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No. 21.80 -- 148
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMEt~TARY
in the Estate of
Alice E. Shumber"er
I deceased.
Harold B. McLane, Deputy
To ji{jd Idl d E. "'lid"" "un, Register of Wills for the County of Cumberlond,
in the Commonwealth ot Pennsylvania.
XSC
Petitioner(s) are the executors named in the Last Will and
Testament of A1; "'" E. Shllmherr:er doted August 18. 19!?9
Decedent was a citizen of the United Stotes and a resident of
x'Il!Iwnshipx
Mechanicsburg Borough, Cumberland County, Commonwealth
of Pennsylvania.
Decedent died on Thursday
the 21st
A. D. 19.J2L, in the County of Cumberland
Pennsylvania at the oge of --1.92- years.
>>msc :iro$X he r
Decedent has not been married and has not had children born to Jhimxx
since the execution of the above described Will.
Decedent was possessed of personal property to the value of
$10,000.00 and of real estate to the value of
None
as near as can be ascertained; said real
None
estate situated as follows
apply
Therefore, your petitioner(s) respectfully ~ies for the probate
of the said Last Will and Testament and for Letters Testamentary thereon.
Dated February 29 . 1980
Name and address
of Petitioner(s)
,.fi/-?Ar hI '.)C--I!,I .
1,.: / ,/ L:k .f
/ If</-L!A.<'.L.'<.- r2'Z;", .j
;>13 ~lel;t. in :!it.
Mechanicsburg, Pa. 17055
COMMONWEALTH OF PENNSYLVANIA ~
ss
COUNTY OF CUMBERLAND
Robert 'II. Kre.ly and Mi.ldred Kraly
151J
named in above application, being duly SHorn occording to law
say(s) that the statements set forth in this petition are true to the
best of his knowledge and belief.
sVIForbn and29subscribed besfoore (~!~t(!'I' 1- If; :~" :ii
me e ruary 19 / I, ('.of,' IL 1/.' ., {, 0:
. V~/r.V1J~ 'f2.,)J) L._ zl,',.,~ o. Deputy / it/I
R;G1,a, d C. AI,d~r3el"l. Register
Filed;
,:) /- io -1'1-1/
1980
Attorney: J. Robert Stauffer
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OATH OF SUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND \
This...... ............,.,..... ....... ,?,~,~~.. ,................ ......... day of .....,..",.." ...~~?~ ~,'.l.~!.'....."..",.. ......."..,.. A, D., 19M....
Harold B. MCLane, Deputy
before me ttld"ud E), A..d", U"". Register for the Probate of Wills and granting letters of Administration
in and for said County of Cumberland, in the Commonwealth of Pennsylvania, personally came ..............
Arlene J. Neumyer, one of
................................................................................................................................................................................
the subscribing witnesses to the foregoing instrument of writing purporting to be the last Will and
Testament of .....g ~~,~...~:.!...~~.~~.l:,~r. .E'l7.r............, ....." .........,.... ............ ...... Dated .. !!.\-!g:....~.Q.1}.'1.~.?.... ..,....
late of.............!1.'?~rr.'!-.!1.i,.9.~.:r?!:w.g...........................................................,..... Cumberland County Pa., deceased
who being duly ................~,~~::.~................ according to law, depose and say, that ....~.!'!.~...~,~~....................
present. and saw and heard the testa.~r..t.~......................, ...f...U.l??....~.:....~.~~~~7..':.~~!...............................
sign, se,~l. publish, pronounce and declare the said instrument of writing as and for hf:l.r............. Testament
and Last Will, and at the time of so doing .................~!f.(l..........................was of sound and disposing mind
memory and understanding, to the best of .......b.~.r.................................knowledge. observation and belief.
S,/orn .
............................................... and subscrIbed before
a'..~ d, . f). )/},,_u...,.><-<.~<"..r-..../
'L.A:4"_..~o::...-' /
............,................,....................,.........l<'...............
.....~0.t.ljtf{:rn~.?::hvb~:,._..~~~.~~.~
R~",lJ.adl E. Aud'V.l;::lvn, Register -.
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA I ss:
. COUNTY OF CUMBERLAND \
....... B.2~.'?r.~.. .~.~.. .JSr..~.?: if... ~ 1:.9:.. !~. L l: ~.~ ~~.. .~;r:.~ ~ if.............,.........,....................,.............................. being duly
......................s.vi~?r.n............... says that as nearly as can be ascertained the said decedent ..........................
.................. ............. ..~.l:.~,~,7.. ..~ :..,.~!:~;1~~~.~~~.~...... ...... .,.............,...... ,................................................... .died on
.........~!'!~~~.~.~~~..................... the .......?~.~.~................day of ........~~.~.~.~~.~.~!............................ A.D.. 19...8Q.
at or about ....2:.Q.Q........."..""............ o'clock. r"M.
.......J?11.9.r.n............ ...,............' .,..and subscribed this
.....:::.gJO'/.ln~~.,.l?::rn(.i].J;,.~"'c-.:. !?~P'.l;I.t.:i
R:...J.u...d E. Aud{.l~on, Hegister --',
)7ji )i,'
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...)t.. "\f'ol. ...z:..........r.Z'ld(i... ...... .... ,...........................
/1,/ .fA' ,h tY
/r /v-- ~. -" ~-<. ;',1 ." '--' -...f1
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.....................J?~)::.........".... clay of .......~~l?E~~.~:y
19.~.~..... before
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENN5YLV ANIA l
COUN'fY OF CUMBERLAND l 55:
Before me. the Regi8ter for the Probate or WillR and granting or Letter8 or Admini8tration in and 1'01'
the County of Cumberland. personallY came .:.1.~)?~.r..~...~!.~...1.9:.~~;[...?:::~...~~.~.~~,~:~~...:~:-,~~.~.......................
who, being duly ....,~)1.~r..t:l............, do .......... depose and 8ay that a8......,..~::.~.~~~~,~:'.~......."""''''''''''''''''''''''
of the last Will and Testament or ......A..1..),!i.(l..,0.,...~.\~w~1?~r..[';~!.'........................."'".........................deceased
..t.'n~,1.........."'" will well and truly administer the goods and chattels, rights and credits or said deceased
according to law, And also will diligently comply with the provisions or the law relating to Transfer
Inheritances. .......:?,YI9.r.r...."".. and subscribed
before me.
::;l~'~'~"'L~:'= A D, 19::~~~y
~.t+.,.....J.J.~..)f.\.....;i;v.=..9.~...,'...........
Ri.Ju:ud B. },.ua....Io.Juul Uegister
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41~"'1.1l.", ..<:1:.,......,................".....
/;;~(;.4/.:0..f;~,<)....?;.;~".,................,...........
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DECREE
Be it remembered that on the .."....."..~~~.... day of .................r::~.7.~~..................... A. D., 19 ~Q..... there
',was probated and recorded the last Will and Testament or .A+J.~~..}.,...~.t:.'::~:r:.~!.'!:,~!.'...............................
late of .......!1~.~h.l!-.ntC??}:?Y.r.5...........""..........."... ......... Cumberland County. Pennsylvania. Deceased. Letters
""""",,,,,,,,,M,',"'"'!"""'"'''' wore ,,,.1<<1 '" ,~~~,'."t",~I",,,<.,,'.,,,,,'.,".'.,,I::;o,'.,:'.,d,,~:'.,!.,,,,,,,,,"'"
Witness my hand and official seal the day and year aforesaid. '/'
~"tj,0f)J.f:f?,l1S ;J~,.J.?,'.R~'Y
, R.-I....d E. ....L...en. Regtster.
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RCC-89
COMMONW1~AI,TI1 OF I'ENNRYlNANIA
Department 01' Itevenuf!
ENTRY INTO HAI,'I~ Iml'DH 1'1' !lOX
TO 11I~MOVJi: A WILL Oil CI~Mfo:TEHY IlElm
}'ebruary 22, 1980
(Dato 01' Entry)
1. Name of decedent:
Alice ;1. ShwnberGer
3.
Date of death:
February 2'. 1980
]A 17055
2-21-Go
2.
Address of decedent:
215 J. Main nt.. !'lech.,
4. Name and address of person who roquested the opening of the hox:
Ruth Kohl' 103 Mountain Lane snola, PA 17025
11ildred Kraly 213 \.J. Hain;t., l1ech., l'A 17055
5. Name and address of the financial institution where tho safe depostt box is
located: The iirat Bank and rrrust Co. Main and f1u.L'ket st., I'lech., FA
G. Number of box:
P03
7.
Tgle under which box is registered:;) 1 i ('P
Snnmnp,....n.p,,.-.
~
t'1inn1p Tl1-r.iR1
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8. Was there a will in the box? (Yes or No)
ye;s
~. I f yes, state date of will, name ann address of personal representative, if
named in the will, and name and address of' attorney, 11' any:A1'P"l1Rt. 18, lq5q
~
Robert 'J. And Mildred Kraly 213 \.J. Hain street, !'lech. , FA 17055
..,Attorney: IT. Hobert :;tauffer 11arket Square Bldg. 11ech. , FA 17055
And now this 22 day of Februu.ry
certify under penalty of perjury that the above record
to the best of my knowledge and belief.
-:I)/tidw( ,(! J:f1J'
, ' OL t{, /:> /~J.vv
, III 80, I hereby
is correct and complete
I.. .('" ,'-{l,.J ~ ' (JI O~
Sidpature
Ava Y. 11ay Saftey Deposit
Print Nnme and Title
Box Clerk
Rcc.n (9.(,6)
I
J APPLICATION FOR AI'iD CONSEtH
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
-- - - - - - - -- - - -
DATE~l'il_I-~980
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
I BUREAU OF COUNTY COLLECTIONS
!
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for consent to the Iransfer of the following securities of a Pennsylvania
Corporation or a National Banking Association located in Pennsylvania: p
:'wehaniesburs, u.
(a) 78 sharos (b)Tho Firs t Bank ':, nd_!t:l1s_~_~()0J.l~Il?y.<?-i'--~- (cl-_'<:-9mmon
(NOTE: In describing securities enter in (0), ab O/e, either the number of shares of stock or the face amount 01
registered bonds, in (b), the name 01 the issuing company and in (c) the closs of stock or the stated interest rate
and maturity date of registered bands.)
ISSUED ONNovember 28, 197~and having a TOTAL MARKET VAtUE OF sl,O,2)~!..90
(Dalo)
as 01 the date of death 01 the decedent, Alice E. Shumberger
(Namc C'! Decedent)
an Feb. 21, 1980
,
(Datc (If death)
who was late af;>1) \-I. ;]a; n Street
(Street and Number)
Hechanie~bllre
(Post Office)
C1l11berlo.nd
Pennsylvania
(County)
(State)
The securities are registered as follows: Alice 3. ~humber~er and Robert 1:1. Kl'u1y and I'iildred
(Nonlo or nom05 in which cortifico!-.es arc rl:!9l.stcrcd) hi P l70~~
Tenants with the ri~ht or survlvors p.o.., //
and iHlured 1\'ra1y, 213 \'Iest ;';ain st., I'lechanicsburg';
C. Kraly, his wife,
ADMINISTRATOR) Robert
EXECUTOR )
as .Joint
1:1. Kruly
(Nome)
(Address)
NAME OF APPLlCAtH J. Hobert Stauffer, Attorney
---l~ari(ej_ Square aldg.
COUNTY FIL.E NUMBER 21-8o-lh.8 ADDRESS OF APPLlCANTJ1e_cha~c~lmI'.l:Ja. 1 0
BUREAU FILE NUMBER SIGNATURE OF APPLlCANl //%,j F /:"\Ol/:/:"':=---
/"'/ (. "_/ .~ ,
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS fPPLI A TION, IT'WILl NOT BEl:7
CDNSIDERED COMPLETE AND WILL BE RETURN ED TO YOU 'FDR COMPLETION. ,!/;,.:-
,
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES ~ ~
DATE _~
I hereby consent to the transfer of the above securities now registered in the name 01 the a esaid
10~
Decedent and waive the Filing of a certificate certilying to the payment of the transfer inheritance tax to which
the property 01 said Decedent is made subject pursuont to the provisions 01 the Act 01 June 20, 1919, P.L. 521,
as amended and the Act 01 June 15, 1961, P.L. 373, as amended. This is also in accordance with the provisions
of the Act of April 9, 1929, P.L. 343.
This Consent to Transfer the herein described property operates only in reference to the estate of the
above-named Decedent.
SignedXr thl, ecretary of Revenue
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..< ,.'~J.".l ~ (FS19 at",e) "1l I~ W--t
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,_ ",:l~l:t, _!;'---~l\iL---- -- -'-'\>., - oN
:Tillt!1.' D (County)
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RCC-:J3 i4.73)
cm'~ION\I'EALTII OF PENNSYLVANIA
IJEI'I\RT\\ENT OF \WVENUE
\l1J\U,,\U OF COlJNTY COLl.I'CTIONS
COUNTY OF _ GU;"Qgr1:.nd.__
IMPORTANT;'
.. .---."
This ,",a'" ",a" he e"",plelCrI ia rlctail a",llilerl ia .lapliealC. wilh all allaelred. wilh Ihe Re~ister 01 \\'ills ollhe
('oualY wl",lC rleceoleal lesi.\<'.I: IteIL"a is rlae wilhia ai"e ",,,aihs altel rlate 01 dealh. ooless ao eXlel"ioo is ~raalCrI
hy Ihe SeelC",ry 01 Ite.eoa'" ISed,.",70J 01 rhe laher;"""e a",1 E"alC Ta. Ael 011%1.1
RESIDENT DECEDENT
-}
Late of ~~~~~_~~._J~\;J~lhf J11~rrJcounty
IN TilE MATTEIt OF TilE ESTATE OF
AFFIDAVIT OF
Al ice I.;~. ShlJ.mher ["'01"
(ST^T~ FULL NAM['; OF DECEDENT)
EXECUTOR
AII:\1INlSTRATOR
Stata of ?ennsylvan"),U
County of C'r:tl~bel'>land
'-'},,,
.--'
I,OOAPt '..:. \:1"11]'1 (;[1':':U .ir"e "::1'n1y Executor S
, . _~ 0_ '------..------------.--
Adlllllltstfl\\Of 0111.0 """ 0111.0 obo,o'Mmod d"odonl boln, dul, ,wom, doposo ond ,0'
Decodelll rlierl IceD. 21 , . )')_CO f ",1010 loo.in, 0 1051 w;ll, oop, 01 whioh I, ho"" oll"hod, \
!MONTHI iDA,1 (yEARI tw,o(rd'. J
HOnllClond address alattorncy or } ,T. :'.obert c',t:nn'fel', ',',IJ.I".;Ct :)(,V"!":' [nee.,
other authorized representative to whom 'r'
~{oc}"'n~~~~"rr. Penna. 170S~
011 ,o""pondon" ,hoold he m,i1,d. :, ~~. v_ ".' - -
That as slleh ;,xec11tors del1<lllellt is familiar with till: affairs nl' said eslale and Ihe property cOIIstitllting
(EXf:CUTOR-AOMlNIST R A TOR)
the a~!'wls thereof and their fair markel value.
That allhe time nf dealh there was nn safe deflILsil hnx regislered in decedent's individual name, nr jnintly wilh, nr
as agent or deplllY nf annther, nr in decedenl'S imlividnal ,,,"lie, wilh right of access by anl1lher us agellt or deputy, with Ihe
cx'ccplion of lhe following: -
,_._--~
THIS SAFE DEPOSIT BOX RENTED
IN NAME:ORNAMESOF
- -
hlice ;1".. Stl1J::ilbc11r'er
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
~~
-= ----===~--
tjAME AND ADDRESS OF I3ANK OR OTHEI~ INSTI'I'UT10N
IN WHICH DECl'.:l'ENT RENTED " 5_~FE [If.POSIT P.O;<'
Th~ PiT'S t p,nn), Wi6~1\1'\JS t -co:;;'rD.I11.-or---
Hechanics'o1.l11r", PG..L_
.., " -'eyk"t ~te
:'lD1.D nr.~. :'\I"'~';" .....,::>-
}lech8.nicscurS, ,r's.' J {u55~
I
That the cl1ntents of said sarc depnsit hox I1r hl1xes arc itemi,.ed nnder Schedules 13
with IheexceptiOlHlf the fnllowing, fur the reasnns hereinafler ,el forth:
of this return,
That Schedule A attached herein alld ma,le part herenf sets fnrth folly and in detail alllhe real property
in the Cnmmunwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mortgage eneumbrllnces upon each pllreel of real property at the date of dealh, giving the amount slill due at
death. name of mortgagee, date. rate of interest, alld hnnk and IlIlge nf record thereof. It alsu sets forlh in the
columns provided therefore Ihe assessed valualion of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B attached herein and """'" pari helCnf selS fnrlh fully ilnd in detail all personal property
wheresnver silUated owned hI' the decedent at the time of death; all mnneys left by the decedent at the lime of
death, whelher in decedent's immediale Ilnssession, standing to deeedenl's credil in banks of del,osit, savings
banks, trust enmpanies, or other institutinns, whelher individually. or in trnst for any other person ,or persnllS
giving alsn se)larately the accrued inlerest therenn, if any, dnwn to the last interest day prior 10 decedent's
death in the case of savings hanks, and In Ihe dale nf decedeni's dealh in all other cases; 1111 honds, postal
savings, treasury certificates or nnles and 11Iher evidellee of iodehtednes< nf the United Slales 10 the de-
cedent: all obligatinns, whether hI' stalute or aglCemenl they arc designated as lilX free, of the Uoited Slales.
or any slate, or pnlitical suhdivisinn Ihereof, tIf of any foreign cnuntry, which arc owned al the time of death;
u\l wearing appllrel, jewelry, silverware. Iliclures, hooks, works of IIrt, honsehold furniture, horses, carriilges,
antomnhiles, I'oals, and any and all other IlerSlnll,1 chattels of whatsnever, kind or lIature, left by decedent.
together with the fairly estimated market value Iherenf; all honds and mortgages held by decedent and nf all
claims due and nwing decedent al the time nf dealh. and all promisstlfY nnles or nther illstruments in writing
for the payment nf monel' of which decedent died pnssessed, nf whatsnever nilture, with interesl thereon, if
any. giving Ihe face value and eslimaled fair markel value Iherenf. and if such estimaled fairmarkel value he
less than the face value. it sets ftlfth hriefly the reasnns for such depreciation as to each item; all moneys
pal'able tn the estate from life insnranee policies carried by decedent: all annuity and endowment cnntrllcts
the proceeds uf which were payahle npnn the dealh nf the decedent; all and the cnrpnrnte stncks and dividends
due Iherenn "nd nnpaid 'I' of the date nf death, hnnds and acerned interest therenn to the date of decedeni' s
death 'illd other investment securities owned hI' the decedent al the time nf death, with the market value Ihere-
nf. at such lime.
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In the cllse of securities 1.11' elose nr l'ltllllly 1~(}I'!JOI'"t.loIlS, tll(' VIII,IUS l'llpnrl.,!d HIOU us f'llr I1S
posslble suhslnnt.lnt.f!ll II)' 1'llIlIlIclnl St.lll1!UWlIts nl' UIll eOI'pol'uLIOIIS, Sllowlll~ t1lf~ IlSS'~t,s /lllcl l1nhl1ltles
thereof ns of' thl~ <lnt.e or ttentll. "Iw schelllllf! 1111'0 sets 1'01'1.11 t1w IlltfH'fJSl. flf' flnCI!dfmt Ill. Ujl~ LIlli!! or
denth 111 un~' co-pnrllwrshlp 01' huslness, 111111 In SUPllOI't oj' 1.111' VIIIIIl! nl' :illcll IntHI'f,>:;t. t.IWl'f! Is 1It1Tl1!Xf!f1 t.u
sold sehcllule, 1'I1llllWI,d stlltr!rnents shl)wlll~l.lletHHwt5 IlTlff lluhllll,lns 01' sIIII\ {!o-pllrl,IlC>l'slllp or ~lIlslllnss.
A COllY of' tI\C' en-pnrtnershlp IlKI'pllmt'nl., (If 01'111, n stllt.nl11fmt sl'tl.lll/!; {'ol'/,b tlln Ilntlll'n of' tlll! II~rl!p.rnl~IIt,)
tog.l't1wr wllh 1\ sl/ltmnent. setl11l).!; l'ort.1t the cll/lrncl.nr of' tI\l' hllSll1i'ss, Its 11){~lllllllIl IlIHI 511C~h otlwr l'/lets
pertaining to tile llllsiness ItS rllllY he )lerl.llll!lIt l,o It 1'1111' 111111 .Illst nplll'HISlI1 Ill' l.hl~ tlpl~ecllHlt.'s Inl.nrflst
therein must lmslIhmlt.tNt. It ShOlllll I\lso Sf!t !'ol'tll In I tf!llll 7.IHI "UI'I11, to,l!,olhl!l' wltll the rntr market. vallie
thereof, finj' ot.her property own!!.1 or befJueal.hl!c1 hy t.he df~C,~d(!lIt III tlw 111lIf! of' dl!llth.
Tile SchC'dule C nttnchcrl heret.o Illlll mnde p/lrt. h(>reof' :.wt.s '.01'1.11 n true III1SWf!r to ouch inqutry
cont.ained therein lUulln UU~ cnSfl oJ'l.I'nnsf'ersnf'pl'operty, I'onl or personal, wIthin t.wo yenrs of decedent1s
ctf!llt.h, in contemplntlon ot' dl?ccdmlt.ls dent", nr IlltendfHl tr> I.(}J.n nf'f'p(!l III possess ton or enjoyment III or
a.fter death, sutll sclwdllle sets rorth the nlll.11r.~ Ilnrl vlllllf~ nf' slIeh pl'operty, t.o whom t.rnnsferrmi, the
relat.ionshtp of t.he transl'el'l"'!es to the r1eeetlent, lIlP. proportiotlutf! shElre j.CIWIVIHI hy oneil transrHree nnll
all other facts of n pertinent IIlltUrt! regnrrHng sulli I.rnnsf'crs. In t.lll! CIlSP. of' trnnsl'ers intendefl to
take effect in possl~ss1on or en.lo)'llumt ul, or Ill'l.l1r r1ellth, there is 111 SO Ill.tllchf!rl to the schedule I~ conY
of the deed, trust ugreemcTlt or oUler Inst.rlllllent. crentlng the t.rllst. Thf!r'~ Is nlso set' rorth In said
scherlule n list of I~ll propert.y, rent unrl pel'snTllll, with its "HIlle, whteh IHll'.;SeS Ilt decedent1s rllHlt.h hy
virtue of the exerc'tse hy decedent., either Indivlrlllully, or.1nlnUj' with nnuUu:!r, or nny power or oppoint-
ment vm.ted in decedent, 01 thet' Ind1.vtduully or .lotnt.lj', hy t.he will, clned, or other Instrument of /lnother,
with II copy of the instrument. crentlng such. power nt.t.n.ched t.o the schedule.
Thllt Sch~dule 0 ntt.ncherl hereto find 1Ill\de }lurt Iwrrwf sets f'nrth the nllmes and addresses of nIl
persons beneficially interested In tiLts cst-ute 1\1. the time of decedent' 5 {lenth, t.he nutllre of' their )'CS-
pective interests, their relntlonshlp, ir IUlY, to t.lle (h~cflllel1t, to~ether with the ages at the time of
decedent's denth of all minors, annuitants find beneficLnrtes f'orltf'e IJllrlc'r rh~cellentls Will. It nlsa
contains n. statement showinJ; which at' the henel'iclllries nllmerl In thn decedent's will, if lillY, dled prior
to decedent, the dltt.es of their lIClltll, t.heir tsslle, HllIl the relnt1011shlp of' snell iSSUl~ to thp- henef'1clury.
That S.:hedule E Ilttoched hereto and Tnnde n part hereof' sets l'orUl Illl property, relllllnd per-
sonul, owned by the decedent Jointly with another or ot.hers, including Int.anp;lble, standtnJ!; in the name
of the decedflnt and others, plus the date find place of' record 01' instruments el'fecting the vestttllre of
red esta.te /lnll the flute of acquisition of personalty, plus the Bllrne., ndrtl"C5S nnrl'r'cl1ltionshi}l, if nny,
of co-ownel'S to the decedent.
TllItt Sc/1edule F uttuched hereto nnd made Il pnrt. herc!Of' sets forth fully IIBd ill deta.il all rlebts
a.nrf. deductions clnlmed for llnd on hehnlf of this deeerlent's est-Hte, jlle1urlln~ funeral expenses pnidj
family exemption, where nppUcublej costs of admlnlstrllt,1oll of this cstntej counsel fees and i'lIrHcinry's
COrrJ!11issions paid or to he paid; cost. expenderl 1'01" hllr.tnl trust.s, tombstones or gruvemllrkers, ....:~ reli-
gious services, in consequence or the dellt.h of th,! flececlent; llehts Ilnd clulms owing; nnflunpnirl Ilt time of
death; taxes nccrlled chl1.rgeuhle for period prior 1.0 dClcellClnt's ll(!(lth (exC(~pt those II 11 owed unrter Section
651 of the Inheritance unrl Estnte 1'nx t\cL)j to~ether with II st.atement of coll/ltcral pledged for oblign-
tions, if any. It is ngreed tlmt the i'iductllry will present 111'00(' nr sldd clllll1led ohllgations upon re-
quest, that if the nmollntnctual1y pnlfl in settlement of nny fee, ennlmlsston or cieht 15 less than the
cst.lmlttc(l umount claiming Ilnd nllowed, that till! same w1.l1 he repol'ted to tile lleg1sl.er of' Wills, nnd that
the amount of' tax IlSSI!Sserl cun he reltssessf'li ill llccordullce thnrnwlt.h.
That the totllls ai' tlU? I\pproprinte columns in Schedules "A", "H", "en, "E", /InrI "1"''' fiS d1.rectell therein,
have 11cen cllrded forwllrd Ilnd properly rej.!;1.stered ill the Summnry.
)JtldA-c ,C C2 ";I-~?1
{~;;Etfr~;{;j~~f~m""m"""""":,,""
.,2.],J.....\';,,~:':.;}J:......:..:..~..:.~}]....,,::..E.!.'..0..9..~.... "...........""......"'~........M~..
(Street Number)
: :~, c::~ ~:1~,'\.9,,:.0,~~.'Y.~.~.~..?,.....?:?~'~"in.. '1 70S~;
(City or Town and State)
Subscribed and sworn to before me this
...m.."'''..''".,...2~,~-<.. "" day of ,,'" '" "7:2"""" ',',c", ' 19,..0.9",
/ /'
(/ '- // /;") /.
/' ~'" l.j....v'... /~?/.- /..:.')1~ _1-..../c~.."'..'-.J
....."~'{..INII~ M UO\V,IR:tlOI"IYI~lBlIC "" ' "
MlCH~mCSiJIIIlC IIGHO. ClIll.IillllMIP COUNTY
MY COMMISSION [IPI!lIS MAY l:J, 1984
Mcmlrer. rCIlt1s';lvanlil A~SO[IJtIO!1 of tlolilTlt'S
SOTE: lll~forf! si~lIlnS!.. nff'lclllvll. m/lkl~ ~l1rl~ 1\11 blank slHle~s In t.Ill~ IIl'fhlavit Hllci :-;ehC>111l11~~ Ilnnexeci ltre
fUled In with detnlls or till' word "Sonn". nllll in t.'lIse t.he II"iSC>t.S Inelwll' rllre fllld I1I1URted securll.les,
securjtie~ of clos(~ or fflmily clIrpornUnns 0)' 111I int.ernst ~n /lilY cn-pnrtnershlp or h\lsln(~ss, t1l1lt the
'datil IH)d s t.ntf'mHTlt,s reqll! re.1 under the J111I'Il~rllph ahO\rl~ rl~l n 1.111J~ to Sdll'dul f? "Il" lire II t. tl1chect. ,\1 so mnke
certnin thnt column #1 In till! "SlImnHlq'" has hf~nn prnlH!rly cnmplt~tl'd tIS Ilhn\'e-dtrect,erl.
"'I.:C~3"J~.
CDMM~'l:H'O~ .MS'(LV"'NI~:
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDEN~ DECf:DI:NT
.....;,,,...
SCHEDULE "A"
REAL PROPERTY
*'
Tho Inal property located In tho Commonwealth of Pllnn.ylvonla .hould be (1) (2) (3)
dllllcrrb"d by lot and block number, .treot and "'Ie' number, together with DEPARTMENT
o gcnoral description of the proporly, with Q reference to ,ho record of the ASSESSED VALUE VALUA TION
conveyance by which tho decedent took title; If 0 farm state numbor of a. FOR YEAR OF EHIMA TED CAUTION
crOt; alia .Iolomont of mortgage oncumbroncu upon each porcol at death DECEDENT'S MARKET VALUE (Do not writ.
of decodont. Taxel, aUllumenl., accruod Inl.,..t on mortgagel, ote.,aro DEATN In thl. .pace)
to be II.ted on Schedulo "F" and mUll not b. doducted from this 'Chlldulo.
None t;one
"
"
,
,
, ,
Reol property in Pennsylvania, with statement of mortgoge encumb'ronces upon each parcel at death of dece.
dent. Property held by the decedent as tenant in cammon with another or other, should be identilied
as to quantum 01 interest and the estimated value should be that 01 the decedent's interest only, (Property
held as iaint tenants with right 01 surviorship or tenancy by entireties should be reported on Schedule "E.")
Insert this tolal opposite "real property", Schedule "A" in the X X X X X
"As Reported" calumn an the last page 01 this return. '
None
NG1tU
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*'
DATE
Cl I )(!)
ESTATE c.~( J .~., '~', ",U ^,,,^aO^Ii~
__ . Q 'I.
FILE NO. -2 1- ~ :J. ll-f--
COUNTY 1-; 'V',^(\ LJ 4>1'; ~
DATE OF DEATH 7 ~! Ci/, Ie; to
~.
~.
.-
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Appraised Value of Estate:
Real Estate
I '7055
s
Personal Property
+ I \7 ~!t)(" L/17
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i-) 1/') '~" () 0
- .,
s c:').ii( k f7 q ',. (b~
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+
Jointly Held PropertylTransfers
Total Gross Estate
"
Clear Value of Estate
~
s ) q
,7-;d ,G;
/ 1/--(-, 76
Total Approved Oeductions
.--
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
s /q II/-b rIb
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Amount Taxable @ 6% Rate
s
tax due
s
Amount Taxable @ 15% Rate
/0;
/
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,
tax due
~J:-'7d (1./
s ~f"7 ;).0 I
TOTAL PENNSYLVAI~IA INHERITANCE TAX DUE
... ... '* .. '* ... A five percont discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
AMOUNT PAID DISCOUNT INTEREST TAX CREDIT
$ ~ ()"~ Q " + $ / ,) 'I ')./0 - $ = s d. / (l ~ db
, ,
?{,b ']5 + = nl--. ?c;
+ =
,
3-;;/5-~()
/ () - 3. ell
Interest accrues at the rate of six (61 percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
is
/"(C~~t~
$ {{', VVI :/v\
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
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