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Home My WebLink About80-00302 I . ..: >< H ~ ~ ~ ~ i i ~ ..\ i 5;l CJ) .0 I ~ . ~ C\1; :3: 0 ~ . C':l :I: 0 w- OO 0 ., - M .! 'b'l.. ~ . .3 .0 UJ z No 21.80 an:;: PETITION FOR PROBATE C; WILL AND LETTERS TESTAMENTARY , deceased. in the Estate of Eva H. SllUlnnn To n;"IIQ, d [, A"d(.1 301'1, Register of Wi lis for the County of Cumberland, in the Commonwealth of Pennsylvonia. ~ Petitioner(s) are the execut ors ._ named in the Last Will and Testament of Eva H. Shuman _ dated June 26, 1972 Decedent was a citizen of the United States and a resident of Newburg ~~~ Borough, Cumberland County, Commonwealth of Pennsylvania. Decedent died on Sunday A. D. 19~, in the County of the 30th day of March cumberland , State of P~nMy'v~ni" at the age of 86 years. ~ ~ her Decedent has not been married ond has not had children born to kHm since the execution of the above described Will. Decedent was possessed of personal property to the value of $3,000.00 and of real estate to the value of as near as can be ascertained; said real Nnnp estate situated as follows -- apply Therefore, your petitioner(s) respectfully ~X<<3s for the probate of the said Last Will and Testament and for Letters Testamentary thereon. Dated May 2, 1980 iI. .J C; Pf:' ' i- L/1.V"uc i. --<'J /li.'uvV\.c<-t.-L Name and address Carl E. Shuman of Petitioner(s) 406 Lurgan Ave., Shippensburg, Pa. 17257 v . Z' . 'kUv'C"i(-U.) )',t;,. " r- :J ... -\/L..~......:A...-1--- award H. Shuman 25 Montgomery Avenue, Shippensburg, Pa. COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND r.::trl \oJ. Shllm:lo. ::Inn HoW::trrl \J Shllm:ln named in above application, being duly say(s) that the statements set forth in sworn according to law this petition ore true to the best of , CI ,> lO Attorney: , ./,TJ I '. .-;../ L-~~'Y Filed; May 6, .J{c,f() - 3l>''I-- " LAST WILL AND TESTAMENT -.--------------------------- I. Eva W. Shuman. a resident of the Rorouph of Ncwburp. County of Cumberland and Commonwealth of Pennsylvania. being of sound mind and memory. do make. publish and declare this to be my Last Will and Testament. hereby revoking any and all Wills by me heretofore made. FIRST: I hereby direct my Executors. hereinafter named. to pay all my just debts and funeral expenses as may conveniently be done after my decease. SECOND: I give. devise and bequeath all my estate. be it real. personal or mixed. to my two sons. Carl E. Shuman and Howard W. Shuman. equally. share and share alike. or their heirs. THIRD: I hereby nominate. constitute and appoint my sons. Carl E. Shuman and Howard W. Shuman. to be the Executors of this my Last Will and Testament. IN WITNESS WHEREOF. I hereunto set my hand and seal to this my Last Will and Testament. written on two sheets of paper. dated this ..~nL!J day of June. 1972. _t,/..J.!:..a.--l~~-~~"-'--~~'Dg...:!:J..~----- (SEAL) This instrument was by the Testatrix. Eva W. Shuman. on the date hereof. signed. published and declared by her to be her Last Will and Testament. in our presence. who at her request and in her presence and in the presence of each other. we believinp her to be of sound and disposing mind and memory. have hereunto subscribed our names as witnesses. MCCREA & McCREA ATTDIlMlY' -.1 LAw tlCWV1LU & GHIPHNaOUAG PEN".. l " / ~, / I ,', /ll t'''' //'(, -'/ ____~~Li~~~ir-~-~~~I-I~~------ 'I' . ,r: J) !.. LL '.' ...L,,..'- .. I I' II, '''''-'LLL_______ 1.9 (i;;~}i'. ~Yt\::.;:. 'I"t'.:. ,. ;:>:-', ""...,,;:..,.,', ll;~~?:~':::.:,): ; II.",. .." i~J?:; ,I ,.......... ;l.....':. ", ",,~ l' .j' '.'" i' ...... ~'; , . 111;;-:1 '-i":.i:J: If.B::.:) . i ~',~:.< \' tf,' o ~ 1,-, M ".0'"., '-.." ;:\.i:~' :<1' I"~ \,,: ,., . , E-< Z JJ.l ~ E-< en JJ.l ~ E-< e:l IJ.< ~ 0 ::t: en ,.l ,.l "" ..... "" ~ E-< JJ.l en < ,.l . .~ - ~ i ... :lj.. ... .- 0 a:: ~ 1CI 5 o VI'- ~ u. . :loC- O>> ~i'i- j . :lj-J:5 ~ Q!~D.. 0'" ' u"'.! i ~.o= ~ . z ..'"- .. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I J 55: _______._____________.m. .~_..__.,.___.__ .,.-. Howard H. Shuman and Carl E. Shuman, --- ------ .----,.--..----------..-------- ..-.-- ~._--'- being duly sworn _... .._.... according to law, doposes and says that they.._..!'.'-"'..El",.J",ec~i'.F."-. ._-- ___----.-.-..-----..-...--.. of the Est.te 01 __&'l>U-,-S.b.\\!Jl.illl._. Hopewell Township late 01 ...._, Cumberland County, Pa., deceased and that the within is an inventory made by. ....___.__......---...-.'- - ---.....--, the said 01 the entire estate 01 said decedent, consisting 01 all the personal property and real estate, except real eslate outside the Commonwealth 01 Pennsylvania, and that the ligures opposite each item 01 the L!lnvent~ry. present it's lair value as of the date of decedent's death. dJ jf ~ !/tcUf Co UMWC~ Sl.lOV' VI and subscribed belore me, \ 7J~-MJ JIu~,"VL Ju 3",t '7 i 19 '60 Executor. Admin,.!"lo. G;"~ ~t'~'l~ . J~ tfI" /7"7 Arehard M. FO!Jol<wnr:f' Shfppaf1sbur!1, Cur',b Cu,' , --'. lilalit)' P.ubllo _ ~p., N~I Addr.u Data of Death --. Doy Month Yur INSTRUCTIONS I. An inventory must be filed within three months alter appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional a..ets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. ~ >- ~ .. .... w ~ ~ '" < '" I W .. ~ "- .... u 0 0 III .. .. w C '" ... ~ w '" .. I- :t "- u. .,; "- e Z .... .... ~ I .... <( 0 Q. 0 u. :I: ....... W 0 <( w .;. > Z ~ - <( II Z 0 0 c ~ 1\ III z 0 \l'=::. 0 ~ U Z w <( ~~ "- " e '" I - -;: I 0 ~ ..0 " .... ~ E - .!! 0 I '" ~ 0 , .... U u: '" COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I. ) 55: Howard W. Shuman and Carl E. Shuman, _._._. "'___ .____~ __________..______ _.~____ _ ._H ___~._____ .----.------------.-- being duly sworn _____.____ according 10 law, deposes and says Ihat they_ are the Executor-"_H__ ___._____... _ _._____.___.._._ of Ihe Eslate of Eva W. SjWJlliill Hopewell Township lale of ' Cumberland County, Pa., deceased and that the within is an inventory made by _' ___ _ ..__.m"__ ..- - --.---.--, the said__- of Ihe enlire estate of said decedenl, consisling of all Ihe personal prep..ly and real estate, except real eslale outside Ihe Commonwealth of Pennsylvania. and Ihal Ihe ligures opposite each item of the ;J:lnvenl~ry. epresenl it's fair value as of the dale of decedenl's dealh. -IJ / ~. (fttUfc:. <::~ ~",IC~ VI and subscribed befo,'e me'17/ChvM~ ~~"'Y\ ~"tt 7 19'CO E",,'or . Adminl.'ro'or ~.i,% +{./'-5~ .j~_d3L /72)7 R~hard M. FogGlgo"~e Shlppon,burg, CundJ. C". .' r Ilolart Publlo ~ 1'><9.. m,. - Addreu Date of Death Day Month Year INSTRUCTIONS I. An invenlory must be filed within three monlhs alter appoinlmenl of personal representative. 2. A supplement invenlory must be filed within Ihirty days of discovery of addilional assets. 3. Additional sheets may be attached as to personalty or really 4. See Article IV, Fiduciaries Act of 1949. ~ >- .,; ~ l;i w ~ ~ l- 'D I W ~ ~ ~ "- u 0 ~ ~ 0 W 1Il C '" t" '" w J: " l- "- .. "- c I- .... u. ~ , Z .... <( 0 "- 0 u. ~ ....... W 0 <( w ,;. > Z '" + Z 0 c " I ~ II - 1Il Z 0 0 '" U Z w <( ... "- -0 " " \ - -.: 0 ~ .<l -0 ... ~ E + ~ ..!! 0 I " 0 , .... U i.i: 00 ~~RCC~~l.7ar';;7' PI_,-:-~" KUO, .-.". -- '"-" --,'"-"" ",.. -;- h ... \11~,,!:~t,,;~,\:?/; .;. :,,' COMMONWEALTH OF PENNSYLVANIA . l~d;~I063fl91' ", ,'. DEPARTMENT OF REVENUE a~)~2~;, i ].1. .~. , ' . :OFFICIAI. RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE 'TAX I ~,'j:'.,,!,~,'i.I,_.>_ .\ \~ ,I C'.'..'.'.....'. ; RECEIVED II I = From, I , - -)"',o.i&" n~~l:~., ' ~, --------------------11'/,1 MUMDRBD ~IGHT ~ 60/100 represenling Pennsylvania Inherllcnce or Carl E. .c. Howard. W. Sh Eslole Tax due from Ihe following eslole, C/O H. Anthony Adaau, leq. 1'2 8. ~f~ A+p..~ nollars ." ;dros5 i 2'" Tax on $ $ llbippeAe:burv . Pa. )7257 6~, Tax on s $ 21_RO_:t02 Dole of Deolh3-30-l980 15t,i't, Tax on $ $ 1I!UA V T SnnJM&N % lox on S Estate Tax, Act of May 7, 1927 $ I Dole 01 Payment A\IlJU.t 26, 1980 Nome 01 Decedent $ Counly CUMberland TOT AL TAX CREDIT less live percenlum of lal{ if paid within !hree months after dole of deolh Plus Interest 01 the rate of _%from 10 $ 599, 50 Remarks: $ "PAID ON ACCOUNT" $ lJill~[P[L~@ill'[j'~ SEAL TOTAL AMOUNT PAID $ 598.50 NOTE: Thi, Triplicate Receipt to be retained for audit purpole.. '1Jltury{ ~; ft<4~/ I nolure) Ma~C. L_i Roti ~1Il) ollfill. Received by NOTE: In ace.pllng the Ira"sfer Inherllance lot on future e~lole$. prior to Ihe death 01 the tife lenanl or lenont IOf yeau, as llyiden,.d by this Illcelpt. Ills understood lhot the Commonweahh shall nol be precluded or prevented Irom hereafter ouuslng additional inheritance lo~ allhe deoth 01 the Ill. lenon! or tenon! for years whenever II appears thaI such oddillonol tOK may be legally duo ond coll.dlbl. fOf any reason whatsoever. ----------------------------.------------------- r-- -.- r.( " !),~ e, .'!1 N , . Co_ . -0 I Cl L!.} ,,..~- .:;. t: c' ." V) ,) 0)0: p' ::> 0: 60 I 1 I i I I i ! \ \ PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION 1. PERSONS RESPONSIBLE FOR RETURN Section 701 of the \nheritnnce nnd Estate Tnx Act of 1961 provides that the following persons slwll preparc and file a return: a. The personal representative of the estate of the decedent ns to property of Ihe decedent administered by him and such additional property which is or may be subject to Inheritnnce Tax of which he/she shall have or acqui re knowl edge; b. The transferee of property upon the transfer of which Inheritnnce Tax is or may be imposed by the 1961 Statute, including a trustee of property transferred in trust, provided that no separate return need be made by the transferee of property included in the return of a personnl represcntatlve. 2. PLACE FOR FILING The return is to be filed in duplicllte w:th the Register of Wills of the county wherein the decedent resided. 3. TIME FOR FILING The return is due nine months nfter the decedent's death, unless an extension for filing has been apptied for and granted by the Secretary of Revenue within the nine,month period. 4. FAILURE TO FILE RETURN Section 791 of the 1961 Stlltute provides that". . .any person who willfully fails to file a return Of other feport required of him. . .shall be personally liable. . .to a penalty of 25% of the tax ultimately found to be due or $1,000 whichever is the lesser to be recovered by the Department of Revenue as debts of like amount are recovefable by law." 5. TAX RATES Inheritance Tax is payabte at the fate of 6% on transfers to lineal descendants, such as father, mother, husband, wife, son, daughter, grandchildren, grandparent, son,in,law lInd daughter'in.law and at the rate of 15% as to all others. 6. PAYMENT OF TAX The tax assessed on the transfer of property reported in the return is due 9 months after the decedent's death. Interest at the rate of 6% per annum accrues thereafter until payment is made. All payments received are first applied to any interest which may be due with any remainder applied to the tax. IF TAX IS PAID WITHIN 3 MONTHS AFTER THE DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED. All checks should be made payable to the Register of Wills of the county wherein the decedent resided and are received subject to the final determination of the Department of Revenue. 7. FAILURE TO PAY The taxes imposed, together with any interest thereon, are a lien upon real property, which lien remains in effect until the taxes and interest have been paid in full. The taxes may be sued (or against any real property in the decedent's estate or against any property belonging to a transferee liable for the tax. 8. FILING OF FALSE RETURN Any person who willfully makes a false return or report required of him shall, in accordance with Section 793 of the 1961 Statute, be guilty of a misdemeanor and, on conviction thereof, shall be sentenced to pay a fine not exceeding $1,000 or undergo imprisonment not exceeding one year or both. REY.451 (1~Ol *' COMMONWEALTH OF FENNSVLVANIA SCHEDULE "B" . OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX PERSONAL PROPERTY RESIDENT DECEDENT (Instructions on Rt.'v/!(!W Sidv) Estate of Eva W. Shuman ESTIMATED DEPARTMENT ITEM DESCRIPTION UNIT MARKET VALUATION NO. VALUE VALUE (OFFICIAL USE ONL Yi 1 Savings Passbook Account at Commonwealth 10,152.2 10,152.25 National Bank of Shippensburg #7501 under ;f'f3.iO account numbers of First National Bank of Shippensburg together with~nterest to date of death 2 United States Savings Bonds together with interest thereon (All series E) # Q 45814893 E 6-42 25.0 81.07 o Q 75768662 E 9-42 25.0 ~3.7~ ft. 0" o Q 109450091 E 12-42 25.0 2.35 71,71;, # Q 167419472 E 3-43 25.0 79.76 # Q 242988944 E 7-43 25.0 (81. OO~ 7J', 'IS' o L 79450699 E 7-44 50.0 (156.64 i.!n.7:i.. o Q 595934238 E 2-45 25.0 (77.05 '(If, &,3 o Q 601986415 E 3-45 25.0 74.63 o Q 656087404 E 4-45 25.0 4.63 "I.), :J.J' I o Q 656087403 E 4-45 25.0 74.6 1~. :<.i I o Q 660456979 E 4-45 25.0 74.63 '/:I..:U' o Q 669138687 E 5-45 25.0 74.63 '/.1..,2? i o Q 682334401 E 6-45 25.0 75.83 1.8. '11- \ o Q 685702040 E 6-45 25.0 75.83 7.3. 'f1 , I 3 Prudential Life Insurance Policy payable 976.0 976.05 to Estate Policy numbers 64651222 and number 72-402-761 4 Checking account at Commonwealth National 1,847.3 1,847.33 Bank in Shippensburg, Pennsylvania account number 412-702426-5 TOTAL THIS PAGE L Ill). OJ. -t ,-'. . j.:J I'-' $fC- QUESTIONS CONCERNING PROPERTY TRANSFERS 1. Did decedent, within two years of death, make any transfer of any material pari of his estate without receiving valuable and adequate consideration? (Answer "Yes" or "No".) 2. Did decedent, within two yoars of death, transfer prorerly flam himself! herself to himself/herself and another party or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) - 3. If the answer to one or two above is "Yes" and the transfers are claimed to bo nontaxable, provide the following information: a. Age of decedent at time of transfer. b. Copy of death certificate. c. Affidavit by the attending physician indicating the state of decedent's health at time of transfer. d. All other information supporting nOl1taxabilily of transfer. 4. Did decedent, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consideration therefor which was to take effect in possession or enjoyment at or after his/her death? (Answer "Yes" or "No".) a. Was there any possibility that the property transferred might return to transferor or his/her estate or be subject to his/her pownr of disposition? (Answer "Yes" or "No".) b. What was the transferee's age at time of decedent's death? 5. Did decedent in his/her lifetime make any transfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end before his/her death: a. The possession or enjoyment of or the right to income from the property transferred? (Answer "Yes" or "No".) b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer "Yes" or "No".) 6. If the answer to five b. above is "Yes," state whether the right was reserved in decedent alone or others. 7. Did decedent in his/her lifetime make a transfer, the consideration for which was transferee's promise to pay income to or for the benefit or cafe of transferor? (Answer "Yes" or "No".) 8. Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change, because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of law? (Answer "Yes" or "No".) 9. If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved in the decedent alone or the decedent and others? (Answer "Yes" or "No".) REV.453 (loBO) 'COMMONWEA~TH OF PENNSV~VANIA DEPARTMENt OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "0" BENEFICIARIES *\ (InstructimlS on Hevcrsf! Siclt!) Estate of Eva W. Shuman - - . BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE 0 F INTEREST OF BENEFICIARY DECEDENT BIRTH Carl E. Shuman Son ye~ ~ - -----.. -, 404 Lurgan Avenue -"- Shippensburg, PA 17257 .-- I u Son yes ~ 25 Montgomery Avenue Shippensburg. PA 17257 - -- '-'-- ---'-'.--" -----"-~- _._-----~------ -.----- -.-----. , - ,- ---------- - ----" -~--- - -_.----- n _.__ - - .------- -- I--- _.------ --- ...--------_. -...--.--. ---..--- .------+_.._~- , _L- i " --- ! ! -------- -+-_.._- -..---.-.-- . --.- , , - -- ..-- - ! - - --------.------.-. ------------~ I , -- - i ---....... --+--- I --- - --" ..- -- -- - -- .-.....- ....--.- . , : The above beneficiaries a:.) living at this time except for the following: , NAME .J ~--=-- DATE OF DE_~ _.-1- _____L__ Schedule "E" must ;nclude all property, real and personal, owned by the decedent jointly with another party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be Included. List real estf,te first. lli:"iTRUCTIONS FOR COMPLETING SCHEDULE "E" 1. Describe all real property as indicated in the instructions for Schedule "A". Describe all personal property as indicated in the instructions for Schedule "B". Include the name, address and relationship to the decedent of the co-owner (s) and the date the joint ownership was established. 2. Indicate the total market value of the jointly owned property. 3. Indicate the percentage of the decedent's interest. 4. Indicate the market value of the decedent's interest. c "" Cl n :v rn (; ~ >- 0 0 Cl '" 7- Cl () c: Cl ..., 7- '" Z t"" [Tl [Tl ~ z ;>:l >- 0 ... 9 t"" Z Z rn ..., rn ..., Z 9 9 -! -< '" rn - '" z 0 '" 0 ..., 0 '"'1 '"'1 :<: ~ >- 0 ..., ." - ." 0 5 z >- t"" c: '" t'1 0 Z t"" -< -< -< ~ rn rn >- >- ;>:l ;>:l d, ~ ~ ~ ~ <>: "" p.. '0 Z ;.l ~ <:: 'i) 0 ;... C1l on .-i ;.l .. .. tIl ::l <ll ;:l .0 .0 " !3 ~ <ll ~ ~ Z u ~ l{\ ~ - ~ ~ 1>0 1>0 - 0 ~ d ~ ~ 1>0 Ii; 0 tIl 0 z d ;.l tIl >- ~ d - ~ ~ I>l Z Z ~ Z ::j d Sl d :..: I>l I>l Z Z ~ 0 u ~ z ~ ~ tIl ~ 8 0 - I>l 0 Po< ...l - SCHEDULE "F" STATEMENT OF DEBTS . ;) f!i.D LDU~,rONS f '\ .;r~~jt4_~;jAP,(?/?~6-,t,~~-~l!lf.()-- " Estate of Eva W. Shuman DaleolDealh Hn/6h 30, 1980 File No'-:::J/-&)-3o,--:L WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING: REV.455 (t.BO) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT OECEOENT Claimant Claimant's Address ITEM DATE NAME OF PAYEE NO. 1 5/30 Clerk of Court 2 5/30 Mrevin Fo er 3 5/30 Penelec 4 5/30 Leader Nursing Home 5 5/30 Chambersburg Anesthisia 6. 5/30 Harry Haddon M.D. 7 5/30 Pauline !'lenger 8. 5/30 Dr. Michael Donahoe 9. 5/30 Borough of Chambersburg 10. 5/31 Hefflefin er's 11 7/31 H. Anthony Adams 12 7/31 Howard W. Shuman 13 7/31 Carl E. Shuman 14 7/31 Katie B rd 15 8/1 Regis ter 0 f Wills Relationship to Decedent REMARKS AMOUNT monument for grave attorney's legal service Executor's fee Executor's fee fee for cleanin deceased's ropert filing of tax return and debts plus excess on probate cost on item #10 above 17.00 1 391.45 15.99 358.83 60.00 55.00 15.39 122.00 10.00 624.80 707.10 353.55 353.55 50.00 10.00 filing of estate funeral expense 11gh t bill last illness care last illness care last illness core personal tax last illne.ss less medicare reim. Ambulance service for last illness 22.30 TOTAL THIS PAGE I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral expenses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes. 4166.96 SIGNATURE OF A1"TORNr:V/F1DUCIARV DATE OFFICIAL USE ONLY DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ f/ rf; t". 'll AT I b PERCENT. (I ./ " ,. ./)(11'1'-",/ Gl~l[H OF WILLS / /) ')? i;1 h'J-t;'Y, .-{/I DATE , . . GENERAL INHERITANCE TAX INFORMATION Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible a(Jainst his/her taxable estate. In addition to debts incurred by the decedent or estate, other items are claimable including the cost of administration, attorney fees. fiduciary fees, funeral and burial expenses includin(J the cost of a burial lot. tombstone or grave marker. All debts being claimed against an estate are subject to the approval of the Register of Wills with whom the Inheritance Tax Return is filed. Evidence to support the decedent's or the estate's liability for the debts being claimed should be attached to this schedule. A family exemption of $2,000 may be claimed by a spouse of a decedent who died domiciled in Pennsylvania. If there is no spouse, or if the spouse has forfeited his/her rights. then any child of the decedent who is a member of the same household can claim the exemption. In the event there is no such spouse or child, the exemption can be claimed by a parent or parents who are members of the same household as the decedent. c: "" t:l n E; m ~ ~ > 0 0 (f) Z C1 n c::: t:l ..., z 3: z ~ m t"l > 9 9 ;:>; z ;<I Z z Z t"l ..., t"l ..., 9 9 ..., -< Vl t"l - (f) Z 0 Vl 0 ..., 'l1 ;<I 0 'l1 ~ ~ 0 '<1 - '<1 0 - Z n - > t'"' c:: (f) tTl 0 Z -< -< :;; t"l t"l ~ ~ ~ INSTRUCTIONS FOR COMPLETING SCHEDULE.:E: 1. If the family exemption is being claimed, indicate the claimant's name. address and his/her relationship to the decedent. Enter "family exemption" in the remarks column and the amount claimed in the amount column. 2. Assign consecutive numbers to eacll item listed. 3. Enter the date on which each debt was incurred and/or paid. 4. Enter the names of eacll payee. 5. provide a brief explanation in the remarks column for each debt claimed. 6. Enter the amount of each debt being claimed. 7. The form must be signed by the person who has assumed the responsibility for paying the debts. INFORMATiON To insuro proper credil to your account, the name of tho ostate nnd fifo number should bo clearly print- ed on tho check or money order. This assessment is modo in accordance with Section 708 of the Inheritance and Estate TOK Act of 1961 (72 P.S. ~ 2485.708). To the exlenJ that inherilance fax is paid within three (31 months after fhe dearh of lho decedent, a discount of live 15) percent Is allowed (72 P.S. ~ 2485.716). Inheritance Tax. other than lax on a future interest. is due at the dote of the decedont's death and becomes delinquent at Ihe expiration of nine (9) months ofter the decedent's death (72 P.S, 9 2485- 711). Inheritance Tax on a future interest is payable within three (3) months after the transfer wkes effect in possession and enjoyment and is delinquent thereafter (72 P,S. 92485-712). 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 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 5 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 party in interest. including the Commonwealth and the personal representative. not satisfied with the assessment may object thereto within sixty (601 days after receipt of this Notice as provided bV Section 1001 of the Inheritance and Estate Tax Act of 1961 172 P.S. ~ 2485.1001). Make check or money order payable to: "Register of Wills, Agent" MaillO the address listed below: