the abo\'e Connly do respectfully repurt Ihall ha\'e
appraised the real and persnnal property as repurted in the fureguing schedule al ,he \'alocs se' furth uppusite each ilem in
the last column t~ the right. .!LtIJ.U1.Li!llJ:,/ d-L
Daled: I1IlJ:ch U, 1980 IINHERIH"CE TAX hPP't'SER'----
TOTALS
Nome of Payee
DEBTS AND DEDUCTIONS
Nature of Cloim
A mount
Cloimed
Amount Apploved
by Regis',,'
Hoffman
Funeral Expense
Cemetery Lot
1,854.00
175.00
TOT ALS
2,029.00 ..:;:(,.:{O, 00
REPORT OF TilE ItEGlSTER OF WII.I.S
I, the undetsigned dnly elected Regisler of Wills in and fur the abu,'e ennnty, dll respeetfnlly reporl Ihatl ha\'e allll\\'ell
deductions in the a",uun's set furth in the ahll\'e schedule as claimed, escept where I ha\'e set furth a greater nr lesser an",nnl
in lhe last cnlumn to the righi_ which greater or lesser illUtltlnt rcpresents the sl&n Jl.l1n --1d as u.dcductioll. ~;,-::;4
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Date nf Applll\'al: ,'J 1,,,,,,-- I 1 -\"1.' C'- , ~, - "'-. ' l' C" vvv.....-'<-
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