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RCC.103 {3.73)
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES ONLY
OF RESIDENT DECEDENTS
COMMONWEAL TH OF PENNSYLVANIA
_ DePARTMENT OF REVENUE
BUREAU OF COUNTY CO\.\.ECTIONS
INHERITANCE TAX DIVISION
*'
COUNTY OF Cum berJ'g )f d -
This return must ba com pIe tad in detail and fIIod in dupllcato, with the Roglstor of Wills in the County whoro tho docodent rosldod within nino
monthl after dato of death, unloss on extonslon Is grantod by tho Socrotory of RlIvonuo.
19_ I. Rt?heri- N.J(i..fl'd21fl'__"f~{,~..L2.J) rr?fuLr..c!nef"<'
(NAME) 1AtlDRE5~1
Mise, -
being duly sworn according In law, Jcposcs llllll says that he is the -1::i.iAe,'- _n_.__.______
, D /, I d (EXEC., ADM., LEGATEE, ETC.l
of the eslate of s..f.EIJJ:::"i1__.I-r...,,-w-e-/~' j'Le1':_'_--- late nf_!2L"- i- L71_S.0-/:J__L;,,{j2.,--------
\CI(v:-bdfWUGH, OR TOWNSHIV'
deceased. and lhat Ihe whole of the eslale of said deeedelll. who died no_. ..JI.I./Y--../4.,.-..I'l 'If.-~.-..------.------
/ 76ATEl
consisted of the assets listed below llnd that ullowublc debts alld deductions cXl:cedlld (he fair mmkct value of the assets llllll
Will
Admn, No,
no Pennsylvania Trnnsfcr Inheritance Tax is lIue.
19,fu
"/ i6.
-/:;;gJ-.11l/h~~'l~
(SlGNflTUREI
Type of Asset:
Reo I estate, Pers.
Property, Jointly
Held Prop. or
Tronsfers
ASSETS
(Attach acldltlonol shoets if necessary)
Description of Asset
!l7a.sla. 77 d fj'c fd SJr<.n 11/ - 5e.c<<.rd/ .P(ql/
.tellll. l1c:cCltol f I/o:>, 1-3101-{,
( rd.r men 'Trttd- ('.,)
/ftf CJet/I'GJ!'ef del17,;;;J,1e,! /;1
ace/de.n f: S:;/c! {;r fc,tlJ/71j dti.?C'J
TOTALS
/< '
~J4-L_-----
I TITLE1
Estimated
Market
Value
Dopartmont
Valuation
CAUTION
(00 not wrlle
inthlsspaco)
1Sl..90
52 bF:
,
(I/o (,{J ~e.
-oS.Sf I!.~-(J.s: 5'1
REPORT OF INIJERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the above County do n:spl.:ctfully report that I have
appraised the real and personal property as reported in the foregoing sl:hedule al the values set forth opposite each item in
Ihe lasl eolomll to the right, ~1tf. .Jtf f." 4.~ JUt. )
Dated: June 18, 1980 llNHERITANCE T APPRAISER)
Nomo of Payee
DEBTS AND DEDUCTlOHS
Hoturc of Claim
!Jtf.1tl7! H<-nera.! 110m
hLneraJ 8t 1/ /7.31. tt'D
less !;ooal .)eG,(,(.rd/ 2.55.00
11g1,40
I<tfj,sfer .,f' WI/Is
f; /1 711 r;:, e
/1/,) ftUi (:"ee.
TOTALS
Amount
Claimod
Amount Applovod
by Roalstor
/18'4.40
3.00
,7S
ff',IS (
IlEI'OnT OF TilE RECiISTEn OF WILLS
I, the undersigned duly elected Reg.ister nf Will~ in amI fur the ~lI)(Jve County, do respectfully report thai I have allowed
deJuctiolls in the amuunts :-let forth in the ahove schellule as clllinlcd. excepl where I have :-;el fonh a greater fir lesser amount
in the, last column to the righI, which gre.lter or lesser amount reJ1rl~scnts lhe s,u allowed as a delluc ;011.
::.-
Ilnte of hpproval:
c::?,j'.&-t,. flf~t 9', If~/)
d) 1-;0- t;? '1-/ II- 35'-
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