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I COMMONWEALTH OF PENNSYLYAIH^
DEPARTMEtlT OF REVENUE
BUREAU OF FIELD OPERATIONS
TRANSFER INHERITANCE TAX OIVtSION
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COUNTY OF _(!lLJILJij,J!.d.,.J.L-
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This return must bo complohtd In dotall and fllud In dupllcato, wilh thu ROlJl!dor of Wills in tho County whoro the uocudont rtlsidcu withill nino
month. ahor dohl of dooth, unloss on oll.toollon 15 grontolJ hy tl,o Socrolruy or ROVllrlUl).
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES ONL'{
OF RESlDENT DECEDENTS
Will ,2/-5(/-.:2-57
Al.ln1l1. No. \1)_
Helen Goodhart ..____..01' 4710 Courtland st ._._ Camp_KU),
(NAMEl ('d1nl~L~~1 Pa. 17011
Misc, S
hdllg duly s\\'nrlllll~l'ordillg III la\\'. dcposes ami says Ihut he is thc _____.~i~.<;;~__..--...- -_.-."
lEXC.C" ADM.. LI~(;....TFE. ETC,1
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of the estllte of __ .._,__,_li~-:\;1;j.!!-".e.-..J?,Pr!tI:l~le...,_,_.,-_.. iatc of___HamDden.ToWDshil1
_ \CI1Y, 1I0110~JGlt, OH rOW~lSHlf)
deceased, lIod that the wholc of thc cstate of said dccedcot, who died on ,___....__N.<:l_ye_m~e,r...?~,L,:L9.79.
(DATEI
consisted of the asscts listed helow and thnt aliowable debts and dednctions e,eeeded the fair lIIarket vaille ..I' the assets and
nu Pennsylvania Transfer Inlwrltancc Tax is due.
Sworn and subscribe
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{SIGNATURE) (TITLE)
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....T-ype..of.
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:PrQf!lllty,)O '1' y .
\h'Held',ptotp'.Mor1Y in J. fl. 1'132,
Transfors
.. ~.~u!~iGl~ Or- \'/i;.:.~ .~ ;1.'
Ccrll.1lh:ion L:1Jiru: ASSETS
(Attach addltionol sh<!ots if nocossory)
Doscription of Assof
Estimated
Markot
Value
Deportmenl
Voluotion
CAUTION
(Do nol write
in this :>poccl
CCNB Savings Acct. #059314-2
Jointly held between decedent
and niece. $950.01 at t
Interest off insurance
475.00
125.40
<116MJ, '/-1)
REPORT OF INIIERITANCE TAX APPRAISER -.88'(
I, the undcrsigncl.l duly appointed Inheritance Tax Appraiser in and for the above Cnlllll)' do respectfully report that I have
appraised the real unl.l personal property as reporled in the foregoing schedule al the values sel forth llppllSilC each item in
the iust eolomo to ,he right, ..J'1!~LJfLuJ_dl!i.L---
Datel.l:~a.Y--8.,. 19An (lNHERllANCE TAX APPRAISER)
TOTALS
600.40
Name af Puyee
oeaTS AND DEDUCTIONS
Notufe of Clolm
Amount
Clain"cd
Amount Approved
by Register
Gilland Memorial Work
Funeral Expense
Marker
1147.54
165.00
Grove Funeral Home
Filing insolvent appr -
isement & Notary
3.75
TOTALS
1316.2
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REPORT OF TilE REGISTER OF WILLS
I, the undersigned dnly elected Register of Wills in and fnr Ihe above Connty, do respectfolly report that I have ailowed
deductions in the Ulllonnts, set forth in the above schedule 'i> el,lillled, except where 1 ha"e scl forth a great,-r or lesser alllool~1
In thc last C(ltumn~t1 th' fight, whIch grt:alcr ur lesser illIluunl represents the sum ill 1wcd as u dcduCllOll. ',--:: I-~'t../ J
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INFORMATION
To insure proper credit to your account, tho 11<11110 01 the ostl1to nnd lile numbor should bo clenrly print.
ed on the check or money order.
This assessment is modo in accordance with Section 708 01 tho Inheritancu Elnd Estote Tax Act of
1961 (72 P,S, 9 2495.7091,
To the extent that inheritance tax is paid within three (3) months ofter tho doath of the decedent, a
discounl of live (5) percent is allowed (72 P,S, 9 2495.716),
Inheritance Tax. other than tax on a future interest, is duo Btlhe date of the decedonl's death and becomes
delinquent at the expiration of nino (9) months after the decedent's doath (72 P.S. ~ 2485.711). Inheritance
Tax on a future interest is payable within three (3) months niter tho transfer take!> effoct in posseSSion and
enjoyment and is delinquent thereaftor (72 P.S. S 2485.712). Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using tho following interest table:
------------ --------- --------- - -- - ---- -- ---- --- - - - -- - ---. -- ------ -- -- - - - -- --
1 month ,005 4 months ,020 7 mOl1lhs ,035 10 months ,050
2 months ,010 5 months ,025 8 months ,040 11 months .055
3 months ,015 6 months ,030 9 months ,045 12 months ,060
1 days ,00017 I' days ,00186 21 days ,00352
2 days ,00034 12 days ,00203 22 days ,00369
3 days ,00051 13 days ,00220 23 days ,00396
4 days ,00069 14 days ,00237 24 days ,00403
5 days ,00085 15 days ,00250 25 days ,00420
6 days ,00101 16 days ,00267 26 days ,00437
7 days ,00118 17 days ,00294 27 days ,00454
9 days .00135 19 doys ,00301 29 days ,00471
9 days ,00152 19 days ,00319 29 days ,00499
10 days ,00169 20 days ,00335 30 days ,00500
-- ------------------- --- -- -- ----- -- -- ---- -- - _.~_._---- - - - --------- -----.
Any party in interest, including the Commonwealth nnd tho personal representative, not satisfied with
the assessment may object thereto within sixty (60) days after receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act 011961 (72 P,S, ~ 2495-10011,
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below: