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No. 21.80 30~)
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of
John M. Roth
, deceased.
Mary C. Lewis
To .nieAsrEl E. /',AElers€ln, Register of Wills far the County of Cumberland,
in the Commonwealth of Pennsylvania.
IS
Petitioner(ll) ~~ the execut~-- named in the Last Will and
Testament of _"ohn M. Roth dated March 21. 1968
Decedent was a citizen of the United States and a resident of
fl --rl Township
~AAMn/VYII'~.1 -Borotlgh, Cumberland County, Commonwealth
of Pennsylvania.
Decedent died on Sundav the 17th day of FebrnRry
A. D. 19~, in the County of
Cumberland
State of
pennsylvania at the age of 80 years.
~ bI~ 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 ~ f~d
(jf ~I 000. 00) d~ and of real estate to the value of
/1'7-1>
as near as can be ascertained; said real
estate situated as follows
appl~
Therefore, your petitioner(s) respectfully applies for the probate
of the said Last Will and Testament and for La ter Testamentary thereon.
IU;/
Dated YJ1~ ~ FlED - . C-
d
Name and address
of Petitioner(s)
John M. Roth, II
R. D. 2
South Mountain Estates
Shippensburg, PA 17257
COMMONWEALTH OF PENNSYLVANIA ~
ss
COUNTY OF CUMBERLAND
John ~j. Roth, II
named in above application, being duly sworn according to law
say(s) that the statements set forth in this petition are true to the
best of his knowledge and belief. . /7~~~ ~
. /. ---_. pt.
Sworn and subscribed before ~/ - /y, ..: 2-
,~"/'
>>~X7 ~jarch 7 1080 //
me, .' ---i/
0J~td~. ~t:;~R~9ist;-
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Filed;
o:5l hff).. 3D
May 8,
1980
Attorney: Barbara B. Townsend
67 vi. 13urd St
Shippensburg, Pa.
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OATH OF SUBSCRIBING WITNESS
MMONWEALTH OF PENNSYLV ANIA \ ss:
COU OF CUMBERLAND
This.,..,.......,....,.. ,.."........."........,..........,............. day of ....."................"..",....."..".....,.... ........... A.D" 19........,
derson, Register for the Probate of Wills and grantin
in and for said County of C berland, in the Commonwealth of Pennsyl nia, personally came ...,.......,..
...........,....,................,.,.....,...,..,......... ....,.,....,.."....,.....,....""....,.....,..". .."...."..,..,....,.".."",."....,.,',...,........""..
the subscribing witnesses to the forego
instrument of w ' ing purporting to be the last Will and
Testament of ............................................,..,......... ............ ....".........,........,. Dated ..........,...............,..............
late of...................,............,......................................,.." .. .................,....... Cumberland County Pa., deceased
who being duly....................,...................... acc
present, and saw and heard the testa..... ....,....................,
pose and say, that ..........,...........,.................
sign, seal, publish, pronounce and
and Last Will, and at the tim of so doing ....................,............................was 0 ound and disposing mind
memory and understan . g, to the best of ,............,................................knowledge, 0
..................... ....................... and subscribed before
..................................................,............................
.......,..........................................................................
,. ................................................................................
ichard E. Anderson, Register
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA! ss:
COUNTY OF CUMBERLAND \
~
..,...........~I:I:.I.lL.......&....... ..8e?:I!..,;..:JZ:.....,.,..................... ..........,......,.................,..............being duly
..........;?fj!,.'?!:...r.!............,..... says that as nearly as can be ascertained the said decedent ..........................
.......;;J.;. /t.1'............ (J.1,......,... .I!?.t?,a!............,.......................,.,......,..........................,...............,........ .died on
...~;ad.~7.................,.. the ........../.z:~....,....day of ..~rfl-!.I.U~..'f.............,..,........ A.D., 1986,
at or about ................,..........,.............. o'clock, ....M,
S\"orn d b 'b d h'
........................,...........................an su scn e t IS
...........................}~!!........."'.. day of .......t::.~,~~!:..,..,
/7
.
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xy'....,............,.....,..~............,...............................
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19, .?9...., before
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R;",lu.udJ'E. AJ .....,uIlt Register
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLV ANI A }
COUNTY OF CUMBERLAND iSiS:
Before me. the Register fbr the Probate of' Wills and granting of' Letters of' Administration in and for
the County of Cumberland. per'sonlllly came .~"!..~'!........../!?:.../?~:r.:~:7"'rz;......................................
who, being duly ....,,;l.w.i'!.~O'......., do~~..... depose and say that as......s:.>:<.~..q,.~.f.!?..c..................................
of the last Will and Testament of' .......,;T,;h'..r\I..........m..........8..<?7.:-!:!...............................................deceased
.........&.~.......... 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. ..;['!d/?(..O'........... and subscribed
before me.
March 7 80
........................................................ A. D.. 19............
....q~...~..:..~~~~..........................
IUd"" E." J~."".I.~~ter
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DECREE
. . 8th v.ay 80
Be It remembered that on the ........................ day of ................................................, A. D.. 19 ......... there
b d d d dth I W'II dT f' John ~;. Roth
was pro ate an recor e east I an estament 0 .............................................................................
southarr,p1:on Townsl1ip .
late of ............................................................................, Cumberland County. Pennsylvama. Deceased. Letters
...........................~:.~.~.~r::~~.~~.7X were granted to .. ........ .... ........~~!:.~..!:::. ...l~::~~!. ...~.~.................................
Witness my hand and official seal the day and year af'oresaid.
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R;...J~' u. B. :...... u~l., Register.
,
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INFORMATION
To insure proper credit to your account, tho name of tho astuto and filu numbor should be cloarly print.
ed on the check or money ordor.
This assessment is mado in accordance with Section 708 of the Inheritance and Esulto Tax Act of
1961172 P,S,!i 24B5.70BI,
To the extent that Inheritance tax is paid within ttlroe (31 morllhs after rho death of rho decodent n
discount of five 15) percent is allowed 172 P,S. 9 2485.716),
Inheritance Tax, other than tax on a future interest. is due at tho date of the decedent's death and becomes
delinquent at tho expiration of nine (9) months after the decedent's dealh (72 P.S. fi 2485-711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer 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 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 deys ,00034 12 days ,00203 22 days ,00369
3 days ,00051 '3 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 ' h days ,00267 28 days ,00437
7 days .00118 17 days ,00284 27 days ,00454
8 days ,00135 18 days ,00301 2B days ,00471
9 days ,00152 19 days ,00318 29 days ,004B8
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 (60) days after receipt of this Notice as provided by Section
1001 of the Inheritance and Es,a,e Tax Act of 1961 (72 P.S, 9 2485.10011,
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below;
REV-4eelll-7QI
OFFICE OF THE
REGISTER OF WIl.LI
OF Cumberland COUHTY
AHO "'GEHT OF THE COMMOHWEAl. TH
, !
,-
STATEMENT OF DEBTS
AND DEDUCTIONS
EST"'TE OF
John M. Roth
FIl.E MUMBER
l....TE OF
Boroljgh of Shippensbura
DATE OF DEATH
Fp-h~y. 17r lq~n
WHEH Cl....IMIHG THE FAMIl. Y EXEMPTlOH, COMPl.ETE THE FOl.l.OWIMG:
Cl....IM...MT REl.A TIOMSHIP TO OECEOEHT
CL"'IM"'HT'S ...OOREIS
HO,OF I
DATE VOUCHER H"'ME OF P"'YEE REM"'RKS "'MOUMT
Musselman Funeral Home Funeral Expense 1,805 06
William A. Freeman, M.D. lIccount 23 50
. Rea and Derick Medicine 10 20
Public School Rebate Annuity 282 03
Employee Retirement Sys tern
Probate 20 00
IIddi tional Funeral Expense 99 75
U.S. Treasury 1979 Income Tax 287 55
-
Sharpe and Sharne Attorne"'s fee 2 000 on
John M. Roth II Executor's fee 2 000 00
Advertisinq expense 33 00
Brackendorff Memorials Memorial plaque 354 00
National Geographic Society Open account 9 85
Cumberland Valley Hose co. Ambulance 15 00
philadelphia National Bank Open account 117 13
TOTAL 7,057 07
(1) above fee, althouah more han the probate estate is
the an
agreed fee due to complexities 0 F the bequests and gifts
throuah the estates of Marv Roth and Franklin Roth.
I, John M. Roth, II ,HEREBY CERTIFY, TH"'T TO THE BEST OF MY KMOWl.EOGE "'HO
BELIEF, THE FOREGOIMG II'" JUST "'MO TRUE ST"'TEMEHT OF OEBTS,J.U2L EXP. SES "'MO EXPEHS.ES F ...OMIMISTRATIOM
SUBMITTED TO THE ...FOREMEMTIOHEO EST...TE "'S OEOUCTlO~S FOCINHERIT HC X PUR SE.
SWOR~ "'HO SUBSCRIBED BEFORE ME THIS /.._:{-I/; . _ f/ / (l.,S.)
O"'Y OF ~?k.("'" 19 X/)
"^'\~w. ,\.~.\ ..~..?r! \~/}
-?--~: ',./v:~. J /-;r:::'/ /. .~ <<';(/~
My {:(',mmi..~i,1n bjtIC.. uctr'Lc.T lO, ~~.
... '. 1l\.,\"..,,~t: ;li tnt BCflout.n
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lit Chamlll:J'~t,efg. \t..\;....:Il, I,,;....lltj. ;11II.
7
PENNSYLVANIA INHERITANCE TAX GENERAL INFOHMATIDN
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of ]961 provides th;]llhe [olloY/in!" perSllns shall prepare and file
a return:
, "
a, The personal represent;]tive of Ihe estate of the decedent as to properly of the decedcnt administl'rcd by him
and such additional properly which is or may be subject to Inheritance Tax 01 which he/she shilll have or
acqui re knowlcdge;
b. The transferee of property uponlhe transfer 01 which Inherit;]nce T~x is or may be imposed by the 1961 Statute,
including a trustee of property (mnsferrcd in trusl, plOvided thai nil sep,Hate fI~lurn need he made by the lr;]nsferee
of property included in the return of a personal representative.
2. PLACE FOR FILING
The return is to be filed in duplicate with the Register of Wills ollhe county wherein the decedent resided.
3, TIME FOR FILING
The return is due nine months after the decedent's death, unless an extension for filing has been applied lor and
granted by the Secretary of Revenue within the nine-month period,
4. FAILURE TO FILE RETURN
Sectioo 791 01 the 1961 Statute provides that" . . .any person who willfully fails to file a return or other report
required 01 him. . .shall be personally liable. . .to a penalty of 25% 01 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 recoverable by
law."
5. TAX RATES
Inheritance Tax is payable at the rate of 6% on transfers to lineal descendants, such as father, mother, husband, wife,
son, daughter, grandchildren, grandparent, son-in-law and 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 ~re 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" lien upon real property, which lien remains in effect until
the taxes and interest have been paid in full. The taxes may be sued for against any real property in the decedent's
estate or against any property belonging to a transferee liable for the tax.
8. FILlNGOF FALSE RETURN
-'.-,-
Any person who willfully makes a false return or report required 01 him shall, in accordance with Section 793 of the
1961 Statute, be guilty 01 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 (1.80)
cOMMONIIVEAl.TH OF PENNSVl.VANIA
. DEPARlMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESlaENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*'
(Instructions on Revers/) Side}
Estate of John M. Roth
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ESTIMATED DEPARTMENT
ITEM DESCRIPTION UNIT MARKET VALUATION
NO. VALUE VALUE (OFFICIAL USE ONL YJ
1- Household Items 100.00 -
2. 40 shares, H.M. Paschall & Sons, preferred stock 100.00 4,000.00 ,/
3. 300 shares, U.S. steel 20.812 6,243.75'/
4. Cash on Hand 20.00 -
5. Intestate beneficiary residue of Estate of
Franklin J. Roth, 1/6 vested interest and bequest
of 1/4 share of same from Estate of Mary E.
Roth 4,590.25---
TOTAL THIS PAGE $14,954.00 1 4,Cll11.1 ,00
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any lmnsfer of any material part of his eslate wilhout receiving
valuable and adequate consideration? (Answer "Yes" or "No".) YES
2. Did decedent, within lwo years of death, lransfer property from himsel fl herself to himsel f/hersel f and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) YES-listed on Sch. E as Decedent' s
3. If the answer to one or two above is "Yes" and the transfers are claimed to be ~6'n\~xclbT~,e~rovide 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 nontaxability 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".) NO
a. Was there any possibility that the property transferred might return to transferor or his/her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No" ,) NO
b. What was the transferee's age at time of decedent's death? NO
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".) --'ICl-
b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".) 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 iifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefit or careof transferor? (Answer "Yes" or "No".) NO
8. Did decedent, at any time, transfer property, the bffieficial 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".) NO
9. If the answer to eight above is "Yes," was the power to ailer, amend or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Yes" or "No".) NO
~errill Lynch
18acjy AssetsTrust
1
DIVIDEND ADVICE
and
SUMMARY STATEMENT
I'I,CIIsr fI[ IIIIN r//ls 57A 7EMENr rOR YOUR IICCOR(]S,
1 ACCOUNT NUMIJER
Y>3 69710121-0
soc. 'lie. QIt T""lI''''Y.''
CIINTII'ICATION NO.
23-6688619
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1 REFER ALL INQUIRIES AND ADORESS CORRECT10N5TO:
I THE BANK OF NEW YORK, AGENT
lp.o. BOX 11,063 CHURCH STREET STATION NEW YORK, N.V, 10249
OF ~lARY E ROTH
ROTH EXECUTOR
ESTATE
JOHN M
RO 2
SHIPPENSBURG PA 17257
285422
SUPPLEMENTARY DIVIDEND INFORMATION.
A NEGATIVE ADJUSTMENT AS OF
DECEMBER 12, 1979 AMOUNTED TO $18.89
'UMMARY OF TRANSACTION AND DIVIDENDS FOR THE PERIOD:
DATK
2/31
1/23
1/23
1/24
1n4
1/25
TYPE OF TRANSACTION
DOI.,\"A" AMOUNT
""ICIl
"." SWAPI.
BALANCE FORI~ARD
'111:..~rUUM"YllI::.U:,I.U l{)/\iJU,HIIII'l(
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t ACCOUNT NUMDER soc. uCli~~~:~=~:~;~~:r:.T~~~;iTlo
:063 69710121-0 23-6688619
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Merrill Lynch
Ready AssetsTrust
OF MARY E ROTH
ROTH EXECUTOR
ESTATE
JOHN M
RD 2
SHIPPENSBURG PA 17257
Ploaso m"ko your chock or monoy order
payablo, In U.S. dollars, 10:
THE BANK OF NEW YORK, AGENT
and mall togothor with this slub to:
THE BANK OF NEW YORK, AGENT
P,O. BO>< 11,063
CHURCH STREET STATION
NEW YORK, N,Y. 10249
$
- -y- --
01: T'" C H
HE'II:
.
JANUARY 1,1980
TO
JANUARY 25.1980
'HA".' THIS
TIt...,.....CTIO,.
DIVIDEND SHA".'
56~;. ';00
69,85~.1
68,856.1
68,877.9
69.619.9
69,642.2
CHECK REDEMPTION
DIVIDEND FOR 1 DAY
BOOK SHARES DEPOSITED
DIVIOEND FOR 1 DAY
~G4.!rC 1. CO
1,000.00- 1. 00 1.000.000-
21.76 1. 00
742.00 1. 00 742.000
22.35 1. DO
DIVIDEi-H) FOR
""., ",,,,"f""
c..oJ 1.11'\';,)
"&"'00 ENDING
DaLLAIt AMOUNT
.HAIt.S PURCHA.ED
IMMARY INFORMATION
21.760
22.350
...RIOD ENDING
DOLLAR AMOUNT
liEN TltlS 5T...TE:Mt;NT IS MARKED "109') INFORMATION" Till: INFORMATION SHOWN WILL BE FILED WITH THe rNTE:RNAL REVENUE SERVICi! PURSUANT TO Fli:Ol!:
,W AND 15 TO nE USED IN rREI'^"ING YOUR INCoMIt TAX nroTURN, WIH:N THIS STATEMENT IS MARKED "SUMMARY INFORMATION" TIH!: INFOIolMATION SH'
1;l'RI!.":lCNTS" SUMMARY 01" TltE: C"1~TIHI"JUT10!lS PAID TCJ YOlll'"OR YEAR-TO'DATIl:.
--.-.,- ,.~ --- .._~.....,_.,....
REV.453 (1-S0)
,. 'COMMONWEAl. TH OF PENNSYLVANIA
DEPI\RTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
*
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(lnstmcthms 0/1 RnVUrSf! Sirk')
Estate of
John M. Roth
+-=. .. -~.. .. . .- .-.-,--
BENEFICIARIES AND ADDRESSES RELATIONSHIP 5URVIVEO DATE OF INTEREST BENEFICIAllY
DECEDENT BIRTH UF
-. - -. - -.--
John M. Roth, II Son Yes ..------...---- One-1'hird
.---- -------
R. D. "
~ -.-
- ------ j----.
PA 17257
---- ----- -
So"yheer Daunhter Yes One-Third
R. D. 10. Box 345
Carlisle, PA 17013
-
Nancv Bell Hemphill Daunhter Yes One-Third
1202 Butterfield Lane
Castle Rock, Colorado 80104
."--
_...__."~ -._---.-- . .-.--------..-. _...- ._,. ----- .- ---'-- -_._---_._~.._--_. _.________m__'_.... _._
--- -
--.-1---
-- ________.=:1 -"----"~---_.._.._."-.- .-_.. ._~._m_.__ .. -.._~,-_._....._- ._._____ nm._,___._~
.-------- -------------_._~. ----- .~._-_._-- - -.-- ..---- --_..,------- ---- ---- ..---.--..--
I -- -
._-----,------
-- --~--- -
-- -.---.---- ~-~-------- -.------. -.-- - - --.---.------.
-----
.. -----._-- ---- I-.
..-.,.- -.----.- .-......----....-- .......-.--..--. .'--.'--.--'--'-- --.--- ..--
-------.---- -.----- _..
--_._---.- ..._--~~---]~-----_. ------..,.---
- -..- - - _"'-'___._U.'. -.-- .._.._uu..
.......- -
The above beneficiaries are living at this time except for the following:
NAME
DATE OF DEATH
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all propertv, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of suruivorshlp. Both tangible and intangible property are to be
included, List real estate first.
1. Describe all real property as indicated in the instructions for Schedule "A", Describe all personal property
as indicated in the instructions for Schedule "8". Include the name, address and relationsllip 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.
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. :millLynch
lady Assets Trust
DIVIDEND ADVICE
and
SUMMARY STATEMENT
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IOC, '.'10 0" fj'''~''Y.''
a'';GOUNT HUMIlIeI!
\'3' 69710127-7
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I ~Jt"lt.l' AI.L.INQUlfllllUl AND AbOFU'fUS'C',}AAtCTIO 11'01
l . THE BANK OF NEW YORK, AGENT
I). BOX 11,0&3 CHurlcH9TREET STATION NEW YORK, N.V. 102"9
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M ROTII
M ROTH
II &
JT TEN
JOHN
JOHN
RD 2
SHIPPENSBURG PA 17257
325767
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Merrill Lynch
Ready AssetsTrust
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: 063 69710127-7
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204-30-6410
ACCUUNT NU"'.." "
M ROTH II &
M ROTH JT TEN
JOHN
JOHN
RD 2
SHIPPENSBURG PA 17257
Pleas. mike yaur Cheek or money ordU
payable, In U.S. dOtllrs, to:
THE SANK OF NEW YORK, AGENT
IInd mall togeth'r with thl, .tub tal
THE SANK OF NEW YORK, AGENT
P.O. BOX J 1,063
CHURCH STREET STATION
NEW YORK, N.V. 10249
$
,tMARY OF TRANSACTION AND DIVIDENDS FOR THE PERIOD: 29 1980
\TIl 1" TYfI" or 't'''N.ACTlott,l, ''',' .. .l.i.A~ A!MOUN, I~ I :."IC. . ., YDYA~ .HAM.... Dn"-"
. ,. "T"'A"I"CTtO' d
/25 BALANCE FlJRWARD 6,123.391
/29 DIIJInENO.FOR 4 DAYS 1?1'5 \. 00 12.150 6,135..5".l
'(29 [lOOK SHARES DEPOS ITED 1,505.00 LOO 1,505.000 9,640.541
(01 DIVIDEND FOR 3 DAYS 11.13 L DO .. 11.130 9,651.67r
fO 1 BOOK SHARES DE POS IT ED 1,629.00 LOO 1,629.000 1l,280.67(
r07 DIVIDEND FOR 6 DAYS 23.68 LOO 23.660 11,304.55(
r07 CHECK REDEMPTION ,,~ 5,264.48 LOO 5,264.460 6,040.07(,
r14 DIVIDEND FOR 7 DAYS 14.20 LOO 14.200 6,054.27(.
:15 NEGATIVE ADJ 1 DAY 2.35 LOO 2.350 6,051. 92[
[29 DIVIDEND FOR 14 DAYS 24.63 LOD 24.630 6,076.75Q
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'.U1ID!) .NDINO
DOLLA" d.OUliT
'HAlt!!:' PUlldHA'.O
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02129/60
66.19
66.190
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~1'1Il~:~:L~~~?:O. < LON/):.T.lljot ,CAPITAl. OAIN
156.14
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156.14
~ARV INFORMATION
.....1I10P .HDINO \. 'DOLLAR AMOUNT
""lI.fUII ,.UJtCHA,uttl
'I'.AII..TO"O"'T.
158.14
NOT "1r:'O"TADLn
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COMMONWEAl. TII 01' PI fllj~,Yi.V^,IIt.
D\YAlHMENT OF r<L.VLtJiII
TRAHSFER IHHERITAMCE TAX
RESIDENT OECEDEHT
.. --. _.n [JORIGINAL..
INHERIT ANCE TAX
APPRAISEMENT
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REV.4fll ~x+ 17-/101
Estate of ~ohn M. Roth
o SUPPLEMENT AL
._.___ File No. __.21:-80-0309
County _ Cumber~llnd..
Date 01 Death _X!!b.!:~_Il.!:Y..Jo7J 1980
- ~~.......-_... - --.-- -- _.'''- ..- ~
In the event that any fuhHIJ Intercst In Ihj~ ,,!i1oto Is Inllufcrru,J ill poss(!uion or onioYrTltlrlt fa colJU'lJlO1 heirs 01 thft decedent after the
.'plrotlon 01 ony ."010 I.. 111. '" 10' yno", II", C"",monwoollh horohy .'p,.nly ,.",".0, .h. rlgh. to "pp"I... "d 0..... "on.I.,
Inheritance tu)Cu at tho lowf",! c.ollolOtol rol~ on any such futu~.lntero~__..__
PROPERTY NOT INCLlTDEi:>TN RETURN-BlJr-jipPRAIS-ED BY TliE COMMONWEALTH
--.---.--.-----------------------------
...-.----.- .-.--.-------.------------...-------- .-...-.-..------.
.----.-------.--.--------.------.. .-.
.----------.--.--.----------------
ASSET SUMMARY
DEPARTMENT'S
APPRAISED VALUE
1. Tolal Real Properly - SCH. "A" . . . . .. $
2. Talal Personal Property - SCH. "B". . . . $
3. Talal Jainlly Owned Properly - SCH. "E" $
4. Tolal Translers - SCH. "C". . ... . . .. $
___.JioIlfL
14, Q54._00
--9-.,81.85
62.1684.00
Unreported $
Unreported $
Unreported $
Unreported $
$ None
$ A954.oo
$ 6,381.85
$ 63,684.00
$ 85,019.85
DUFE ESTATE
-
DANNUITY
TOT AL GROSS ASSETS
OREMAINDER
----.-.-.-....--.------.--
_._-_.,._~..__.._._.__.~------
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I do hereby certify thotlhe ohove appraisement is mode in conformity with Pennsylvania law and has been filed this
day with the Register of Wills. _.. I .. '. l' . '
CJfli,(L'r(I... (y jl.jI,lli~l_iL~_. 10/06/81
AF'PRAISER DATE
_..___~___,__~.___._____._.___,....____._....__________ __.._______.______ ~...________.._____._. n._ ,_.__,__ .-.
TOTAL VALUE
$
___._____ _______. ._~..__.._._____..d_
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Estate Nome
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
21-8o-Q2QL____._.____.____________
John H. ..Rot~--- __.___~__._._.~_____.._____.
Q Original
o Supplemental
o Remainder
REY.4l14 EX+ tll-801
Fi I e Number
Dote of Death
February 17. 1980
Social Security Number
REPORT OF INHERITANCE TAX APPRAISER
I, the undonlgned duly appointed Inheritance Tax Appraiser In and for tho County of . Cumberland
Pennsylvania, do respectfully report that I have approised the raal and personol property as reportod in tho lor.going
return at the valu.. set forth opposite each \tam In tho last colu to the right in Sc odulas "A", "B", "C", and "E"
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Datad:
October 6. lq81
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INHERITANCE TAX APPRAISER
INVENTORY
VAl.UE AS APPRAISED
ADJUSTMEMTS
CODE (HARRISBURG USE DMLY) REMAIMOER APPRAISEMEMT COOE.
92+
R.ol Property (Schedul. A)
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None
00+
Perlonal Property (Schedule B) 10+
Jolnt.Hold Prop.rty (Schedule E) 21H
Tran,for. (Schedule C) 30+
TOTAL GROSI ASSETS _____85.,019-85--
Le.. D.b.. and Deduction.
(SCHEDUl.E F)
Cl.EAR VAl.UE OF ESTATE
o Life Estate
o Annuity
40-
93-
FOR USE OF REGISTER OMl. Y
Tax on $
g!Jt5.
PRIMCIPLE VAl.UE CODE
\
COMPUTATIOH OF TAX
S
$
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5-
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Bill
FACTOR
6%
T ax on $
15%
Tux on $
Tax on $
Tax on S
Exemptions
Total E,tate
TOTAl. TAX
IMTEREIT FROM __ TO
BAl.AMCE
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Leu Credits
DATE OF PAYMEHT
AMOUMT PAID
OISCOUMT
IMTEREST
TAX CREDIT
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+ $
5
=
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IMTEREIT FROM
BAl.AHCE
TO
5
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~~~~I(K~e!Ho63'oi. '... .. COMMON~~A~~J~TO~ :e~:~ESVLVANIA .'.
~"'., ..... ... OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE.TAX
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TAX AT 6%
TAX AT 15%
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, RECEIVED
II FROM
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ADORESS
John M. Roth. II
a 0 Barbara B. Townaend. Be .
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8hippelUlbul'i. pa. 17257
TAXAT_%
ESTATE TAX
TOTAL TAX CREon
477.81
--ESTATEINFQiiM/lTI0N;7--- 1'-8--0
DATE OF DEdD. J. .
~OUNTY
21-80-309
November 19, 1980
JOHN M. ROTH
Cumberland
m
m
LESS DISCOUNT
PLUS % INTEREST
(FROM TO_I
FILE NUMBER
DATE OF PAYMENT
NAME OF DECEDENT
TOTAL AMOUNT PAID
477.81
POSTMARK OA TE
REMARKS · PAID ON ACCOUIIf1'
SEAl.
RECEIVEO BY
/'//u~ to I~cd
( M' s~~Af.l:wia
Reg .ter of Will.
REGISTER OF WILLS