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HomeMy WebLinkAbout80-00349 ,I'"~ 0_,'- :! " .;\1': ,'.' a " m " I i I ",' = .,." ~ ~ fo4 . ~ p., ..: ,~ I - 0 ~, r-l Jl 1 ( G - .. ~ LIJ I REV.455 0.801 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ,STATEMENT OF OEBTS /~ TRANSFER INHERITANCE TAX I. ANO DEOUCTIONS RESIDENT DECEDENT___..,.:z.;:"'&.....t..'.~2 JIt~1 ~djUcJ[/[L_. -... E t t f Lor tt l' St D t 1 D <h Fe;ruary 27 ]980 SCHEDULE "F" *' ')1- )(.. 3;/1 saeo e a '. orev aeo ea , Ie 0,'- . - , WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING: Claimant Reiationship to Decedent Claimant's Address ITEM DATE NAME OF PAYEE REMARKS AMOUNT NO, ~ March 11 Charles Mver - Ronald Hall exnenses for Mrs. Loretta F. Storey Funeral Home 02 nhn.nn , - , , , TOTAL THIS PAGE I F'I N I hereby certify that to the best 01 my knowledge and belief the loregoing is a just and true statement of debts, funeral expenses and expenses of administration submitted to. the estate,as deduct; ns for Inheritance Tax purpos~% JH!UI'H1I.! yl.)~I:o~/r l U<JZIJST (OD, 'TR(j:"<(~ (; ,- !;C,;(/[&1!iaJr WITN L(J('c.TlI'l ,y '- '" t. <.S.r~)RC:'V I I f ~.. ~ q- J- /) f IGNATlJRE OF ATTORNEY/FIOUCIARY" 1 ....OAT OFFICIAL USE ONLY ~EBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ ~ iJ &tJ, H )AU/';.I AT j?- PE RCENT. 94 /J~'J llA _ (!, " 'L/7. /J j . ~ REGISTeR WI\...LS _tJ-s--io DATe: GENERAL INHERITANCE TAX INFORMATION 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 lees. funeral and burial expenses including the cost of a buriai 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 fiied, Evidence to support the decedent's or the estate's liabiiity 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 chiid, the exemption can be claimed by a parent or parents who are members of the same household as the decedent. 1'"' "" I:l ("l E; tT1 E; ~ Z :>- 0 0 Vl Z - Cl n c: 0 ;; s: z ~ tT1 t'1 ~ Z ;:::l 0 - 9 z Z tT1 ..., tT1 ..., z 9 9 ..., -< Vl tT1 - Vl Z 0 Vl 0 ..., ." ;:::l 9 ":j ~ ~ 0 - ":j 0 "l - Z ('l - ;l> ~ c: '" tT1 0 Z ><: ><: :;; tT1 tT1 ~ ;l> ;l> ;:::l ;:::l 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. PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION 1. PERSONS RESPONSIBLE FOR RETURN Section 701 of the Inheritance and Estate Tax Act of 1961 provides that the following persons shall prepare and file a return: a, The personal representative of :he estate of the decedent as to property of the decedent administered by him and such additional property which is or may be subject to Inheritance Tax of which he/she shall have or acqui re knowl edge; b. The transferee of property upon the transfer of which Inheritance Tax is or may be imposed by the 1961 Statute, including a trustee of property transferred jn trust, provided that no separate return need be made by the transferee of property included in the return of a personal representative. 2. PLACE FOR FILING The return is to be filed in duplicate w:th the Register of Wills of the 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 for and grClnted by the Secretary of Revenue within the nine-month period, 4, FAILURE TO FILE RETURN Section 791 of tile 1961 Statute provides that" . . ,any person who willfully fails to file a return or other report 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 recoverable by law," , I I I' I I I ! 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 OFTAX 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 r6ceived 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 for 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 imprisonmeot not exceeding ooe year or bOU1. REV~4!i2 ('-801 COMMONWEALTH OF PENNSY~VANIA OEPARTMENT OF REYENUE TRANSFER INHERITANCE TAX RESIOENT OECEOENT L ESTATE OF _ oretta SCHEDULE "C" TRANSFERS F. Storey * INSTRUCTIONS: 1. Answer the Questions on reverse side. 2, If the answer to any of the Questions on the reverse side is "Yes," provide a description of the property transferred per Schedules "A," "B," or "E," its estimated market value at date of death, dates of transfer, to whom transferred and relationship of transferees to decedent. Attach a copy of any trust deed or instrument relating to the transferred property. ITEM NO. DESCRIPTION On September 27, 1978, Loretta F. Storey entered into a revocable deed of Trust with Dauphin Deposit Bank & Trus Company consisting of the following assets, Valued as of her date of death of February 27, 1980 Cash $5,000.00 Bell Telephone Company of Pennsylvania 8.625% 36-year Debentures due 7/1/06 6:( 23 shares American Telephone & Telegraph Company, $4.00 Convertible preferred Sic 'Ys 3 shares Pennsylvania Power & Light Company $4.50 preferred :II: Xr 260 shares Pennsylvania Power & Light Company $4.40 preferred J~, 100 shares Pennsylvania Power & Light Company $8.00 preference CoJ.:,''' 60 shares American Telephone & Telegraph Company, common 'f" '/,f 456 shares Dauphin Deposit Corporation, common .3.,< j,i;~" 160 shares Esmark Incorporated, common .3.3, TOTAL THIS PAGE ESTIMATED I DEPT . VALUATION MARKET VALUE (OFFICIAL USE ONLY) $ 5,000.00 3,250.00 ~38.55) /I ,j-,y, f.:.3 105.75 9,360.00 6,350.00 2,835.00 14,820.00 0,280.00) .;-:.<.JY(), 0 0 $ 46,639.30 IIf J' 15''/. ,] J' I ..!Jg-t( QUESTIONS CONCERNING PROPERTY TRANSFERS 1. Did decedent, within two years of death, make any tmnsfer of any material pml of his eslate without receiving valuable and adequate consideration? (Answer "Yes" or "No".) No 2, Did decedent, within II\\) years of death, transfer property from himself! herself to himself/herself and another party or parties (including a spouse) in joint ownership? (Answer "Yes" or "No",) -1:!2- 3. If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following information: a. Age of decedent at time of transfer, N! A b, Copy of death certificate, c. Affidavit by the attending physician indicating Iho stale 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".) 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 'INo".) ~ b, The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer "Yes" or "No" ,) 6. 11 the answer to five b, above is "Yes," state whether the right was reserved in decedent alone or others. N/A 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".) YeR 8. Did decedent, at any time,transfer property, the bllleficial 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".) Yes ,9. 11 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" ,) Yes REV..453 (l-80) COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT OECEOENT SCHEDULE "D" BENEFICIARIES ~~\ ~ (lr,structioIlS on RUV(HSO Sidu) Estate of Loretta F. Storey BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVEO OATE OF INTEREST OF BENEFICIARY OECEDENT BIRTH Charles M. Storev husband Teresa Knaby friend 20% Carol Ann File niece 4% N. L. Comfort nephe" 8% - Ed"in a Comfort "ife of N.L. 8% " Comfort Dorothy Ann Comfort Grandniece 15% - -------- ----'-- David La"rence Comfort Grandnephew 15% 'Cheryl Lynn Comfort Grandniece 15% , Kenneth Eugene Comfort _Gr andl1e1:-hew ____ 15% ------------- -,_...-. ------------- -- ------ ----.------.----- - I ------- --,------- --- ------ ~, .-...---.- -.-.,--- - - --- . ---.. --- - --- ; The above beneficiaries are living at this time except for the following: NAME OATE OF DEATH REV.454 (l.SOl COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT (Instructions on Reverse Side) *',-", .~' r ,.' : SCHEDULE "E" JOINTL Y OWNED PROPERTY Estate of Loretta F. Storey -- . ==- P TOTAL E VALUE OF OEPARTMENT ITEM R DESCRIPTION MARKET C OECEOENT'S, VALUATION NO. VALUE E INTEREST IOfficial Us. Only) N T Dauphin Deposit Bank & Trust Company, certificate of deposit registered in the name of Loretta F. Storey Charles M. Storey IC.. ..(.'-r.: ;:._1.... account number 1425012336 $ 10,422.13 Dauphin Deposit Bank & Trus t Com- pany Checking Account II 82232822 9,'/"I',,;Ii'Al r~,.,,'hl."'( 3,267.76 $ 13,689.89 - TOTAL THIS PAGE D- - , -'~V4l INSTRUCTIONS FOR COMPLETING SCHEDULE "E" Schedule "E" must include all property, real and personal, owned by the decedent jointly with another party or parties as joint tenants with right of survivorship. Both tangibie 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 "B". I nclude the name. address and relatior,ship 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: "" 0 n >- i"1 ;l> :s z ;l> 0 0 0 Vl 0 Cl n c: 0 ..., z :::: z t'" l"1 :>- 0 9 t'" l"1 ~ Z ;:::l - Z Z 1"1 ..., tT1 ..., z 9 9 ..., -< Vl tT1 - en Z 0 Vl 0 "" 9 ":j ." ::<:I ~ I ;l> 0 I "" ":j - ":j I 0 - z n - ;l> ~ c:: en tT1 0 I z ~ -< -< ~ tT1 tT1 ;l> ;l> ;:::l ;:::l REV.4'B4 EX+ (3.801 INHERITANCE TAX SUMMARY SHEET (BUREAU USE ONLY) file Number --Z1-80-0349 Estate Nome _Loretta_F.._Stor_e~----..---_._-- Date of Death February 27, 1980 Social Security Number _.__;tpJ::3't~4835 REPORT Of INHERITANCE TAX APPRAISER I, the undersigned duly oppointed Inheritance Tox Appraiser in ond for the County 0/ Cumberland Pennsylvanio, do respectfully report that I hove opproi sed the real and personol property as reported In the foregoing return at the values set forth opposite et:lch item in the last column to the right in Schedules HAlt, "Bit, uCfI, and liE" Doted: Aup;uat 5, 1980 ';.',. Y" /) -.1o:./1:/.._'/.' /'A':f>/'] 'f' INHERITANCE: TAX APPRAISER INVENTORY VALUE AS APPRAISED CODE AOJUSTMENTS (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE Real Property (Schedule A) Personol Property (Schedul. B) Joint-Held Property (Schedule E) Transfers (Schedule C) s 00+ 10+ 92+ TOTAL GROSS ASSETS 2lH 3D+ Leu O.bts and Deduc:tlonl (SCHEDULE F) CLEAR VALUE OF ESTATE 40- 93- Valuation of life estates or annultl.s. . . . . . . . . . . . . . RATE FACTOR PRINCIPLE VALUE CODE FOR USE OF REGISTER ONLY Tax on $ ~ COMPUTATION OF TAX $ $ S $ $ Exemptions Total Estate I TOTAL TAX INTEREST FROM BALANCE TO S $ $ 6% Tax on $ 15% Tax on $ Tax on $ 1'ax on $ Less Credits DATE OF PAYMENT AMOUNT PAID TAX CREDIT s $ INTEREST FROM BALANCE DUE .... .<l ~ ~ ~ ~ ~ ~ ~ ~ ~ E-< <l r.>:I . OJ ] ~ III f<< M ;l :;! M ~ f.< f.< OJ - ~ .0 U Z .s ~ M C\l (\j ... 0 ~ I:) M \D ~ - 0 ~ 0 ~ ~ ~ Ii; 0 III 0 z d - ~ III >- ~ 0 z ~ ::l ~ ~ z z ::l 0 SE 0 ~ ::<: ~ r.>:I Z Z Q U c.:l Z ~ ~ III ~ 0 0 ~ - ~ u 0 ...l INS.!RUCl iONS fo 1!'~;lJre pro;lo~r credit 10 ,'OW account. !!w r;iPlI(: (.1 !hi: I!~;talt] rlnd ldt! number !;llOl.Iltl tw dedrl'r' print- ed on the check. or rnone~' order. Thi:.; ur,St~S511lL!fI[ IS lIlilde in ...ccordlmc~~ wl!l. ~('(llon ,DB of the lilllt~{lt<lnC(J ;lnd Er,I.JW Till( Act 01 1861 U2 P.S. ~ 2118S. 708l. T'-1 the l!):teJ'11 Ibm inhl~lilJnr:l~ li.lX I~; p:lId wilhon H:!f~' (~l) flwnlhs alter tlH: dl~dth of Ow decedent. lJ dIscount 01 five (5) percent is allowud (72 PS. S 243b."J16j, Inheril<lnCe Tux, other thim tax on a future Ifw~r(!!;t. i:.; dul.' at rhe ,jJt8 0f thl) dcu:den(s dtJilth ,JOti beconlCS delin:'1uenl at the m:pinJ\ion of mne (9) rnolltlls alter trW decedp.nt'~ denlh 172 P.S. ') 2485-711). Inhel il,mce Tax on a future interest is pal(ilble within three (3) months aller the trClnsfer Wkm, effl~cl In pO~;5es5iofl nnd enjoyment ami is del;;)quent ther(!nfter (72 P_S. !; 2485."1.::), CalclJl:Jle inteH':.;t !Iom lllt~ delinquent diHe slluwn on the fdce of this form \0 the dme of uctual po'{lT\tnl! uSing the followinG 1I1lt're~;t (db1(-: -----.--..-..-- -----.-.--- ---------- -- ... ---.. --- ---_._- ....- .-- - -+ - -. - - ..- - _.- - -----..- --- -- -- - ---- 1 month 005 4 months .020 7 tl\onll15 035 10 rnonths .otiD 2 months .010 5 months ,025 U llHJlltllS ,040 11 mOl1thr, ,055 3 months ,015 C m0Ilth~; .030 9 Illondl':. 04, 12 rnonths ,080 ---,-----.--..-....--. 1 days ,00017 11 diIY~; 001 e(j 21 days ,00352 2 day!:; .00034 12 days O(\:?O3 22 days 00369 3 days ,00051 13 days OG~':::O 23 ddYS ,00386 4 days .00068 14 d<1~'5 002':'~7 2.4 (jays ,00403 5 days ,00085 15 dilYS OO:'SO 25 days .00420 6 days 00101 16 (jilYS OO']li7 26 days ,00437 7 days ,00118 17 da-f:; .OO2d4 27 daY5 .00454 8 days .00135 18 dnys GO:JD! 28 dnys ,00471 9 dnys ,00152 19 !JiWS .00318 2~ dnys ,00488 '0 days .00163 20 dnys .O(~:135 30 days ,00500 -- --- ------ --- ------- - -- -- -- - - .-. - - - -.- -- --.- - --..- - --..- - -- -- - ,--" ,- -. - - -.,--.--- ---- --- ~-~ Any party in interest. including the CommOllWfJdlth JnrJ tile pC'I~;(Jn;JI rl?~reSrn\iJll'''e, nol satislied with the assessment may object thereto within sixty {50} da\,~; ;,f:er rCCl'il;~ nf t1)i~ !\Jotlet:: 35 provided by Section 1001 of tho Inhcritnnce and Eo:.lilte Tax Act 011961 (l2. P,$ ~ 24~J5'OO') Mal...e cl;t~i:k 01 i!lUl'l')' ~.'rd{!r pdy:d.Jll: [0 -'RP.~jl:jkj o! Wilis, ;-'\W:r1t" J\1,jil III th,' dddre:~~; 110,_,:..j bt,luw !N~~.ItIJCTION~; 10 1:1!;urC JHOI1f'r crl''':'1 t'l ,i!llf ,W, ''';;I~ Ih~. 11,':1',' ('(j on the (;twc;'; or rnOrley (,((It!! tl,,' f ',[d"'! .mil II:'~ 1,;l<oIlh'r 511111110 ill: "!f,.l't'r' prll1\ TIll;; '-::j';I.",';n:l'111 :~, HhHlc 'f! ,u;\ "II,' \'1,'1:11 ",:,/I'/i))J f,' ;,Ii~ i1\I"'~I!;lilt.:.: ,1'1,1 ~ ~,I,:!( 1;1> /"1 ut 1961 (7:1 f',S ',1 ;J';.::~_i "/()i3) Tn th~: :;~t(>nl 1!1.;; iflJ',I!!dj'('I' j I~. dl~COUIlI of fi'.'p l~)i [Jl!rCel1t I', <l11')'.\'l;'.t o:! p S /;/1' .'/.': ',';. '" ;31 1":11\:1, ::([(.) 'ill' 11,,>,)11 ,i ,j,' 1i!',('<lvol,- " ,\-1:J~) '} 1 <Ji lnIIPrlt<Jlh:~~ 101x, l'lh~~r li1,HI (;1" nl) ,) :;:!.Iri' !l',I"(; ';~, I'; lllll' ,J! I',,~ dill~,' tJ ~h! dt~:~,'dpT:t'~j d'-'~lIh ;lnri b~~con>es delin<IU(!1l1 a! Ilw t~l(plr;lljon of Il'n!' ~9! f!ll.lIlH"1 "r,'.'r :l~" ,jl'ct'(ll'~''t':, (~'.':J!h O} p,~) :. 1.,113:)-/11) Inh('rrtdllc~~ Till( on i.1 futrJrtJ Inlerf!sf 15 PdYilbh~ willll/'i three (3) n\onltl$ aller lhf~ tritn';k'r f..lws 1~1f~ct If\ p(-'sses~,iun i:\nd enjoY/lien! ,ll\d IS dpllnquenl Ih~re~llt(rr (72 p,~; i) 2.:1(3~)-/;;~) CI:l:\jld:l~ 1'110-'1".;\11(.:11 ;!Il; ih:lmqllt'llt dill/..! ~;~lown on llle filee olthls fUlfil !o lhe u,llE' of ili;tU<.11 ~,jYtlwnt l,~I[1Y th(: rlJl)v~"lrl9 ,.1:,>:,":;1 I,,!):!.' ------------- --_._-- -- --- ---. - ~ 1 month 005 4 mmlth~; 0:10 7 nolJl",[il', 2 months 010 5 tn:'.lf1th~. .U~i~, H 1'lfiOlII',' 3 months 01ti u months UJO a rncnl ~\:; C(,::i '1.)Il\(,r:;i\'; 050 .055 ,060 '."1,:0 11 r""tlnl~, 12lil(1Il',hs I),Ej -'~._,--,-- ......_-'---_. 1 days ,00017 11 d J 'i~; V;J lib 2 days .00034 12 <1<1'r';; 00;,:0] 3 dilY::> .00051 13 d,1YS ():J22U 4 days .00068 1 4 {)dY~~ (;(1/:]'/ 5 days .00085 11-) dil','" O:J:!~JO 6 days .00101 1 G d;IY:; tki~lij 7 7 days .00118 17 (Ll''fs OO;'H4 8 days 00135 18 Gays O(J3tJ1 9 dilYS .OJ152 111 d;IV'; (tl):~ 1 1.1 10 days ,00169 20 d;IYS on33:-J :~ 1 ;:]u\'S .00352 22 dilV5 00369 23 UZJ',':> . ()o386 2-. (!:lyr; .00403 2:; dilYS 00420 2(; r.;IY5 .00437 2/ ():lY5 00<15<1 28 days 00471 ~19 (J;)yS .00488 3D dnY:i .00500 -- - -- - ---- - --.- -.----, --- _..__. _ _ _ _ n.u _.__n ---_._ _. - - .. _.. _n._..... ~._ _. __.~___ ___ ___~_. Any parly In In!(~rpsr. d1:.'ludiny the C(l~lIll\()ll'\"':"-idnl ii1Hi till.' perSO;'idi rq)je~t'nl,j:I..'t., l';nt !;CJIlsflcd with tho DsseSSflwnl milY ()!\;~'tl lhl~re!O wilhlfl <;;'1'.)' ((;\)1 d;jy:; c,f(er rpCI'I[:.! ()( 1 Ill'; Nc,llce uS pj0vld~~d uy Section 1001 of the Inherilanu~ Jnd [:,1,111: Till( Act nt I Uti1 (-';? P~;, !: 248S \001) M;:!ke check 01 1:'l1:p'V ord!'r I'ilyabie ({) "Rl'qj~,ly( oi V\/liiS, Aq'':I:('' MGillO th.' :,k;rl,,;~; li:,IC~i,j ll'''U'\\' I 1 1 l i S 1 I I --- - "78):~~~'t?~J:::'''{,>:,,,, 1,.)<IJ'j'/''1'~'l~jI',''-~,~" '~.,.:., '''' 'j;~"" ',J"'~ t \ 'I ,.., ,:::., ,10).",1\ .,;;,.;4!.\'~J!~f;/' ;,~\eOMMONWEALTH, OF, PENNSYLVANIA" ;,:,;":/ :,',,: ;~.. '1," f.5~\' i4t!ht"l>:'~,.\;:,;: :DEPA':!TMENT'OF'REVENUE ' " ",' ,:' ",", ','" .,' ::::, ,r. , )~1t~1.~~t:,J~I~~':~.~~}~~r ~1'P~N,~,~V~~~~,I~':~N"~RltA_N~~~ND"E~~~TE,~AX.,i":>;':, , RECEIVED ______________8 IM'Y~I IX IWIIDllal r~OUR. 711/100- representing Pennsylvania Inheritance or Estate Tax due from the following estate: ..dol\ors '-~m' P.",,,.,, PQoait 8"'''''' " T '.0. Box 2961 2'7< To, on $ $ $ $ $ I $ $ 6,654.75 $ '~reS5 aarrialmlg. 'a. 17105 6 % To)( on S File No. 21-80G349 Dol. of Deoth 2-27-1980 15'7,,10)(' on $ Dole of Poymenl .~_M" !O, 1080 '" la, on 5 Eslole To" Acl of May 7. 1927 Nome of Decedent toO....... .. T A'l'nIlWY County C....-l'l.Qd T01 AL TAX CREDIT less five parcenturn of tox if paid within three months after dole of death Plus interest 01 the role of _%from to $ 11emorks: -'AJD XII PULL- lJOO~[p[b~@&'ITrn 5 E A L 6,654.'15 TOTAL AMOUNT PAID $ NOTE: This Triplicate Receipt 10 be r81lined for ludlt purpo.el, I Received by NOTE:. In actopllng Ihe tronsfer Inherltanc.e 1011 on future e5toles, prior to the death of the Ilfo lenant or tonant for yecrs, os e...idenc.ed by Ihls rec.eipt, It Is understood lhol the Commonwealth sholl not be prec.lvded or pre....nted from hereolter oueuing addiUonal Inher1tanc.e tOll. al the deolh of the IIfo lenont or lenont lor yeon whon.ver II appears that suc.h addlllonollall. may be legally due and c.ollec.Uble lor ony reoson whatsoever, I --,----------------------------------_._--,~:."~'