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NO. 21-80
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'ro ......".. ......."........~\.l.~.~y. ,,~.~. ".~.J.:::,~?,t~ ",,, ..".......,.",......... ......"..,. ..... "',,' "... "",..
Register uf Wills 1'01' lIlI! Couut). of CUlllherland. ill I he CUIllIl""Jll'ealth of l'ellns)'!I'llllia.
_:.:;:::~;.,...:1~11~-!,etilion of . ,..... '" h.f).t;;;" ..""" ,c'.:"" ".', ,.G,,!,:{:, ,I.,.,C;, ~~.,'::' .,.'" ....'" ,,' ". ""., ..." ,." ..'".."" .',
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'd t I' "-:~I' Im.I",11Ip (' 1,'1' 1(' t' Cl.t' ,'I"! "I.
was a reSl en 0 ...!-,.T.~tY.",.."".......I'( 01 h ,1I1ll It! lUll .OUII ~. .., 1\ C n (! litHo>'
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vania, and a Citizen of Unit~d States, and depa!.ted this life Iuteotate in the Coullty of (,\.'."~,./kj;..~,,.~'" ,)
..............................,..".,.., and State of ""Q~~,.~~.>',1.l"v.,(\,iY."/)",, ".'.'" "..",.' "'" ,...",..' ..,.....,..', ",...........".. "............
on ..t.~!...?!):flt.I.v................. the ........,..........2,ti.:'!....,.. da)' of ..,..,..I.l.PR.I..'",...........,............, A. D., 1!I.,},.'l.,
at the age of ...~1..5....., yearo,
That the said ....,..P..~..;j.f.Q,!~.....f~,I..,\3.H,r,!,-.,;.A........,...... deceased, left surviying the following
named widow or -husband, heirs and next. to kin, to wit:
Name
Relationohip
Residence
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f-.opc.f!-'I u I t- (... 1'- r) (L.c (""'vII.--. y~ L rjtJ/..;o\...',/ofZ. (I 1~/.1..:'
That those a oye named include all of the next of kin, so far as' nown. r'
12 U()
The said decedent was possesse.d of personal property to the estimated value of $....'........r..g..Q..Q.;...~~
') , (.,,,
and of Real Estate, less incumbrance, to t.he estimated value of $..;:':-c..9'..S?..\:!,~....t;;-:::Us near as can be
ascertained.
That the said Real Estate in so far liS is known is located in ..~.~.)..,.....f,(.f,/.JI~..,..,5..r.::.....:....,
...N.c.. w,......" ,(..u..l\1,. lIP,!, (,!....h.."', r,V, Q,...J"...c..~.!:<. ,Il.( F.:, ki f.~,. (,'"!).,,...... C. "" ,\" ./.1..1., J...).. .el.1. "....,.......
Therefore, your petitioner(.) respectfully apply(ies) for Letters of Administration in the aboye
named estate.
Dated ..,..'i.).f./.....,......,..........,...., A, D" I!).t~:..
, I Signature Ilnd Address ,
uf Petilioner(o)
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COMMONWEALTH OF PENNSYLVANIA 1
COUNTY OF CUMBERLAND t ss:
,......,.......l:..7..f.J,.i..... "',.,'~. ,,:....,"'~"<.,i" :[."'-.,?:,b".",,, "'" ",.." '" ""." """ "'" ,., ".,..".." "..'""""""...",., named
in the above application being dull' ...)..,~..;;.,1,r"...L.................... aceonlinl( to law, oay that the facts set
forth in the above applieation are true to the best of ..\:\?,;:; knowledge and belief.
sworn ., /'Y1."" ~, ,17) .~":I'/</1
............"......'"",..'.....,'" '...'",., """..." and subscribed 1 p...""..",.. ,":~..,'" ,~'" '" ,.:.,:/..M<", C;.!......."....,.." """",..'
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before me, t ....,......,................,..,............,......"....,...................,..,..,....
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,yo ....L"tj",Y'c.../:...,...<r"~"';i;;;;;;;.. ............................ ............,............~....=;........~
Filed: ....,~~.~y....?3..:..,....1:?,~,(~........,..................., (O\'el') Att~r;l~.I': ~,;:~~~(:~.',~:r(S%;~;.?~::h-j S
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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55:
_____________________n ..._.___________...___.____._ --- -.-.--- ,. ----- +._--- .,. .- -_..--_..-- -.-" -- ,._....~
Mae E. Butler
being duly sworIl..~..___ according to law, do poses and says that she
is the Administo~a,~~i~._____.. of tho Estate of _~;r..e!il.j;(;m_);;..B).IJ;le,r,---,.. ..,-,,,..-- ..'-
late of the Borouah of New Cumberland , Cumberland County, Po., deceased and that tho
within is an inventory made by _______..__..!!!.e__.._....__ _ ,..... tho ,old l\,dl11if.li,s.tr~1,;,r.ix_
of tho entire estate ef said decedent, consisting of a\l the personal preporty and reol o,tote, oxcopt reol CItato ouhido
the Commonwealth of Pennsylvania, and that the liguros opposito each item of tho Inyontery ropro.ont It'. fair value
as of the date of decedent's death,
and subscribed bofore mo,
\ X /lJdZ Z~ LJ~(;Al!6~
, 1I"1lo~l(. Admlnlllr,ior
Hae g, Hut1.o):
, p, O,OOX 912
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fJ(.1A.('l- :( 19 J I
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'tI-'~1 114 ~n;;
~1(),t,;lf,;l)(J
Blndcnboro, NC 20320
A,Jd,.u
. ..-...------.-----
Date of Death --
28
Day
.------.--.
..,]\Q.ri1,,_
Monll1
19RO,
V..,
-- -. .----.--.-.--.----'
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I. An inyentory must be filed within three months alter appointmont of porsonal ropro.ontoti~:'~;
OJ''''
2. A supplement inventory must be filed within thirty days of discoyery of additional o..oh. r.~..',
F.Il
3. Additional sheets may be attached as to personalty or roalty ).:~
4. See Article IV, Fiduciaries Act of 1949. ~~::
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INSTRUCTIONS
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Invenlory of Ihe real and personal .slol. of
PRESTON E. BUTLER,
d.ceos.d.
REAL ESTATE:
Being Lots Nos. 3 and 4, Block "R", Plan
of Buttorff's Second Addition, having
thereon erected a two-story brick dwelling
house known and numbered as 693 Fifth Street,
New Cumberland, Cumberland County, PA
Consideration $42,500.00
Less settlement fees,
Mortgage payoff, etc. 26,198.61
Balance converted into
cash after sale of
house
16,301\ 39
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1,325 98
18 75
271 85
72 00
860 82
PERSONALTY:
Checking Account No. #124-826-8
Cumberland County National Bank, N.A.
u. S. Government - wages due
Rent check for above mentioned house (1 month)
Refund from Homeowner's Insurance policy
u. S. Government - 1979 Income Tax Refund
TOTAL INVENTORY
22, 40
18,873 19
Refund check on interest on mortgage
-
THE A:TNA CASUAL TV AND SURETY COMPANY
Hartford, Conn\'cliclIl 06115
LIFE & CASUALTY
POWER OF ATTORNEY AND CERTIFICATE OF AUTHORITY OF ATTORNEY(S)-IN-FACT
KNOW ALL MEN BY THESE PRESENTS. THAT THE ~n.iAC^SUAl TY AND SUR(TYCOMF-ANY, a corporation dulyorganizcdunderlhe laws of the
Stale of ConnectICut, and ha.....lng liS prIncipal office in the City of Hallfofd. C\lunly of Hilllford, SlaW 01 Connecticut. hath made, constituted and
apPOinted. and docs by these preSj~111S fl,..l{e, conSltlure and apPoint R. W. VanNuise, Ronald C. Kinsey 0'[' Lynne
Wet'1l\an - -
of Camp Hi 11, Pennsy 1 v ani a ,its true and lawful Attorney(s)-in.Fact, with full power and authority hereby conferred
to sign, execute and acknowledge, at any place within the United States, or, if the following line be filled in, within the area there desig-
nated ' the following instrument(s):
by his/her sole signature and act, any and all bonds, recognizances. contracts of indemnity. and othm writings obligatory in the nalure of a bond.
recognizance. or conditional undertaking, and any and all consents incidents thereto
and to bind THE JfTNA CASUAL TV AND SURETY COMPANY, thereby as fully and to the same extent as if the same were signed by the duly
authorized officers of THE A:TNA CASUAL TV AND SURETY COMPANY, and all the acts of said Attorney(sHn-Fact. pursuant to the authority herein
given, are hereby ratifled and confirmed.
This appointment is made under and by authoritv of the following Standing Resolutions of said Company which Resolutions are now in full force
and effect:
VOTED: That each of the following officers: Chairman, Vice Chairman, President, Any Execulive Vice President, Any Senior Vice President, Any Vice
President. Any Assistant Vice President, Any Secretary, Any AssistantSecretary, may from time to time appoint Resident Vice Presidents, Resident
Assistant Secretaries, Anorneys-in-Fact, and Agentsto act for and on behalf of the Company and may give any such appointee such authority as his
cenificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of
indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of
Directors may at any time remove any such appointee and revoke the power and authority given him.
VOTED: That any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking,
shall be valid and binding upon the Company when (a) signed by the Chairman, the Vice Chairman, the President. an Executive Vice President, a
Senior Vice President, a Vice President, an Assistant Vice President or by a Resident Vice President, pursuant to the power prescribed in the
certificate of authority of such Resident Vice President, and duly anestcd and sealed with the Company's seal by a Secretary or Assistant Secretary
or by a ResidentAssistant Secretary, pursuant to the power prescribed in the certificate of authority of such ResidentAssistant Secretary; or(b) duly
executed (under seal, if required) by one or more Anorneys.in-Fact pursuant to the power prescribed in his or their certificate or certificates of
authority.
This Powt!r of Anorney and Certificate of Authority is signed and sealed by facsimile under and by authority of the following Standing Resolution
voted by the Board of Directors of THE A:TNA CASUALTY AND SURETY COMPANY which Resolution is now in full force and effect:
VOTED: That the signature of each of the following officers: Chairman, Vice Chairman, President, Any Executive Vice President, Any Senior Vice
President,AnyVlce President, Any AssistantVice President, Any Secretary, Any Assistant Secretary, and the seal of the Company may be affixed by
facsimile to any power of attorney or to .my cenificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or
Attorneys-in-Factforpurposes only of executing and attesting bonds and undenakings and other writings obligatory in the nature th>9reof, and any
such power of anorney orcenificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such
power so executed and cenified by such facsimile signature and facsimile seal shall be valid and binding upon the Company in the future with
respect to any bond or undenaking to which it is attached.
IN WITNESS WHEREOF, THE A;TNA CASUAL1Y AND SURE1Y COMPAN'{ has caused this instrument to be signed bV its
Vice Pt'esiden t ' and its corporate seal to be hereto affixed this 3rd
davof January ,19 80
Assistant
/:~:,~::.:":'~;;.~<\
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THE
.ETNA
CASUAL 1Y
AND
SURETY
COMPANY
BV
7/?~
Assistant Vice PresIdent
State of Connecticut I
ss,
County of Hartford
Hanford
On this 3rd davof January ,1980, before me personallV came R. T. RIPPE
to me known, who, being by me duly sworn, dfd depose and say: that he/she is Ass! stan t Vice President of
THE A:TNA CASUALTY AND SURETY COMPANY, the corporation described in and which executed the above instrument; that he/she knows the
seal of said corporstion; that the seal affixed to the said instrument is such corporate seal; and that he/she executed the said instrument on behalf
of the corporation by authority of his/her office under the Standing Resolutions thereof.
(~~
CERTIFICATE
I, the undersigned, Secretary of THE .ETNA CASUALTY AND SURETY COMPANY, A slock corporation of the
SIat80f Connecticut, DO HEREBY CERTlFV tha~ the foregoing and an ached Power of Altorney and Certificate of Authority remains in full force and
hesnot been revoked; and furthermore, that the StandIng Resolutions of the Board of dectors, as sel forth in the Certificate of AulhorllY, ale now
in force.
Signed and Saaled at the Home Office at the Companv, in the City of Hartford, Std! 0 conn~_P'l't'd th~ ~ ~ /;' /1", davof
/1/;;7 ,19RD ,.;":::""\ ~ fttJ~
; ~ ".;~~~"l' . By
is-Im-EI (M) 3-19
.... r
.....~~I", ....,,:~~~../
Secretary
PRINTED IN US,A
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e
5. A description of the real estate to be sold is as
follows:
ALL THAT CERTAIN lot or piece of ground situate
in the Borough of New Cumberland, County of Cumberland
and State of Pennsylvania, bounded and described as
follows, to wit:-
BEGINNING at a point on the north side of Fifth
Street, said point being at a distance of fifty (50)
feet measured in a westerly direction from the north-
west corner of Fifth Street and Eutaw Avenue; thence
in a northerly direction along the line dividing
Lots Nos. 2 and 3, Block "R", on the hereinafter
mentioned Plan of Lots, One hundred forty (140) feet
to a point on smith Avenue; thence in a westerly
direction along smith Avenue fifty (50) feet to a
point; thence in a southerly direction along the
dividing line of Lots Nos. 4 and 5, Block "R", on
said Plan, One hundred forty (140) feet to a point
on the northerly line of Fifth Street; thence in
an easterly direction along Fifth Street Fifty (50)
feet to a point, the Place of BEGINNING.
BEING Lots Nos. 3 and 4, Block "R", on Plan of
Buttorff's Second Addition to New Cumberland, said
Plan being recorded in the Cumberland County Recorder's
Office in Deed Book "N", Volume 5, Page 498.
HAVING THEREON ERECTED a two-story brick dwelling
house, No. 603 Fifth Street, New Cumberland, Pa.
The names of the purchasers are John R. Sackman and
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Patricia A. Sackman, his wife. The consideration to be paid is
Forty-two thousand five hundred and 00/100 ($42,500.00) Dollars.
A copy of said Sales Agreement is attached as Exhibit "A". The
property is presently vacant.
6. The only recorded lien known to the petitioner is a
mortgage with Pennsylvania Bank and Trust Company, with an existing
balance of $22,204.06. and the property has an equity of $20,295.94.
800K 1\.)'7 r;,Gt 603
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AGREEMENT OF SAtE
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rrl.lfl':;..i~l'~lll H('III f:.~tlJte Sl!rvirt,s for Cl,,,trul Pcnrl$yft"miu
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.!:..:}[,~: ,..'.;", ~ry[ '.,I:>,.-'.',.}r'- -"L' jA',.y,<'?"v (.'1.;-.r1' ,r./:/'T.JS- ..."/.Il /,0 /,/'I>.I':rf "'0
.~l. ...: ....:_... '_ . .~...,.: _.., .: I.. ."....."J ,:.1;.. . ,f... .y...., ...,."... ,..... ':i":.;.". '.. ,,(...,...... ;-.--.,.-,.... .r:. :/.r.?:. .~,..... ..."':'., ..I.. .... r.'..
tA/- ;:1. ,_.~. ",;"7;:<'// i(Te':/,'" jye (,5y,'?"-\~[L.)t1/I!. ,.j,tIY.,\f..'..f.:" ,(1(,!,'.<< {,I.'I.,~~ "X'!, . .!{o:I,'TI::'(I,',!d, ' .,.-'1.,:. : ....'
'.J.j,:C ,:)./l},:r":"::'.., ....;::n."~ (:,$'" !.:r:I.Y~(.'/-.17..9. (" .:, ,l~"::(r.r..f.;TJ., (iN.!,!." .1.1:/j!'.U,~, .,(',(,.l, /!/'::Y}~.r;::."
" 2. joT.}TlE'iE'<., t.:;>on """ f,;lll'" of ,he Duy,,{,) '0 m~" . ,<I""",' by par',. ,he purch,,. money In full on or before . .C!,(~ r.". .~,< c., '
:1-1 . ..-:;~;' .'':'': .i.. l:us A';''''!'I''r.'.~.t ~aU C't void and the a:nou.''lt paid by thl! Buytt(,) Ilhalt be forfeitrd .ilS liquidilled dar.wgtt. Ptrmbslon Is wanted .o\muk'lllft
.r\~~iJ~r ,.:;:(C~". tnC-. ~:J m~..1. wlll:O\:t fu."'l:he: nolir.1I' to I~~ pdrth..., hl:~o. \he f:(ttlement date of thi!l Agreement for a ptriod not to t'Xc~d fnrty.fi...e (-$5) d:l'll, l~
:':l. 'A:1t:O:-:'5lcort ,}~d .,~.t':'d ti-.~t U "her f1.l!1 COo:)pP.f,lt:Uf'\ of bUYP.r(3). afom.a.id financing Is not approved, the deposit wiU be returned, lts, any l:J(po!ntt lnrunt'J on
c. :';".J..:tr lit \:-.~' SIJ)'r.r. fc~1 ~1:O".cl'!r ('If d.'\"d and rurcJ,.1Soe :r.O:'l':J' !.. lvrt'by waived. The 8uYt:th) hl'rein ilgrec(s) to m'lke formal mort~ge JClan ;tppliCJti'Jn with J
.1;<.it~.:.l iir...e m9ftg..a~ k~':e-:, wiL\ir. ttll ilOl d.w~ of th,. il<Ctpl.lnCe of thi1 Agret'mtnt "rod further aK/et(s) to m.1klt appHc;ltion fL')r r~lid mnrtg.lge loan;t'l des4':ribt-d .
!1..:,"t.~!t wHh.,)t :c,l~~ t~ 1.3', !'::-,CC':'$ until ~id ~i:\.1nd:\g i:t approved.
,_ J. .~~;o.;..tfEA:t EST.", n tAT:tAS: r:,~ phl!T'1birl,g. ho:'i-li(\~ aml rrrm.mer.t tight fixtum, .lfld aU lTetS. lihrubbtry :lnll planb ..ow In or on tht pmnl!lo'!'t ~re
'~':";"~"':y./l.tnfl:'f:,~l~~t l1,e~l~alsoinc!\;~\.,thtfo\lcwir\gl'Xtr:\s: I ~ Ca. ,\ -:n:: 1 I."~ ~ \
./...;?...!:';?_. '.'(:"" /-.,;1_:..('7.(:",..,~..., .;..I;;/' hl.I.Z'"' d?l'f.4.$,., J:~!.",:.. .{11.~" ,lr;.r!:I,'!/.!:('''::." .... .f!.!/..(;'/'(!r.':7/.',(1,.}
.:t:."~l(..j~:i7..'//'~/-;"i~.. ./1":". .a(!"{':.f~S:7 /~, I. .'...................................:........ ................... ...... ............
4. TR)..'l''Sfr.:R T,'.:a....;: Real E"ta~ Iroln5fer tJ.Xf'S 'vill tit: p"I~~AtS follom: '
...... />":. "f..~'/f:./~,...,.../ 7.~>", .',,:;r~~<:.t.:'<. ,,,,,,..,,. ....,.,........",...,," "..""".. ",,,.. ,,,,..,,, '"'''' ,'" ,,,..
'.. " :'G55,.5:;;O";, b"",>lo>';' 10 beD""n ,..../:1~....:~.&~7.7/,E.1!1.1trr:"",..".., ,....,..,.., """ ,..........,......" ",;..
: i~J_~t~~\ ~~ :i,~ ~l~e .~i ... I.-./.ti'..:...... . d(lll.1.l" pet' I~Y wm be paid by ....,.. .)).//1.... .. .. . . . . ............".. ...... . . ................ .. .. .... ..
'i~,~:l.,'" .;.~L.-/.,~1,..t....."."'" i~s-~"";t~a1ah<'\~. ,.' .
6. ;.:;;1.i$1'}ls....rs :~T 5r:rrI.tML"IT: T:lll.~. mil, watrr. .1nd s.ewer N'nts and ..11 othl!r pt'riodic clalnu nnd chuges 5holll b~ arpertlont:d to date cl
*,;~i..:~""I't. l'u:\'~';..e ;r.ce- i::<:;1.lM 1i.:e1 ell rnnainlr.g iOl t:ll'Ik at time i.lf ~~ttlement. /l '/.. f!..., ..11 .t'.I., n
. '. ,:', 5':W!'tiS 0r \"IA~ A~'"O '::'"c"\'i'ER: S~Jef 1~,imnts :hat this prop.:ny is serviced by .1:'t(b. .-..t.... watff and . .%v~ .~, .I\--se'w~l'. Ftlr.}oott. Stl!"3'
f-..~..I_.................- .......a--c:._ fullv n.:r,;.' rnr .:aNi. ;u d Ihl: d.1te of L"is iW'l!mlent. art in sati.~f3c~ory t;ondilion. If afoteQid ,>.,te:n$ are privat-e, $:-ller"""!~_I.'?....!:!!.~'~~~...r
INFORMATION
To insure proper credit to your nccount. the namo 01 thl} estate and filo number stlOuld bo clanrly print-
ed on tho check or money order.
This assessment is made in accordance with Section 708 of the Inheritance and Estate Tax Act of
1961 (72 P.S. 9 2465.708).
To the extent that inheritance tax is paid within three (31 monalS nller the deBlh of the decedent, a
discaunt of five (51 percent is allowed (72 P.S. 9 2485.7161.
lnheritcmce Tax. other than tax on a future interest, is duc at the datu of the decedent's death and becomes
delinquent at the expiration of nine (9) months after the decedent's death (72 P,S, 9 2485-711j. 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. ~ 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 days .00034 12 days .00203 22 days .00369
3 days .00051 13 days .00220 23 days .00386
4 days .00068 14 days .00237 24 d,ys .00403
5 days .00095 15 days .00250 25 days .00420
8 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 (60) days after receipt of this Notice as provided by Section
1001 of thelnherilance and Estate Tax Act of 1961 (72 P.S. S 2485.1001).
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below:
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
~~
~
COUNTY FILE NO:
"t/- /U -3 ~/(.)
DATE
'," ' b!
/f.. I'~'c.. ,,;' ,? / '/ t'
'/:J.I;,.i :." 1,~IU(:t.:(~
) " I
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TO: t;...""vl_.{~0CL..A-4';1 "...i. ,,::;.' ,.(.-',........1__'../,-_1
. II
; . I' '. -(I 1 ,r I- 1/ r.!-
./l,/,/....r".{{!./ ~_~il)6 :~?j-' r._.,l~I:'-"~'..(.li,(..J.-{ ~..j/c,
,
ESTATE
,
tIC,
COUNTY
j/ 5';) - 3 ~/I.)
/:>//)) :bc,tLMt-L
/ I J. 'h '1 ,', . (J{A
OA TE OF DEATH ,j('V1-r..c-~'",' / 1,1 (I
tI I
FILE NO,
/fNI
Appraisad Valua of Estata:
Raal Estata
$ /0 t1t)( ~/~I
~., I j"
+ "" '::J I' . ()
Personal Property
Jointly Hald PropartylTransfars
+
Total Approvad Oeductians
$ ),:" !' '/:1.7 'I
,3 .'/ ('I >;' I
,
Total Gross Estate
Clear Value of Estate
/ _ I' ~.- "Y'
$ ~ I!;,I.~' ~~'(/
.
~-~-_._-
Less: Approved Charitable Exemptions
.' _,"" " ,~ ~ ~:;'.v~
$ / 'j I :).~; ::J(.I
Clear Value of Estate Subject to Tax
Amount Taxabla @ 6% Rata
$ / J- ,P:j.j)- !:i C"
,
tax due
$
'-( r;, ;"3
I __1 ..:J
Amount Taxable @ 16% Ra,e
tax due
*._-*.
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
_:---"'./ ' -t -r-.v " )
.... ,~.-it-1'~;~/.J~~'/..fkY''-' r/~l.j'r))/ t>;:M) P$ /yP /
A fiV; percent discount totiting $'
Inheritance Tax is paid by
$ '11;-; 33
',j ,.,- /
"./ --
>/ ;,--) ~?I.'i
l{c '- (; i
will be granted if the
Less Credits:
DATEOFPA~
AMOUNT PAID
DISC.Q!,lliL
INTEREST
TAX CREDIT
~j-;J':i-il $ h'l~)tl +
$
$
=
$ '/'I I () 'I
+
=
+
=
Interest accrue:; 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
,I', ,.;..-, .r >P'i..."J/
-;i/ '"/,.! .../ ,. '.~~!.L..).<-- "."(,,,~(/, 1
. /fA--v .;,.U..
',- .:~'.I 'I.'
See Informal ion on Roverse Side
i -:t I . i ~ It>, i ,"':i. i '
f
I
I
INFORMATION
To insuro proper credit to your account, the name of the estate and file number should be clearly print-
ed on the check or money order.
This assessment is made in accordance with Section 708 o,f tho Inheritance and Estate Tax Act of
1961 (72 P,S, 5 2485.708),
To the extent that inheritance ta~ is paid within three (3) months after the death of the decedent. a
discount of five (5) percenl is ellowed (72 P,S, 5 2485.716),
Inheritance Tax. other than tax on a future interest. is due at tho date of the decedent's death and becomes
delinquenl at the expiratian 01 nine (9) months alter the decedenl's dealh (72 P,S, 5 2485.711), Inheritance
Tax on a future interesl is payable within three 13) months afler the lransler takes eHecl in possession and
enjoymant and is delinquant thereafter (72 P,S, 5 2485.712), Calculata interest from lhe delinquent date shawn
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 deys ,00051 13 days ,00220 23 days ,00386
4 days .00068 14 days ,00237 24 days .00403
5 deys ,00085 15 days ,00250 25 days ,00420
6 days ,00101 16 days ,00267 26 days ,00437
7 deys ,0011 8 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 parlY in interest, including the Commonwealth and the personai representalive, not satisfied with
tha assessment may object thereto wilhin sixty 160) days after receipl of thIS Notice as provided by Section
1001 of thalnheritance and Estate Tax Act of 1961172 P.S, 5 2485.10011.
Make check or money order payable to:
"Register 01 Wills. Agent"
Mail to the address listed below:
Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against 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 including the cost of a burial lot, tombstone or grave marker,
GENERAL INHERITANCE TAX INFORMATION
All debts being claimed against an estate are subject to the approvai of the Register of Wills with whom the
Inheritance Tax Return is fiied, 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 Pennsyivania,
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. The family exemption is
allowable only against assets which pass by a will or by the Pennsylvania Intestate Laws,
r ." d (") > rr1 ~ ~
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
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 each item listed,
3, Enter the date on which each debt was incurred and/or paid,
4, Enter the names of each 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,
REV.449 EKt (3.60)
COMMONWEAL Tll OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER IHHERITANCE TAX
RESIOEHT DECEDENT
AFFIDAVIT OF
FIDUCIARY
(Instructions on Reverse Side)
*
Estate of _ PREST..9~~_J;;.._BUT~.E_R____.
Lost Address ~QL_Fi.itJLi31:_r~.~-
New Cumberland PA 17070
____.--.- ____.__1
((TrYl ISTA TI:) {'ZIPl
Dote of Death April 28, 1980
Social Securily No. 216-34-9674
Bureau File No.
Counly File No. ,J 1- ~'(y .34 ()
1. Decedent died:
( x) Intestate (wilhoul 0 will)
( ) Teslate (leaving 0 last will--copy allached)
2. Is the filing of 0 Federal Estate Tax Return required for Ihis eslale? Yes_ No X
3.
Executor/Execulrix
x) Administralor! Adminislralrix
Name
Mae E. Butler
Address
P. O. Box 912
_ Bladenboro, North Carolina 28320
(CITY) ISlUEl ('lIP)
) Fiduciary.
,.., cD
r ':d
~,,' ~ ;:Om
.-;:'Al <'1,..,
c;;";:t. :3: '2C:1
ri:,.! ,co '.'1':7)
~l.,L) ..lC"..l
i- :~.: c l''1t~1
~.':~ :-' N ; ,~?
, , ,n :"::,
."..'
~S~:i ,
:13 ,-,
...::) ."
4, All correspondence should be moiled to ( X) AlIorney
5. If an attorney is represcnling Ihe estate, indic'ote:
Nome William J. Peters, Esquire
Address suite 305, 100 Chestnut street
-Kar~s~~ Pennsvlvania 17101
(CITYI (STATE) (Z.IP!
List 011 safe deposil boxes legislered in the decedenl's individual name, or joinlly wilh, or os on agent or depuly
of another, or in decedenl's individual nome wilh righl of access by anolner as agent or depuly. Include the name
and address of the bank or other institulion where Ihe safe depasil box is located, the name (s) in which Ihe box
is regislered and the relationship of the jainl holders 10 Ihe decedenl.
NAME AND ADDRESS OF BANK OR DTtlER INSTITUTION
IN WHICll DECEDENT MAINTAINED A SAFE DEPOSIT BOX
NAME OR NAMES IN WHICH
SAFE DEPDSIT BDX IS REGISTERED
RELATIONSHIP OF JOIHT
HOLDERS TO DECEDENT
None
--
--.---------.---
--
Under penallies of perjury, I declore Ihol I have examined Ihis relurn, including accompanying schedules and
statemcnls, and 10 Ihe bcsl of my knowledge and belief il is true, correcl ond complete.
-lC /l!~ E' 6~
SIGNATURE OF FIDUCIARY
j~~-JI
DATE
PENNSYLVANIA INHERITANCE TAX GH!fRAL INFO!1MATION
- - .--;----..--
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Eslate Tax Acl 011961 plOvidw, 1I1;illlie Inlli)winl', person:-; shall prrp:He and file
a return:
a, The personal representative of the estale of tlie decedent as to property of llie dr,cedent mlministered by him
and such additional property which is or may be subject to luherilallce Tax 01 which lie/slie slinllliave or
acquire knowledge;
b, The transferee of property upon the transfer of whicli Irlhelilance Tax is ornl;IY he imposed hy the 1961 Slatute,
including a trustee of property transferred in trust, provided tllilt ni! sel);u;)le relnrn need be [\lade by the transferee
of property included in the return of a personal representative,
2, PLACE FOR FILING
The return is to be fited in duplicate with the Register of Wills of t1111 county wherein the decedent resided,
3, TIME FOR FILING
The return is due nine montl1s aller the decedent's death, unless an extension for Iiling has heen applied lor and
granted by the Secretary of Revenue within the nine.month period,
4. FAILURE TO FILE RETURN
Section 791 of the 1961 Statute provides that" . . ,any person who willfnlly fails to file a relurn or other report
required of him, , ,shall be personally liable, , ,to a penalty of 25% of the lax 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 tather, mother, husband, wife,
son, daughter, grandchildren, grandparent, son-in.law and daughter-in-law and at the rale of 15% as to ;]Ii others.
6. PAYMENTOFTAX
The tax assessed on the transfer of property reported in the return is due 9 Ilronths aller the decedent's death, Interest
at the rate of 6% per annum accrues thereafter until payment is made, All payments recei ved are n rst appli ed to any
interest which may be due with any remainder applied to the lax. 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 01 Wills of the county wllerein the decedent resioed 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, whie:, lien remains in effect until
the taxes and interest have been paid in full. The taxes may be sued for ngainst any real property in the decedent's
estate or against any property belonging to a transferee liable for the t"x.
8, FILlNGOF FALSE RETURN
Any person who willfully makes a false return or report required ot him shall, in accordance with Section 793 of the
1961 Statute, be guilty of a misdemeanor and, on conviction thereof, sllali be sentenced to pay a fine not exceeding
$1,000 or undergo imprisonment not exceeding one year or both.
--.
" F. 2853 01 A 7/76
-------.
rCl,nl ApPHl\'tlfl ()~'AO fJo. fJ3.R.lI}01 Pagl! ~
.__ --a.-T';PF.OFLoAN --.1\
t"[] r ;j~ -2~-OI;Mi~A' -J~D' CON V ,UNIN;-- ._~
.~J-~J_~~~,-__ --=-.Q'_'::~!:~"~'I;' -- Lo,n Nu-b.' _.._.~\
li r ill) NlJllIr)~r 1. ".
r,Lf, I it 2058
lC.'M",lrll1nUO' '-i7;lr..!;tu'r.,"o-~J-;.~TiQr, .-..-
A,
ABS'l'HACT LAND ASSOC 17\'1'85, INC,
244 Sout.h 17th Street
Camp Hill, Pennsy1vanh 170U
SETTLEMENT:iT A TEMEN"r
U,S, DEPARTMENT OF KOUSING AI'O UABMl DEVU.(WMENT
----------_..__._.~--_..-----_..."
--..----.--------.-.--....-..--.-----.---...-
C, NO'rE: Tllis farm is lumis',"d to give ~'au a starement oi ,.cwo/serrlemr.nt co"'. A"wllnts p"itJ W ."" I>V the '''It/oment "yent am
sflown, /fT.'ms mDfked "(p,o.c.J" were paid outsid" tl", closing; mev ,m' ,/lown /",rc for i"lorm"tio".1 pmposes and aro not
included in rhe totals.
D. llAMa OF UOR-HOWE~-SAC fj;"W~-;-J7.)hD-r<: --;~D;i-pnt'-;':.i.~:j~:l--A -:-;"hT;3-~if~---------"----._-----
ADDRESS=
E.NAMEOFSE"I~LFji-:-llUTLr~i:t;8~~:-;^7\;;;~C;, i ,;tr11 to ;:"oT-th-';-E5 t;te ~f---------'--
ADDRESS: P.t'est.on E. B'J.lJ.~~~: \
F.NAMEOFLENOlR:---".-lI ;:\rl-;;O-;'~--l-"..::'-ll-;------'..---.-.-.. - -.-.-------------------- -----
i I:. ~n " ."".,
ADDRESS: 222 Marl\;et~. Stre(~l \
O:-PAciPfiiTV L OcATiON;-_~.~j.0S~.~\.!{~.~c:;;~JL15y.ly-'UljcL-l.1JJL~_----. - .---- -.-.----- .. --.,
IlOl:OU9h of New Cumberland
,
_ _.____.___-~.UHBE!l. Lb.\:;J~..J,;Q\lN.TY.. .l'.c:rU1 ;;..:1 \1.ilI1 i-'L--------.------ --- . .. ... ..1
H. SETTI,EMENT AGENT: ABS'fR7\C1' IJi\ND ASSOC rATES, TNC. I. SEl"TI.EMENT DAn':
ADDRESS: 244 Sou\:\1 .L 7 th S nee\:
_.__--~.mlll?-!l.i.H-'-.l~Q1JnEY-l...'l.ill....i.,L--J..l.0j.L---.-------- December 9th, 1900
PLACE OF SETTL(MENT: A.BSTRl\C'r Li\ND ASSOC I1I1'ES, INt:. Tuesday
A[)DRESS: 244 south 17th Street. 4:00 p.m.
_____ __. __._n___ _._C9!]19..Jilll....--i:~n.n:i:;l;l.J.Ulif--l1Ql1 ---.---.-- ---.----------- .
J, SUMMARY OF BOPAOWER'$ TRANSA~~~. ___ L_.__~~_~J~~~.~~~~~~~ANSAC'ION -.-.......j
to~S AMOUNT~ROM 80R!:9.!!F.r~~ .___.____._._ --t-- _~OO (~~~?~~~~{~! eYE ~C!J..~~!:.. -~.-_._--,.-
101, Con,,,et "'e> Pile. 3UOD...Q1l. __ ..~.~o_~,,-''-'~I~'~~.- :1? 'iillLOll.-.-.
102. P."onol prop.'W 407 pc,,,,naIO"'O""Y ,
103. Settlement thargos 10 b~ rune ttfGOl .-- /, I ~ J 4'T."7n-~~ ~03.-'----_. - ~--'--'l
::: -= -=:~__~-~~~- :~f- __:~ --_-==-.--- =1
Adju,rm.nts ror I,""" "aid ,w ..II., m adv,,"" Adju",nc,," (Dr "em, ""d rW Jell" '" advonu J
106. ~vlt;;~~-'.'.' 12/..2/..e~ 1/] /..BL....::::E. _==~~:t~lL-=-~:O.G.c~0~'" lD;.'~2,L.9/.W'Wl!i1, =f UJ:---
107. Counw ta',~U2/Jl.O to l/UllL-- ______2...15---- :<!2'-E.~..~~.~..n/..9/:SlL'.~J..1,L8l.- - -2-.l,$...
108. Auemncnn to ~ 408. A.~Sl'~smena to
~'3clmLl'il9l.aO 1';'- U.U.B"-:=- -=::::-..:ii1.1.JiCL.:= ~~i.SC'l1rc1I~-12,L9./.80~to- 7/'/8] , 1 64 .60-~:
110. 'f1WI'r 101.l,L80 tn 1/~.Llll--_.-__.---2-SL- ~cSotJcr-J.o/l,LBll.-to ]/J/61 =t 2..-53---
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GROSS AMOIINT n". .
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Page 2
f L, SETTLEMENT CI1AAGES
---.--------.---
100. TOTAl. SALESI8ROKER'S COMMISSION Oiled on p,;c, Ameri can He;]] ty Group
.__._$ 42,500.00 ~L,__ %- ?,Q7S.OfJ---------.----
_._.-.!!.:l/jlian of CO/llm/ulon (JI'!!!...!~) 4!..!!!!!.!!.~____._.----_.-..-__.__
101. $ 10
-.- .-.------.-----------------------------
71J:~. $ 10
loi-~I~--;t-S;;I-I~8nt
_.--!MOOllV retlllned by broker IJPIll!ed 10 COfn~~-=====--=---==--=-.-:.:~ ______._ _______. ...2.,.g:i.S...-OO ./
-,ri/., Other 181el agel"t Chlfgel
70~~AddilrOIl"1 comn'liulon
-----------..--.-----.---..--
----SOO ITEMS fA YABL< IN CONN..E~()_,,-!!!!H LOAN _ ._____. ._....._ ______
:~~~.. c'an O~lllnitt,u0-;e 2-.% ~n l~ir.oilt.olLIbnk_(l.'il.iCi-.]!j_OO.-=: _13.:\1~u1CQ- .7.s...oo.~
180:' lOilnOiscount % ____.___.___.__.____..._.~.___.__ -.---..'--'-
I~:~ APp"i'~1 Fe. 175. OQL.~ Hilmi 1 toD.Jl-,nk _..__.____ _ __.l~.O"'c.__
!~~'dil Ilepo" (!l3..0.0~-HamiJ-t:on-B<"lI1k--.. __ .._._____ __ ___. _--1!.O.c__
iao~ l.ender'S Inspection Fee_._______. ._.__.________ ...___._____ -...
r"'--"- ---
IOCE. MI}llg,lIJtlln~urar\':J '\rJPI;CiJtiO~~~___._______ _______________ ---.-------..
:iloj- Assumption Fue
'~,~_L!?QJ:CM to l~l.!;QD- )'laokJ;()r l:el:~.;ir5.==--=-_=:=_..:_==___=__=_-= ==--- --l=.2llU
309.
....-.--------------------------------.--..----- ---
,,~
311: -------------.------------------.--------r 'I---
--- --,- -----------------.------.------ -- ....
--- --goo. I1EMS REiJUIRED BY"LENDER TO BE PAID IN ~\DVANCE
---..- -------------. .--.---.----,----. -"
""'-;;;""""-'2.'9'60 '''''U3l/''-'"~'' ';' __""=-zJ-"ays r'L1AL- ----
)O? r~~Qe 'n~ur"nco PrflnH~~~______~~~I~~-..--_----- __ -
'J~~ -IIJ~~~~r('m,um lor___-1.__Xr.,~~_ .'----=-_ _~:_l:.____~:....__~ ','. ." - .
JO. Vp'"rs to
- .--- -- ---------------------- --
11J~1
---_._- .---.------------------------- - ------
/000. RESERVES DEPOSITED WITH LENDER
1.~~~__~~d insurance ~__ 1l1~-nth @ $'-9~-33--==-~~_r ll\~~~__..~-==~=~==__ _ 9. ~.3 =~
tn:r;r M('rllJage inswance monlh (ill $ per Illonlh
1'?~~. r;,ty prOPCrl\' !.lites' 11 _ I~~~~~ @ $_i..l9._-==~e~~.~~!=-_.=__=__==~===_ .----6a.~
\_or~~:._~~~_operty la.\es 11 mtmlh (~~_1..D9____._.~~~~.~,,_'~___._____._____. 3'~ Q9 v'
1 Of15_ Annu.,l "ue5Sme~~._.__.~nlh~ ..._ _ ___.___~~::..~~'!.~~.________~_m____._.
PAID FROM
~ORROWER'S
FUNDS AT
SETTLF.MENT
PAID FROM
SELLER'S
FUNDS AT
SETTLEMENT
____40_._____ ______.____.__
-.--.---..--.---.--.- --
'~06_ ..schooL--
\007.
--..-..--
~ona
_~~_22..51____~:~~c:.~_ ___________. ---.1.9~.99-L-
month @ $ pel mf...nth
----------.-- .-...-.---.---- ~--_.__..------
7
month (eu S
____!~::..Il.\~l.t~~. __n.._. ___._._____.
.--.--------
, '00. TITLE CHARGES
.....-- ---_.__..-------_..__.._--"-"-~
11~)~__$~~osin~~_____.__...__~.___.__________.__.____..___.__._.__' __
, 10;'. Ab~llilct or litle ~l'a!ch to
.----..--.---------------.----..-.-----------.---- ----
11111 1 ,tie eW;lminalton 10
- .. -----~- ----.---.----..----------- -.-.----"'---.--.--...-. ..----.-.---
111); T,lIe jns\lr:lnc~ Ilindl~r 10
_. __...' _____ _._._ .____..__...._____.._ __u__.___.._.___~___.__._..___._. -.----- - -.-..----...--.--- -----.----
1 .l(~:~ ~~~~I~I:~1 prvp.~!<JtI0~_.U.p.t;'.tgggeLI::Abstract..Land..J\zsocia tQs.,..Joo _ _..-4.0...nO../__
'll';_'I~'.':"V ''''____.,,________..__~'_Vill''...de S..StacknkL....- _ _...........5..DOd_ _....5.. '/'
1.'.[:I_~_I~rneY'5 't>e_._________..___~'JjJli.ar::t _J...._J?c.t.erS.,.-1::sq..______.. _____-~;.~ ~....5.q. Qq/~;"
_.._"...!;.~~clud::!..~(JOVtl jtrms.:!..lImf)c.'!:..-._______llOl_&___ll05-JW:.:crl..prcpL-n.-- _'.~ ,. . ':':' >~';:.,:,r..",~:.
i 1.l)3.:...2~I~~~~~_.___.___.__.__.. .._.__:':Abstracl LandAs~c.L."1Les,_Jn .._...316..-15~..L
.__._.J.i!!:!~dcs "bov~ liemJ '~!~~~____..________nl102_r_-l103-&_1104_..-.. .___.____.____
'~y .~_.. ~!:~(.::.~'.. cn~~_.___,,_______ ....____ ~-32.,5no...o.o ___._._____ d_.____
_~~:~__~.~_~~~~~1~___._ ..___.._________._.~__A 2~500_ 00.____.._.._ . _.___ __._..~____._ -
'I.: L.DisbursenEnt..fce..tD...1I.bstrac:t..LandJ\srociatesr..Inc.... .--'-' - .- .-..----=r..=.ll..OO
il12
,-ii::::==-==--=~~::::_::::::.~:_::=:=_~-.:.=~_-.:.=:":::::-_.::_.-.:.::::::. .... : ::-:::: .:::::t==:::::=.- ----
1;00_ GOVERNMENT RECOR{JIN(j AIVD TflANSfEH C'/Ar'?(ii:'S
. -.--------.-.-.----.-----.-----.------..--..-.-------. --- _. -_._-----_._~ ---.--- ---.
?_t~~_~~~~~_~....?l.el!._$ ..lO.. 50- _:.~~'!.! Ig,~~_~._9 .. 00...._..__,. 1~~~I.:.i~~.:~ _._____
;..:ll2_n~.:vlcotlnIY t~_~~~~!?~.~~I!.:..I__~.425...00._:...T\~~'2~,~~~!.~_._ _. . .__ .__~_._
~ 70 1_.._~I.':..~:~~~~~~~~,_____~~c~__~.425~OO._..:.!:'.'::~'~J~.!_~_~_ . . _ . __ _ _ _.___ ._
Ln.l
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-- -.. ---..-----------..------ --.--.-.. --- .---_.... -~.__._._---- .-.. --"--' -- .-.--'"
;'0';
------..-----.-..-- ~.--- ~_._-_.~-_.- --.----.-...-..-.. ------. .-.
,:?OQ. ADDITIONAL SETTLEMENT CHARGES
\ 10 1 Survey 10
+ ...-.------.. ---.-.---.--- ---..-'.'--'-'--' -._....-
i:).~.'~_ P..~~_l~l.il)t!~~~~.. . ..__.. _ _~.I~~_.__ __m___~__' ~_ ___;."..~.,,_ ~_~._'~.!. >.:" _ _~
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of de~th, m~ke ~ny tr~nsrer of ~ny m~teri~1 pmt of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No",)__
2. Did decedent, within two years of death, transfer propHrly from 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 aoove is "Yes" and the transfers are claimed to be nontaxable, provide the following
information:
a, Age of decedent at time of transfer,
b, Copy of death certi ficate.
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",)
. 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",)
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, aoove 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 care of transferor? (Answer "Yes" or "No",)
8. Did decedent, at any time, transfer property, the bl31eficial 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 EX+ (3-00)
. COMMONWEALTH OF PENNSVLVANIA
, DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
*'
(Instructions on Roverse Side)
Estate of
ESTATE OF PRESTON E. BUTLER
--
~
SURVIVED
DECEDENT
Yes
DATE OF
BIRTH
INTEREST OF BENEFICIARY
BENEFICIARIES AND ADDRESSES
RELATIONSHIP
_ .1:1-
Mae E. Butler
P. O. Box 912,
Mother
]j:ntire Estate
----------------- .-------- ---- ----------.------
J=
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 property, real and personal, owned by the decedent jointly wi lh another
party or parties as joint tenants with right of survivorship, Both tangible and intangible property arc 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 "S", Include the name, address and relationship to the
decedent of the co-owner {sl 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: ." 0 n ;.. '" ;I- ~
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,,~. 1l:1~~11li.:ly~rJ.~if;itii;;!li.;:q':Ni.,H0.:'.....',...'.'"'COMM.ONWEALTHO. FPENNSYLVANIA . . ....... .
",' ~'f~"U'?r.:~AI;}V'i~~.r"iY\;';'J"~'':;i,:''..c:':~''i:!::-''_,',,',(1,0,"" .,', ,-.Ii"""" ,', "" ,'-, " " ' , '
. 4 'l'ioft'1;(j'295'1!8""'v',"" ..,... OEPARTMEN.T OF REVENUE ". .... . .. .
. '!if%t:",;~;\:;.,."i.,.}:OFFICIAL RECEIPT' PENNSYLVANIA INHERITANCE AND ESTATE TAX
I' . ~~""i''''~''C!'i'''''' ...., . . ....,. ..' . . . .
..
'I
=
~
.~
III RECEIVED Mae E. Butler
,""\ FROM
TAX AT 6%
TAX AT 15%
TAXAT_%
, I
. ,
100 Chestnut Street
Harrilburq, Pa. 17101
.
ESTATE TAX
1 ADDRESS
13.80
TOTAL TAX CREDIT
'--ESTATEINFOfiNiATIO~.jip-~ii--28- 1-980----------
DATE OF DEATH '
21-80-340
FILE NUMBER
LESS DISCOUNT
PLUS % INTEREST
(FROM TO_I
DATE OF PAYMENT
May 15, 1981
PRlSTON E. BUTLBR
NAME OF DECEDENT
m
m
TOTAL AMOUNT PAID
COUNTY
Cumberland
13.80
~-------------------------------------------
POSTMARK DATE
,
I REMARKS .PAID 1M FULL"
r
RECEIVED BY .
SEAL
I
REGISTER OF WILLS
------'------- ------'-- --,-.-----'--.--"-..,