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Tn In~lHl~ pr(Jpi~r crcdlllu your ;I':';')('i:t. !"" ;,,11110' (:\ !I'~ !",td!l: .lfH.! ,'lit! fIlliTllJ.:! :,II(;~Ji'J~!l' r;"<lIIY jlfllll-
nd on till"! ch{~ck ur flHHlI!Y llrour
TlJi!i ,,~~,P~.~IlH~rl{ r'j lllilde ill i'l(..I:IJld,llICf~ \'Jlli, ,_;I':!.',.<I\ /(If; 01 tI\!' trdh~~ltar\I'I~ ilnd L~:tdlt) Till( An (If
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,I, .'l' Ci) rl'or,t!I~; ;d:L'r lhe dt'J\l1 ,,1 n'I' d'!Lt~d"l1l. d
diSI;ounl 01 fivt.l (~l purcenl r':i allOWt!d (/"J P.S ~! ~'<1f~~~. -" 1 6).
InhVfrti!!1C.! Till{, uther lh:m t;:.>\ on :1 f!;lur.' inlul:~;t, I'; dll" ,!I ihi; dilUJ "f 11\1~ (jn:f!r!nnt'[, r1P,ltll itnd ll/!I;olnp.s
delinqu"fl! fit th,~ f'~IHri'lllf)lI 01 nlfH! if}) 111Ilrllh!; ..lllt:r tlw dIJc('th~r)t'~' tJo.-;nrr (72 PS ~; LtJfJ!:l-711), Irdlf!f1tance
Tax on il future intuest 15 payabltJ wlthlfl thrf)f~ (31 1110llt 11 5 ;!fler tile lfi1fl~,t.-ir 1ilk.::; dler! In pos~ession unci
enjoyment and I!; dolinquent llltJ(Pdlter 0:' p S. ~; 2,~W) -;l~'l CilltuiillC Ifdt'rl~:;lll'..rl\ ll..~ dollt1ljlwnt dilltl stlOwn
on llH! fac,e of lI~j,; forrlltO 11w UJ~e of ilLIlJ;.'1 p(JYJ1\l~:1l t"ilf1\l till! fuilvwin{J l[\te;I~:il tdlolw
--------- --.. __un..______~"
1 munth DO!) I-I rllon!h~j 020 ., Illor.ths
2 months .010 G 1l1ontJl0i .O2~ t~ 111,m:hs
3 months 015 G nlordh:; Cl30 9 llIlJf)lh',
035
.O,H)
04~)
10 mor"-Ils
11 rllonths
12 monlh:;
,050
.055
,060
----.----.---------.-- .~-
I days .00017 II dol}!'; OUlf;()
2 dllYs ,00034 I:? d,lVS lL,203
3 days . ()()05 I l:idi1';:C; ,002::0
4 days 00068 14 ll"Y5 (1{)2JJ
5 di.lYs 00085 1l)(1;,'1'S UiJ/~,O
6 days ()()IDI 1 G d~l'i~ OO,:l3)
7 rlnys ()()118 1-' dd'l'j nOlE"
8 days 00"135 1 S d;-1'{5 0(;301
9 d:tys (XJ152 19 GdY,~~ 00318
10 days 00169 20 d;JY~; O()315
;.~ 1 cia\,:; .00352
ndnys 00369
23 days ,00385
24 days 00403
'15 d<.tys ()()420
26 days ,00437
27 days .00454
28 day~ .00471
29 diJYs 00488
30 d.JYs .00500
- - - -- - ----- -.-- -- ---- - - ---.. _. - - - - -- .-..- -- -..
. -..-... --..- - -- -- .~. - - ------ --- - - - -- ~
Any P<:HW In imerest, Incllrdin!J 11w C(Jrnfllur~VJI~illtlr
the assessment O1Jy ol>l"ct lherelo v,llllrn 'ir1,ty (G(\\ dd\~,
1001 uf the InlltHitaJ)ce anti t5ldll' Till( Act oi 18i.i Ii /2 P.;.:
dnd \11~! w:r;llf,;JI ll~pt'-'Sl~nl.:i!ivc, not su:i~;fic;1 willi
;:.11\'[ rt)c,~ipr d till', r~ll!ICI~ ilS !HOvl,:;ed by Seclion
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Rcci'0a (3-731
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
6UREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES ONLY
OF RESIDENT DECEDENTS
*' 1- "-r.
COUNTY OF_~'y~!!ll]nLh~()
....
This return must be c::omplotod in detail and filoJ in dUIlIlc:alo, with ,hn Rnul.tnr of Will. In tho Counly whOle tllll lltlellll..". ,..hl'1I1 wltlt'n nlnft
months aftor dato of death, unless an extonsion is gronlod by Ihe SOCllttory of RnvlIlluo,
Will "I-f', --:;I.'$"l
Admn. No.
19_ I. -Les.ter-J.--'-';; .."nb___.__..__,.______..r -14-Hemloc"""[\",; 'Mechanics bur'"
1I1/1T.1Tr ~'Io^Ilt'l'm,,', ~
Misc. PO. 17055
being duly sworn according to law, dCPOSl'S I\lHI says thlll ilL' is lh~ _.~______s..9.J._~_...!!~~_v_~.~J.l1.9..hci.r
\1 )/,LC., "1)1.\,, Ll'-OA111. 1.11,1
laic of . -~+i~'~~'~~(~~il"'~~~~~~~'~~
OClllClCIllOK' or .J1azie....E . Staub..
consisted ur the assets listed hclo\\' and Lhal allowahlc dehts !llltl dl~llllClillll:-O l'\I,.'I'I'tk(1 Ilw fail 1Il1lrkl'I vllttle or the nsseUI IIntl
deccasctl, and thuL the whole of thl: estate Ill' saiJ d~i.:cdcllt, \\110 dil'li nil
March 16, J.980
(\l^ 11'1
no Pennsylvania Transfer Inheritance Tax is JUl,.',
Sworn and subscribed be foro mo
lM9 8,0 -^ S b N IJjpeA~,~",,<l! "
ar ana , lilu, ohrv ubhc
J ...;(..C'(,-?f,l! Sole HeJJ:."
, (TI1LEf
~, " , ,
ASSET!
E.'lmllt.d
Mill"'"
Vulu.
Department
ValuatIon
CAUTION
(Do not wrlte
In thl" ee)
Type of ASlct:
Roal Estate, Pan.
Property, Jointly
H.1d Prop. or
Tran,fers
/r{c.l"rl'lhvr" fi\
'\'I1~\jlql'" \.'1.'1\1 Y
(AIIc:lehaddillonollhulth IllIlIIIUU'Y)
Dalerlrtlon 01 AI'"
Personal
Property
25 Shares Adams county National !Junk ( . '/.
Common Unlisted, Littlestown, )111. /'1.111
$ 600.00
Joint Property $100 U.S. series "1]" Savings Dond, No.
C 215 504 982 1], issued [.'ebrullry, 1955,
held jointly with her son, [,OLlter J.
Staub (W-4-;-Z0).2 /1, t I,.
.~--.....,
(~~:l:..o)
/ <' J', :,,-,p
Joint Property Savings Account, No. 502-956-6, first
Bank & Trust Co. of Mochunicsburg, Pa.,
held jointly with her son, Lester J.
Staub ($l,7Z6.68)V
(Account opened February 13, 1964)
863.34/
TOT ALS
1 575.44
~S"'1/.1.I.J
-f{~
IlEPOIlT OF INIII-.I\I r,\N('E TAX ,\!'!'IIAISEII
I, the undersigned duly appointed Inheritance 'I'lI.\ ApPl'lliscr in llnd fur the uhovc ('uunty do respectfully report that I have
appraised the real and personal prnpcrty us Tellurlcll in Ih~ I'nregninp, ",dll'IIlIlc lit lhe \'lItuCtl set forth oppnsite each item in
the last column to the right. . .iLt'" /7C. 'dI.LuiJ..
Dated:. June 25, 1980 --.-----~li'lllllllf^.~7t~-1-^)( ^~PI1^15Em.-'-.~
Name of Payee
OEBTS AND OEDUCTIONS
--N~I'~-;;.~-I"C'i~'j~;;" --.-.-..
Amount
Claimed
Amount Approved
by Register
Cocklin Funeral Home
Dillsburg, Pa.
Funeral Expcnsea
$2,140.40
I
i
1_-
TOTALS
1/-0
1lll'1IUIlII 1IIIIUlilSIIIIlII'WILLS
I. the unJcr:-oigtlc~' duly l'lcdl'11 I(qll..li'llIl \\111" III 111111 1111 lh\' ,thuH' ('\llIllly, lln respectfully repuft that I have allowed
dcJuctilllls 'in Ihl' llmount.. !old tHllh IlIlhl' ,lh..\'I' '\IIWllllli' .1" r1illllwll, ,'u'l'pl "here I have set forth a greater or lesser amount
in the I.st c..luI1I" Il'~'~. 1.11. \,hil h 1-\11',111'1.,11 k....ll .1I1'HUIl! II'PI\,..t'l1l!\ lhl.' :-own ..Ilowed as 0 dcdu'lion.
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RCC.n. IQ'6al
COMMONWEAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
'*
.--------.-.---.-----.------------ .--.
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby mode lor c oosenl to the tronsler ollhe following securities 01 0 Pennsylvania
Corporation or 0 Notional Bonking Association located in Pennsylvania:
DATE April 28, 1980
(0) 25 Shl'lr@B (b) AdAma county Nl'ltionl'll Bank (c).-CQl11mOn
(NOTE: In describing securities enter in (a), ob Ole, either the number 01 shores 01 stock or the face amounf of
registered boods, in (b), the nome 01 the issuing company and in (c) the closs 01 stock or the stated interest rate
and maturity dote 01 registered bonds.)
ISSUED ON February 22, 196,lIond having a TOTAL MARKET VAtUE OF $ 600.00
(Do'.)
os 01 the dote 01 death 01 the decedent, Mazie E. Staub
Cumberland County
who was late 01 Nursing Home
(Street and Number)
(Name of Decedent)
Middlesex Township
Carlisle
,on March 16,1980
(Date of death)
Cumberland
(Post OHice)
(County)
Pa.
(Stat.)
The securities ore registered as lollaws: Mazie E. Staub
(Name or names in which certificates ara registered)
HEIR
__HiOOl
)
Lester J. Staub, 14 Hemlock Drive, Mechanicsburg, PA 17055
(Name) (AddrBss)
NAME OF APPLICANT Lester J. staub
14 Hemlock Drive
COUNTY FILE NUMBER .:::if .~:" -.:;~'C; ADDRESS OF APPLICANT Mechanicsburq, PA 17055
BUREAU FILE NUMBER SIGNATURE OF APPLICANT j0~1 J" &~
HOTlCE: IF YOU FAIL TO PROPERLY FILL 11'1 AHY PORTIOH OF THIS APPLICATIOH, IT WILL HOT BE r
COHSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
Dnu ~x PUI6
COMMONWEAL TH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
DATE GA'!. .1'~./'i~'"
I hereby consent to the transler 01 the above securities now registered in the name 01 the ~Ioresaid
Decedent and waive the filing 01 a certificate certilying to the payment 01 the transler inheritance tax to which
the property 01 said Decedent is made subject pursuant to the provisions 01 the Act 01 June 20, 1919, P.L. 521,
as amended ond the Act 01 June 15, 1961, P.L. 373, as amended, This is also in accordance with the provisions
01 the Act 01 April 9, 1929, P.L. 343.
This Consent to Transler the herein described property operotes only in relerence to the estate 01 the
abave.named Decedent.
~~
~
Signed lor the Secretory 01 Revenue
) '. ). '.
By )(-"'.1.._ I )", Llt)
('., (Slgnotur.) I
M!"-~ l(o';1,j,. ,'II,\:iL t:(t"j.,,\.,.,\
(Tt I.) t (County)