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No 21.80 30.1
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of \[/'.'1\-\ R.l,.jlV l\1.:......._G.A~ GQ-\tlL ,deceased,
, '" I kl j:>,. M, }-(I>:' \.\ C.'\ k) c.~ ,,\ i1. e, ,,-,e.. \() AI k\'I
M~ry c. Lew~S ~,\{\;C-~\ ~.~ '\'1 (1.\.01 \\.: (. (-\ C. \'\i.?.. 1 \:..1.::..
Ta R.vl.a. d C. AI ,dEl !38Q, Register of Wills for the County of Cumberland,
in the Commonwealth ot Pennsylvanio,
IS
Petitioner(s) Gfe the executJLLl>.- named in the Last Wiil and
Testament of \J ,c" ,h R"I '" M, ((~.l;,'IC Ie dated ^,-)/,.J'~\ ?i)"lc, II
Decedent was a citizen of the United States and a resident of
Township
'Bor-eugb', Cumberland County, Commonwealth
\..\ A ,\'\ ;~ -nf. " )
of Pennsylvania.
Decedent died on :-" ,'0 ':") '\' '"'
,'Ju T \-\
day of
ApQ\L. ,
State of
the
A. D. 19~, in the County of c... v ('i\, D, i: ('.... U',,-J D
'1:>;:: ,\: ^ '; <,. ....\ L \J ,,",,'V ; r-> at the age of1.?:> years.
,~ -hes- her
Decedent has not been married and has not had children born to him
since the execution of the above described Will.
Decedent was possessed of personal property to the value of
U. \ ) 000 ' Cf) and of real estate to the value of
It; '2 " -
o CJ,C)(....... .....'-.)
I -
'.
.
estate situated as follows
as near as can be ascertained; said real
I ",,,\,)<-,, (.,~, ,'":> \20,"\"1'> & <;"'(hX(,lill.J \l1... ~Q...
'F "'''' ~ (\) ( \.\ kM ~ -.J -\(,.,:.;,.\)"'.\-;") r c:- f'V\V ~ .
~e~t*Y-
Therefore, your petitioner(s) respectfully applies for the probate
of the said Last Will and Testament and for Letters Testamentary thereon.
Dated MP<-"'- I 1'lt:.O
I
Name and address
of Petitioner(s)
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c:...\..\ ~f1...l-.o II CO
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COMMONWEALTH OF PENNSYLVANIA ~
ss
COUNTY OF CUMBERLAND
('.d f\ (~ Li.) IT ~
Iv\ '
\-\.:::,.'1C\L
named in above application, being duly
say(s) that the statements set forth
:-\ .J.~ C \~ N according to law
in this petition are true to the
best of
Hr II..
knowledge and belief.
) r./'j,) / -
7/ 1/.L-<"-'1-'//}'"
sworn
and subscribed before
", /'
C,,,; ,>,y..-/",,/7.:.
v:Flo
me I.;ay 1. 1980
'/)) , A,! l; ,)
-L/.i~t;1d ~~:'?~~,{~: Register
-~._-----~
Filed; l~ay 6, 1930
.;;l.1-~P - 3D/
Attorney: 2..'.<:.?\ L
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OATH OF SUBSCRIBING WITNESS
COMMONWEAlJl'H OF PENNSYLVANIA I ss:
COUNTY OF CUMm~RLAND \
-
This. ............... ........... ...... ..!:':.~.1!.;~ .c.................. duy of......... /!1.(:I,.;.::....................................... A.D., 19.5..~..,
before me R;,I.~..l E. t.l.awlsR, Register for the Probute of Wills and grunting letters of Administration
in and for said County of Cumberland, in the Commonwealth of Pennsylvania, personally came ..............
........................ b.. i2. \-;':-r. /\ .((.:\?........ },";,;.........( .'..~.'. .}:).. Q. I......!? !:.~.. .C? f..............................................................
the subscribing witnesses to the foregoing instrument of writing purpo:cting to be the last Will and
.. \.,:)- ~'1
Testament of .....l1l.~.T..I;\..~~I..':.<.........{~L..,.....\.:;;.i'~i.::,.b..V,.U..1..;"................ Dated .......I:....("w;.,.L..:..::-:...J. 1
-
lateof.............I::\..~..()f.....~..y.~..,\J...................\..(.,...&....k:~.J.:\.'::.1.';>.............. Cumberland County Pa., deceased
who being duly .........:~.,.<.;.',L;..;....~........... according to law, depose and say, that ........b..e.........'.;..iU..~.....
present, and saw and heard the testa.:t..i~...;(.\.................., ......\{,r.\..1.!:':j,',-.~..\-J........I\\..;.....0.\';:?;-:.0.~;,.~.~~<-
sign, seal, publish, pronounce and declare the said instrument of writing as and for h..\:.C........ Testament
and Last Will, and at the time of so doing .................;?\;\.~......................was of sound and disposing mind
memory and understanding, to the best of ..............\~...\..:,......................know1edge, observation and belief.
sworn . ~
............................................... and subscribed be,ore
~:~ ~\ ~
.....................:.........Z~......................
....~g~..0..:..~;~~...........................
Rl....l...cu B. ....J.QUU, gist.er
..................................................................................
..................................................................................
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA t ss:
COUNTY OF CUMBERLAND ~
.................................................~:..::~..~\.~:;.........\;..D..~..........C\~.. ......Hs..\.I'\,;,,:\;.,rJ.::.:;... ........................being duly
................~::'.'?~.~..................... says that as nearly as can be ascertained the said decedent ..........................
\ ~..~::U~f;;. \;i 11.'''1'' ..t:!\.......G, .'.~.js .\?:>. \;~.\.\...\ ft..,...~: \ ::~\i.:....i~.... x;,':~l\:... \ h:-.l.I>i..... ;';'.!.\~;'.\;, .\;\\; \\..,.................... .died on
\ tl...( ~ fA f\'\\\\~L\ k.l\l\\I'-~tN C" r'i2.~.\.l.lll~
.....~;~.>..:.M.:;:,...:~~......"............. the ........:.{.~,i.;;..'.~..........day of ..............\\.\~.'~.l..>........................ A.D., 19J,~~
at or about ........':L~..??9.................... o'clock,"f..M.
...........~:-:-:~:;.l!..............................and subscribed this
1st !:fay
................................................ day of ........................
19, .~.~..., before
r
," ..../. // _', J. '
(/.>?/. ;>:;;" /J/ y(/.,V~....:...,__
......................................h.......~........j............~...........
....01{.(j...<(n...e....:;(i:!:,~:!.'!.........................
Im:}uu E."jI(. dCJovu, Register
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL1'H OF PENNSYLVANIA}
COUNTY OF CUMBERLAND SS:
Before me, the Register for the Probate of Wills and granting of Letters of Administration in and for
the County of Cumberland. personally came .....(:f.-1./"7.(.~l,,.;.:r:f..t;;.........A1...:.....6(?:';.(..(,\'..C~.~..............
who, being duly .....::?f:.,!.V.:'1.r.:-:.:., do .!:':S.... depose and say that as..:f.~.s,,~.y...!.3..~..~.............................
of the last Will and Testament of ..........1<:.~::T..'..\.l}..';')..~.........i\'.\...:.......Glf\I?~\\.?.(J,.I..\,..\<;:,................deceased
...:::>K.lr............. will well and truly administer the goods and chattels, rights and credits of said deceased
according to law. And also will diligently comply with the provisions of the law relating to Transfer
Inheritances. ....S...,.'.';?.I;...!....... and subscribed
before me.
May 1 80
........................................................ A. D., 19............
........q1Mt.l!.,./t(~~........................
R:{.h~..a . ..t.... ...fill, ~~~r
.c...C~~?i.....)?f..;..#..4.:0;Ii!.O'_.......
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DECREE
B . 6th May 80
e It remembered that on the ........................ day of ................................................. A. D.. 19 ......... there
Kathryn M. Garbrick, a/k/a
b ted d d d th I t W'II d T f :.:. r:ilthryn GarJ:,ri cl" a/k/a
was pro a an recor e e as 1 an estament 0 .....!I:ai:y...K:rt:l1'fyn...Ga.fllY:T~R......................,
1 f Hampden Township C b I dC .
.ateo ............................................................................, urn er an ounty, Pennsylvama. Deceased. Letters
Testamentary T Chv.rlotte 1-'1. Heiner
....................................................... were granted to ............................................................................................
Witness my hand and official seal the day and year aforesaid.
., .
........~})((<(:~-;;.6/..:...~~~..
R:..l)" .a E. .\Rd'lr"'"''' , Register.
COMMONWEA~Tli OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I_
J
5S:
Ch'lr lotte H. !l.. iner
.____ ____n___.._ ___,_._____________._..~"___ - .~.,.~-- ------.-
being duly s'>/orn ________ according to law, deposes and says that "he ___J.2---------- --- ----
_~:<ecutrix ___------------------ of the Estate of l(athn'll~cl
Harn!>den TCMnsh if.>
late of ______ _____ _ - --------, Cumberland County, Pa.. deceased and that the
within is an inventory made by _____<:.~ar!_Cl~t~_~_!._'~~~r:..er ___ __ ------, the said f::<ecutr ix
of the entire estate of said decedent, consisting of all the personal proporly and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the ligures opposite each item of the Inventory represent it's fair value
as of the dat~~d:::Jeath.
/71 and subscribed before me,
.----------------------....
"",,- ")],<""",~y"" 1
/V0-<<JrJ .~ .e;J;;;t
/ .
_____i-iui/L~:
)7) // .J/<'~
Executor. Adminhtrator
SHAWN S. COHICK. Notary Public
Carlisle. Cumberland Co.. Pa.
My Commission Expires August 21. 1983
c/o Saidis ~ GuidO
2 ~ \'1. H iqh str",et
C" rUs le, P.... 17')13
.-----------
Addreu
D.y
I\prll
Mortth
1930
Date of Death
20th
Year
INSTRUCTiONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personally or realty
4. See Article IV, Fiduciaries Act of 1949.
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~EV-449.(8.78)
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COMMONWEALTH OF PENNSYLV lUnA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPEI{A'I'!UUS
..
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COUN'fY OF _ _~_\~~~R LAND
R~SIOEMT UECEOEIH
.--------
IMPORT AMT:
-
IN TilE M'\"I'TEK OF TilE ESTATE.OF . }
Ka thrvn M. Garbric..k..-t1._J<a tbJ:Yn___-_
(STATE FULL NAME of' OECf;:DEN1'lGarbr ick
a/k/a nary Kathryn r,,,rbricK
Loto of ...."mheJ::-land-.--. _.~____.__.,___.,_.___ Luunl,
AFFIDAVIT OF
EXEClITOIt
I\D~t1Nl~;TIt^TOI~
Sta.. of Pennsylva[l:ia_______ )
County of Cumber land J '"
Charlotte ~I. Heinpr
Executor
_-_llIr
-----...--..--------------..--..-
of tho ulalCl of th" IJLove.namod ollc"denl boing duly '....orn, dOJlo$O
and soy
Decedent died
1\oril
?'1
(DAY)
, 19 RO J ~o'la'c loovlng 0101' will, copy of which is herClooltoChfld.}
~lnle'IOI(l
(MONTHl
Namo Clnd oddre" of ottornflY or }
other outhotlzod ropreuntatlve to whom
all c:orrupondtnce should b" mulllld.
Rober\: C. Saidis, Saidis & Guido
2r, W. Hir1h street, Carlisle, PA l70B
That as such Executr ix_deponenl is familiar with the affairs of said estate and the propcrty constituting
t EX E CUTO R-A DlAINIST R A. TOn:
the asslHs thereof and their fail market value.
That at the time lIf death there was no safe dCllositlJox registered in decedent's individual name, or jointly with, or
as agent or deputy of another, or in decedent's individual name, with right of access hy another as a~ent or deputy, with the
exception of the following.: -
NAME AND AOORES~ OF BANI(, OR OTHEH INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
l~one
THIS SAFE DEPOSIT BOX RENTED
IN tlAME OR NAMt!S OF
HELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
-=----===-.---.--- -
That the contents of said saf~ deposit box or boxes are itemized under Scht:dules nf a of this return,
with the exception of the following, for the reasons hcreinarter set forth:
That Schedule A attach~d hereto and made part hereof sets forth fully and in detail all the real property
in thcCommonwe~dth of Pennsylvania of whidl dl~cedcnl dieo having an interest therein. It also sets forth the
mortgage encumbrances upon each p:irccl or real property at the date of death, giving the amount still due at
death, namc of mortgugetl, dall:, rate of interest, and bonk ano page of record thereof. It also sets forth in the
columns provided therefore the ussessed valuation of each of said parcels, the estimated market value thert:of
as uf date of death of decedent.
That Schodule B aHacheu hcrcf.tl ilnd made part hereof sets forth fully and ill detail all personal property
whercsover situat~d owned by the dcccdellt at the time of death; all muneys left by the decedent at the time or
death, whether in decedent's immcdiutc j'Jossession. standing to decedent's crt:dil in banks of depusit, savings
biinks, trust companies, or olher institutions, whether individually, or in trust for any other person or persons
giving also separately the Ul.:l.:rued iHt~res( thereon, if any, down 10 the last illlerest day prior to decedent's
death in the case of :-;a\'ings banks, arid to the date of decedent's de:lIh in all other cu:-;es; all bonus, posti.\t
savings. trcasW'y certificatc!'; or flutes and other evidcnce of indebtedness of the Unitetl Slates to the de-
cedent; all ublig"tiolHi, whethel' by statute or lIf.rccmellt they arc designatctl as tax free, of the United States,
ur any state, or pulitical subdivision thereof, or of any foreign country, which arc owned at the time of death;
all wearing 8pp,lIcl, jc....,c1ry, silvcrwurt:, pictures, hooks, works of art, household furniture, horsc:<J, caITiages,
automobiles, boats. and any and all ulher personal l.:haltcls of whatsoevcr kind or nature, left by decedent,
together with thc f~irly estimutt'o l1lilrkel valli(: thereof; .111 hUllds and lIlortgages held by decedent anll of all
claims dl.tc ami /)w!ng decedent at the tillll~ of death, and all promissory noteS or other instruments in writing
for the payment of money of which decedent died I,ossessed, of whatsoever nature, with interest thereou, if
any, giving the fllce value and estimated fair market value thereof, and if such estimated fair market value be
less than the face v~luc, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity ilnd endowment contracts
the proceeds of which were I'ilYlIble upon the death of the decedent; all and the corporate stocks and dividends
dUt~ thereon and unpaid as of the dutc of death, honds and accrued interest thereon to the dale of decedent's
death and other IovC'sImcnt securities owned by the decedent at the time l)f death, with lhe market value there..
of at such time.
.
. I
In the CI\!:H! of' :oh'(~I\I'1UllS \)l' close of ruml)y (~Ol'pCrlltJ()IJ!i, the vllllles rUJlort.NI ItrlJ III) "Ill" U6
plIsl'OJhlo Huhstl\fltlnltHI hy 1'Il1'tlld'\l fit.!\Lellllmls 0(' tho CI)I'pl)r'It,llJIlSI shnwllll( till! !.is'i0t'l /lnd Itllbl1!t~les
therf~ol' I\S or tllf~ i\lItc of 110'1'.,)', Thl' se'I(llhll(' nl:w SI!ts l'orl,1I tilL' l'll.f~rp!;L I\f 11nceflent lit t.fl/! ~lmp. or
"Cllth In lll\~' cO-l'nrlllt.'rshl\' 01' 1.)llslll'l~", flTlll In :"'lllp()f't. of' thl' V(llIll' uf' <;ll,~h Inll_~rnst t.hel'f! Is Itllnnx~d t.o
snltl scll.'(hil(~1 fllllllll'l!ll :-tt'lt,I~lT'.lmts .:;1\C'l'Nln!~ 1.I11'fl~<;Ht5 rllld 11!\lIllllll's 01' sll!fll~fl-p.'lrlrll!l'.'itlt{l or hu!'\ltll~o;5.
,\ l'lq'r of' Ill" t'r)~llllrllll'r...hip ,\~rl'I!TlI"'lIt, (If' nrlll, tl st.IlII'Ulpnl. ;~f"ll"l.!; f'orth till! IIlltur'! of' th,~ II.l;rt~(,ll1enl)
tO~?,l'tli('l' ....ttl1 /\ stllt.I~IIU!Tlt sl'l.lln~ l'orl.h tilt} ellllrpwl,pr nf' I.h,' hll..llll'''S, Its loeut.llJn, IltHI sll(~1l OUH!r ('/lets
l',~rtlltl\illl.!; t.o lIw 11\I~tt1...ss liS lUll}' h1' llprl.IIWlll. 1.0 II l'ltl,. IInrl .IllS!. PlpprlllslIl of' !.Iu> df!cj~llcntls IntArl!st
tlLt!I'I~tl1 mllst hesuhmlt.t.I'd. It Shollltllllfill set. l'ul'tll In 11.1~11I1"'.I'd f'orm, l.f""t~I.IH!r wltll t.h.~ fair mllrket vnJuf!
l.hl!rf'ol'. I\IIY otllel' propert.y OWIll!d or ImqtU!lll.hp.II hy till! tll'nl'lh'lll. fit till! t illll! of dl~lll,h.
the 5c/1(>dIJlp C IlI.lneIJl'!d herAt.n ItIll! Illude \Illl't 11l'I'pol' SI~t.S fnrt.h II trill! nnswer 1'.0 e/l~h inquiry
cont.ntllod l.herp.ln nllcl in t.lle cnSH 01' t.rnnsfcI's ofprnJl'-'t't.y. 1'1!1l1 Ill' pl!rS01\111 ~ 1t'lthIn two years of decetlent..' s
dent.li, In '~ontpmplllt.lnn of decedent's Ilent.ll, 1'1' Inl,l'lJ!h'd t.o t.~kA ef'fpct in possession or en,1o:r11lrmt Ilt or
after de/lt,h, suld setH'dllle sets fllrth t.lle 1l11tHrt~ IIlld vnlu" of sUf~h f1rnf1(~rtr, to whom trlUlst'f:'rrerl, the
relnl.,lollshLp nl' the transfefees to tile Ili!CClhmt., UII~ propol'l.lolllll.e sllllfe I'r'l~etvf!tI hy ellch t,rnflSfl!N.'I! ami
all ot.ht~r fnets of 1\ pertinent nnl.ure rnl!.nr(l1l1~ sn}o f.rllllsfl'rs. In the ellS!! flf' t.rnn<3fers 1ntemtpc\ to
lIlk(.' effect in possession OJ' en.loynl('T1t Ilt 01' uf'ter dl!llt.h, thef(' Is nlso ILtllll'h(!(1 to the scherlull'! 1\ copy
of t.he deed, trust Ill!,reement or ot.her instrument, crcnUng lilt' tl'ust.. Tli(~r.! Is nlso s('t. f'flrt.h in saLd
schedule H list of Illl prOllllrt~., rell! lUHlllcrsollu1, wlt.h It.s \'!lltH!, which pll~;ses fit lll~cetlentls clP.llth by
virtue of the exerctse by decedent, either tndtvirllllllJy, or.ln1ntlr wit.h IUlother, or nny power ot' Ill'lloint.-
menl vested inc.Iecefhmt, either lnrltvidulllly or .Jointly, hythc wt11~ ftp.(HI, or ot.her instrument of another,
with Il cop~. of t.he instrument creattlll!; such power lIttnchetl to lIll! sc:lwrlulc.
Thllt Schedule 0 attached hereto Ilud made pllrt. hereol' set.s forth the rll\mcs nort ndc.Iresses of nU
persons bcnef'ic1al1y interested In this estltte tit Uw Umi~ of' decedent's de/d.h, t.he lIuture of their rl"!S-
pective interest.s, thelr relationship, if any, t.o the dece1leut., together wJth the ll,-~es Ilt the time of
dect~dent.ls denth of fll1 minors, nnnuittl.nts tltlrl bl'neflclnrlt!s for lil'e uncleI' decedent's Will. It also
cont.ains a stntement showing whieh of tile beneflcinrles nllmer! ill the rlecnclent' 5 wi1'1, if any, died prior
to dececJent, the (iates of' their dCllth, their issue, lmrl the rellltlonshlp of s1leh issue to the benerlciary.
'!'hat. Schedule E nttneherl hereto nncl mlule n part Ilt'rf!of sets forth l\ll property, real ancl)Jcr-
so111l1, owned by the decedent. .10intly wit.h tJ.llothel' 01' others, Lncluding intnng;ible, standing in the name
of the decedent /met others, plus the date nnd place of recorcl of' lnstrumclIts f!f'fecting the \estiture of
real est.ate nnd the date of' Ilcquisitlon of personalty, plus the nume, nrldress and relationshill, if any,
of co-owners to the deceden t.
Thl~t Schedule F attached hereto fmd mude a part. hereof sets forth fully and 1n detail flll (lebts
nnd deductions cl~iimed for and on hehlil f of' this decedentl s esl!ltt~, Includtng funeral expenses paid;
famil~' exemption, where nppllcnhlej costs of admJnlsl.rnt.1on of t.his estnte; counsel fees /lnll f\ldlcial'yt 5
commIssions paid or t.o he pnldj cost expended for burtlLl tl'ust.s, tombst.ones or gl'nvemnrkers, and reli-
I!;tous services, in consequence of t.he denth of the decerlent; deht.s nnd claims owing nnrl lU\IHdd Elt time of
denth; taxes Ilccrued chnrgeahle for llertod prior to ,lecedent's CIOllth (except. those allowed und(!r Section
651 of the lllheritunce IUlrl Estate Tux Aet) j to~et.hcr with II stlltemf~nt of collateral pledged for obliga-
tions, if any. It 1s flgrecd thnt the fiductary wtll present proof of slllrl claimed obltgations upon re-
quest, thnt if thf! amount nctulllly Jlldd in settlement of llny fee, commtssion or debt is less than the
estimated nmount claiming II.nd allowed, that the slime will be reported to till! Register of Wills, and that
the wnonnt of tllX ussessetl CIUI llC rf~llssessecl in uccoroanee thl!l'cwi t.h.
Thill. t.h(~ t.Otllls of th~ apl1l'oprlllte Cl)lllnlll5 In Schcttules "A", "B",
h/l.vj~ been clu'rletl f'orwJlrll lUll' properly registered in thl~ SlInIDmry.
Subscribed and sworn to before me thiBd.Y.:'!..~\.....
.m..... m" . .. day of .. .. ..I!I/aUf/lr #/119/9
~l/lt.lJtJ ~Lr!f.u".,~'/!;
"~",
"E", llUO "F" I\S tl1 rected therein,
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. ....l,.....i:1y:i;<'!:??;,......!.//..#'L-?>~......,......,..
R (E:reCl,ttor-Admill.mrator)
.D. ~, Box }1
!<IOTE: Bpl'orl! slJ!;nlnp; llff'trlIlVlt. muke f,ure IlIl hlllnk splH:es III tile Ilt'flfll1vlt. /lnll schedules I\nnexell lLrc
flllpd ill with t1t!tlllls or tilt! wurl1 "SOIl(~", /llllt In ens!! tht! IlSSl'ts tlU'lml" 1'lIre IlJlfI unlisted securities,
sel'III'ltlt!'" nf' close or fnmlly eorpnrlltlollS or IlII \Il{l'rest III 1L1l~' e(\-pHI.t1Wl'~ld}l or IH15lncss, tltnt the
dlltll IlTlli st.lltt'mCllt.S rl~qllll'Ptl 1II1ller th.... IllH'Ugl,ltph 111)(1\'" l'l'latlu}.'. to Scl\l'tlull~ "B" fil'P. llttach('ll. Also make
cHrlldll t.hnt column #1 III the "SIlIT.tlHU'Y" hIlS bl?en pl';:)lll'l'ly l'umpletNI liS rd'ov~-di rect.eti.
SHAWN S. COlliCK. Notary Public
Csrlisle. Cumberland Co., Pa,
My 'o~1mjssjon Expir,'s August 21, 1983
(S;:;;;~..N;;;;:;b;;;:r...'....................._.._.
York, PA 17401
.............,....................,
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REV_414 EX+ tHol
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
1ZI Orj ginal
o Supplemental
o Remainder
File Number ________21-80-0301
Estate Name __________..K'!.t.\:l!'YILtI.._(:!lr!>rJ-cJ<__
Datc of Death ______!t-2P".JtO____
Social Security Number
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inhorltonce Tax Appraiser In and lor the County 01 Cumberland
Pennsylvania, do respectfully report that I havo appraIsed the real and pe..onol property a. reported In the faregolng
return at the values set forth opposite each item in the last column to the right in Schedules "All, HB", "C", and "E"
Doted:
FAh""~,,l' ?5, 19R 1
~Y<I,,'/J ;-Rftld,j)
INHERITANCE TAX APPRAISER
ADJUSTMENTS REMAINDER APPRAISEMENT CODE
INVENTORY VALUE AS APPRAISED CODE (NARRISBURG USE ONLY)
Real Property (Schedule A) $ 43 000 00 00+ 92+
Personal Property (Schedule B) 9 139 63 '0+
Jolnt.Held Property (Schedule E) none 20+
Tran,fers (Schedule C) 30+
TOTAL GROSS ASSETS ______5..?-ln3___ -92
Less D.bts and Deductions 40, 93-
(SCH EDU L E F)
CLEAR VALUE OF ESTATE
OLlie Estate RATE FACTOR PRINCIPLE VALUE CODE
o Annuity
FOR USE OF REGISTER ONLY
Tax on $
s;QQE.
COMPUTATION OF TAX
$
$
$
$
$
6"
"
Tax on $
15%
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
TOTAL TAX
INTEREST FROM
BALANCE
TO
$
$
$
Less Credits
DA TE OF PAYMENT
AMOUNT PAID
TAX CREDIT
S
$
INTEREST FROM
BALANCE DUE
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!'-,nEY.1l8lEX - -
.1 ~'~~,i;i"":;'r,,': 'I" COMMONWEALTH OF PENNSYLVANIA
\ ~.N()l: K 0 0039 S" DEPARTMENT OF REVENUE
I ~)I'(:, ' ' OFFICIAL RECEIPT' PENNSYLVANIA INHERITANCE AND ESTATE TAX
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TAX AT 6%
TAX AT 15%
Cbarlotu M. Be1Mr
CO' , Iq.
26 w.
Cadll11., P.. 17013
'--~f~iT~JNJ~~ATIo-7-;il-2o---i98-o----------
TAXAT_%
RECEIVED
II FROM
ADDRESS
2,342.89
ESTATE TAX
TOTAL TAX CREDIT
FILE NUMBER
21-80-301
LESS DISCOUNT
% INTEREST
TO_I
5, 1981
DATE OF PAYMENT JU
NAMEOFDECEDENT DTB1\YII1 M.
PLUS
(FROM
GMB1\ICIt
m
m
I
TOTAL AMOUNT PAID
I
2,342.89
CWlbedaDd
COUNTY
------------------------------------------
POSTMARK DATE
,"-" .-..-"
SEAL
RECEIVED BY
'--..;~J"L/f~~~~:u/.
_ Ragl.t'er of W111.
t
REGISTER OF WILLS
COMMONWEP;LTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
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COUNTY FILE NO:
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DATE
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DATE OF DEA TH--'.-!':';, ,C
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Appraised Value of Estate:
Real Estate
Personal Property
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+ ( ".
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Jointly Held Property/Transfers
Clear Value of Estate
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Total Gross Estate
Total Approved Deductions
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$>",','/ "// ::'>,)' I/,
Amount Taxable @ 6% Rate
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tax due
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$ .:.:< -/ L .,.", /,' _
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Amount Taxable @ 15% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
G :: ::; ./:? y '1
,
* * 1: * * * A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
OATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
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Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
/."r
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Assessedby: . " "'., I -
Seo Informal ion on Reverse Side Ag.nt~orlh'Comrwe~.
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To Insure proper credit to your Dccounl, tho numo of Iho osllllO and lilo numbur should be clomly print.
ed on 1ho check or money ordor.
This assessmont is modo in accordanco wilh Suction 700 of tho Inheritance nnd ES1<ltc Tax Act of
1961 172 P,S, 9 2485-708).
To the extent that inheritance tax is paid within thratJ (3) months after the death 01 tho decedent, 0
discount of five 15) percent is allowed (72 P,S, 9 2485-716).
Inheritance Tax, other than tax on a future interost, is due at tho date of the decedent's dCl1th and becomes
delinquent at the expiration of nine (9) months after the decedont's death (72 P.S. ~ 2485-71 '). Inheritance
Tax on 8 future interest is payable within three (3) months after the trilnsfcr takes effect in posseSSion and
enjoyment and is delinquent thereafter (72 P.S. 9 2485-712). Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using the following inleresttable:
------------------------------------------------ - --- -------------- -- -- - ----
1 month ,005 4 months ,020 7 months .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 11 days ,00186 21 days ,00352
2 days ,00034 12 days .00203 22 days ,00369
3 days ,00051 13 days .00220 23 days ,00386
4 days ,00068 14 days ,00237 24 days ,00403
6 days ,00085 15 days .00250 25 days ,00420
6 days ,00101 16 days ,00267 26 days .00437
7 days .00118 17 days .00284 27 days .00454
8 days ,00135 18 days ,00301 28 days .00471
9 days ,00152 19 days ,00318 29 days ,00488
10 days ,00169 20 days .00335 30 days .00500
- ---------- ---------- -- - ---- ----- --- - ------- - --_._--- - - - - ------ --- -----..
Any pllrty in interest, including the Commonwealth and the 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 of 1961 172 P.S. 9 2485-1001 j.
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below: