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No. 21.80 .),\
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of
VIRGINIA R. SCOTT
, deceased.
To Mary C. Lewis , Register of Wills for the County
of Cumberland, in the Commonwealth of Pennsylvania.
is
Petitioner(s) or.eothe execut rlx named in the Last Will and
Testament of VIRGINIA R. SCOTT dated APRIL 25. 1980
Decedent was a citizen of the United States and a resident of R.o.2, Mechanicsburg,
Township
Monroe XB~~1fIl} Cumberland County, Commonwealth
of Pennsylvania.
Decedent died on _ Sunday
the . I,8th day of
May
A. D. 19..ll.!L-, in the County of
Cumberla nd
State of
Pennsylvania at the age of 61 years.
xkmx *,wx her
Decedent has not been married and has not had children born to Ill!m:x
since the execution of the above described Will.
Decedent was possessed of personal property to the value of
$10,000.00 upwards and of real estate to the value of
$10,000.00 upwards
as near as can be ascertained; said real
estate situated as follows a farm ,de"aee in Monroe Tnwn<hip, r."mherlonn
County, Pennsylvania
~ii>A)(x
Therefore, your petitioner(s) respectfully applies for the probate
of the said Lost Will and Testament and for Letters Testamentary thereon.
Dated
Ma V 23 , 1980
Name and address
of Petitioner(s)
it!.( a%(" j it<.Lj~
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DIANE 5. WHITE
R. D. 5, Box 99
Dillsburg, PA 17019
COMMONWEALTH OF PENNSYLVANIA (
COUNTY OF CUMBERLAND ~ ss
DIANE 5. WHITE
named in above application, being duly
say(s) that the statements set forth in
sworn according to law
this petition are true to the
Sworn
knowledge and belief,
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and subscribed before iL.J.cld.J(f /) t'{tdt' -f/ /
,
DIANE 5.' WHITE
best of her
me Mav 23 19 80
.'J}llz~:l !!!'fd/~gister
{,ota
Filed: May 28. 1980
C::N-fo ~.3s.
Attorney:
JAN M. WILEY,
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OATH OF SUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLVANIA 1 ss:
COUNTY OF CUMBERLAND \
This, ..,'"..,~;J.r.""",..,"'" ,.""" "" "',"" "',"',"" ,.", "" day of "",.."Mn~"" """,' "" """"" ,..,.", ,."", "," ,., A,D,. 19 ..~,9,...
Mary C. !,ewis
before me R:~I.~. d JiJ. .\Rlio.oiR, Register for the Probate of Wills and granting letters of Administration
in and for said County of Cumberland, in the Commonwealth of Pennsylvania, personally came ....,......,..
Jan M. Wiley & Glenda M. Wethington
................................................................................................................................................................................
the subscribing witnesses to the foregoing instrument of writing purporting to be the last Will and
Testament of .."."." X ~ ~~!.~, !,~, ..~,:., ,~,~.~~~..,"",..,"",.,",.,"""",..,""""",..,"""" Dated ",ApI', i L ..25,... ,1.9130."..,..",
late of ..,..'", g:,~:." f,l, ,,~,7,7,~,~.ry,~,~,~~~,~~.',"~~~:,?7,,:!::",~,:.:,' ...,....""""",., ",...., Cumberland County Pa,. deceased
who being duly ........,~~~~~......................... according to law. depose and say. that ....they..,I',e.r,e..,................
d d h d h Virginia R. Scott
present, an saw an ear t e testa..~r.;."....................... ............,...................................,........,..................,
sign. seal. publish. pronounce and declare the said instrument of writing as and for h..er,........., Testament
and Last Will. and at the time of so doing .....,6he......'.............................,was of sound and disposing mind
memory and understanding. to the best of ......~h"i.r..............................,knowledge. observation and belief,
..........9\<orn....'..'..,..........,...., and subscribed before
.."..,',..,';,~"',:Y.:c"..,""~,~",..,"
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'GLENDA M. WETHINGTON J
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R~~luud ua...~t.Jvu:t~ister
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA 1 ss:
COUNTY OF CUMBERLAND \
...,...........',.,.."..., ....'", ...9. t,~,J:l,~" ,~,: ..)i1!,~ I~",..,.,..".,.""""...".......""",..,..",.,..""""....."..."".."".......,.., ,being duly
...............~."!.9X.r!........................ says that as nearly as can be ascertained the said decedent ,Virginia..........
",..,....,.. ,\l.,:., .~.~,9,~,~.."....".."....""."""",..""".."".,.."""..."....".."""'"'''''''''''''''''''''''''''''''''''''''''''''''''''''''' ,died on
,..,',....,..;9.\'.(I.9,~::i...."......"....".., the "'",.....l~.S~".,"""""day of ""..,HiI;j"."....,...."",..,...""........", A.D.. 19..80,.
at or about .......?,:.?,?............................ o'clock. r.:..M,
.............,fi~Rr.r............................,and subscribed this
, '
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....!;,~f1,/..(..~.......,..../~d.c~.S".....................,..
DIANE S. WHITE
23rd ,'" d f M
...............................................;, ay 0 .......;<oJ::;...........,
19, .....ao. before
o/Jl. ' /) ,~ .,
.......,...(~..,~,:..";9e..{,~~,.,..".."."'.."'..,..
Riel.ll.i1 Ihroin. Register
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA}
COUNTY OF CUMBERLAND SS:
Before me, the Register for the Probate of Wills and granting of Letters of Administration in and for
the County of Cumberland. personally came ,..,....,..........UTA!llE.,.5....WH1:m..................,.......,..,......,............,....,
who. being duly ......5WOr.O............, do 05,...., depose and say that as,....Exocucr,;,,................,........................,
of the last Will and Testament of ..,......,\l.lRGLIllIA..Jl.....5COII...........,..............,.......................,..........,deceased
........,.....,.5HE.... 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, ..,...,..5.wor,o..,....., and subscribed
before me,
................~~x..~~.....................,..,.., A, D" 19..~~......
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, ,f.~tr.,{r.~..e.<"f.!!:!.4.~"",.,',.......,",....,"
DIANE S. WHITE
..................................................................................
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DECREE
Be it remembered that on the ........?!?,!h......, day of ....,~~>:......................,..........,..,. A, D,. 19 !!R..... there
was probated and recorded the last Will and Testament of ....)i,~RQ~NM'd,:..,~,9,9:r:r,...............,.......................
late of R.D.2, Mechanic5burp Monroe Twp" CumberlandC t PI' 'D ed Lette
, .............,................,...........,0;>".......,..........., .....,.... oun y. ennsy vama. eceas, rs
............. ...X~p. ~,!',\'l~,!1~,!'.r.Y.."..,......", were granted to .."..,.. .I?.t !WIl, ,R .....\'!~},>.~"..,..,"',......,'" ............"..' .....', .....,....
Witness my hand and official seal the day and year aforesaid,
"..,..921t2{~",c:.,:...~.."...
Itl .d E. A, . Register.
'I. ...
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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55:
DIANE S. WHITE
u_.". .____..__ -..,--.
boing duly sworn___ according to law, do poses and says that s he ---l.-s-ehc
Exac.utrix_____._.__._,____ of the Estato of VTRr.TNIA R. SCOTT
late of R.-D., ..2,,_MonroeTwp., Mechanicsburg, __,_, Cumberland County, Pa" doceased and that tho
'th" , t d b Diane S. lfuite th 'd Executrix
WI In IS an ,"ven ory ma e y .___ ___ --- -.--" e sal
of tho ontiro ostale of said docedont, consisting of all tho personal prop.rty and real ostate, oxcopt roal estate outside
the Commonwealth of Pennsylvania, and that tho figuros opposite oach itom of tho Inventory reprolont it's fair value
as of the dato of docodont's doath,
Sworn
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/E"'X~XlOOOOiIlHilJ!r EXECUTRIX
DIANE S. WHITE
R.D. 5. Box 99
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GlEr.DA M, l,',r.Tdi:IU!,,\! 'I"'''' _ I> .', f-
Di'l \'RliD'" .' ,.~ ' ,......, . i..;;','
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MY COM.\~IS.s!~J!j rXf'111::S n'~(:_ '..,';}
Membu. Pcnr:s)'lvan:J A~G~'al;Q~j ~rN~!l~~~~
DILLSBURG, PA
Addrlu
Oato of Ooath
18th
O'Y
May
1980
Month
Vear
INSTRUCTIONS
I. An inventory must bo filod within three months aftor appointmont of porsonal ropresontativo,
2. tA ,suppl~;;'ent !!)v.ntory must be filed within thirty days of discovery of additional assots,
3. tA'dditio&!,1 sheittmay be attached as to personalty or roalty
1..0_ .' t;jt;;)
4. tiSee ArticlelV,:fttJuciaries Act of 1949,
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Inventory of the real and personal estate of
VIRGINIA R. SCOTT
deceased
Page -1-
REAL PROPERTY:
Proceeds of public sale of 53.487 acres in Monroe Township, Cumberland
County, Pennsylvania, with improvements thereon situate to
Louise S. Lehrman
178,000. 00
IT BEING a part of the same premises which Second National Bank
of Mechanicsburg, Executor of and trustee under the Will of Ellsworth
H. Bittner, by its deed dated April 2, 1952, and recorded in the Office
of the Recorder of Deeds in and for Cumberland County, Pennsylvania,
in deed Book 14 Z, at page 31, granted and conveyed unto Jack B. Scott
and Virginia R. Scott. The said Jack B. Scott predeceased his wife
thereby vesting full and complete title in Virginia R. Scott, the
Decedent.
Proceeds of private sale of 109 acres, more or less, situate in Monroe
Township, Cumberland County, Pennsylvania, to Dean -T. Scott of
3317 Dauphine Dr., Falls Church, VA 22042
218,000. 00
ITuBEING a part of the same premises which Second National Bank of
Mechanicsburg, Executor of and trustee under the Will of Ellsworth H.
Bittner, by its deed dated April 2, 1952, and recorded in the Office of
the Recorder of Deeds in and for Cumberland County, Pennsylvania, in
deed Book 14 Z, at page 31, granted and conveyed unto Jack B. Scott and
Virginia R. Scott. The said Jack B. Scott predeceased his wife thereby
vesting full and complete title in Virginia R, Scott, the Decedent.
TOTAL REAL PROPERTY
396,000. 00
PERSONAL PROPERTY:
1. Savings Account, Dauphin Deposit Bank no. 11 60730 5,910. 53
(Interest to date of death) 311. 98
2. Checking account, no. 76 36068 7, Dauphin Deposit Bank 2,431. 70
3. Sale of 1980 Chrysler Cordoba 6,000. 00
4. Patriot News, refund 7. 65
5. Proceeds of Sale of Clothing 50. 00
6. Proceeds of public sale 16,488. 25
7. Chrysler Corporation - refund on car purchase 50. 00
8. Stor-Mor, security deposit refund 4~. 00
9. Additional check from public sale 20. 00
10. Cash on hand 17. 00
11. Sale of Cumberland Valley Co-op Stocks 1,313. 49
12. Tax proration of sale of real estate to Lehrman 632. 05
13. Tax proration of sale of real estate to Dean T. Scott 73. 85
TOTAL PERSONAL PROPERTY 33,354. 50
TOTAL REAL & PERSONAL PROPERTY 429,354. 50
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,.\ REV..44'J EX+O(3.so1
'. COMMONWEALTH OF PENNSYLVANIA
DEP~RTMENT OF REVENUE
'\ TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
AFFIDAVIT OF
FIDUCIARY
(Instructions on Reve..e Side)
..
Estate of
VIRGINIA R. SCOTT
Date of Death May 18 , 1980
Social Security No. 226 09 9~44
Last AddressJJ1.-L-.-
~c.hanicsb,u!:g ._l'A.-1205 5
{CITYl {STATEl {Z,IPl
Bureau File No.
County File No. ,;( /- ,q'{J -35;1
1. Decedent died:
( ) Intestate (without a will)
~x) Testate (leaving a last will--copy attached)
2. Is the filing 01 a Federal Estate Tax Return required fOI this estate? Yes~ No
3. Qo{ ) ~Executrix ) Administrator! Administratrix
Nume ---I}:ban~.-WR;.te
Address R.D. 5, Box 99
Dillsburg, PA 17019
(CIT'O (STATE) (ZIP)
) Fiduciory.
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4. All correspondence should be mailed to (XX) Attorney
5. If an a"orney is representing the estate, indicate:
Nome
JAN M. WILEY. ESOIllRE
Address
P.O. BOX 288
List 011 sofe deposit boxes registered in the decedent's individual nomel or jointly with, or as an ngent or deputy
of onother, or in decedent's individuol name with right of access by anotner as agent or deputy. Include the name
and address of the bank or other institution where the safe deposit box is located, the name (s) in which the box
is registered and the relationship of the joint holders to the decedent.
tCI'TY)
DUSJlIlRat P~. 17Q19
STATE)
(ZIPI
NAME AND AODRESS OF BANK OR OTHER INSTITUTION
IN WHICH OECEDENT MAINTAIN EO A SAFE DEPOSIT BOX
NAME OR NAMES IN WHICH
SAFE DEPOSIT BOX IS REGISTERED
RELATIONSHIP OF JOINT
HOLDERS TO OECEDENT
Under penolties of perjury, I declore thot I have exomined this return, including accomponying schedules and
statements, ond to the best of my knowledge and belief it is true, correct and complete.
DIANE S. \i1I1E
//!( ti~/ './/J&
/ -
SIGNATURE OF FIDUCIARY
?~7/J/
DATE
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 the 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
acquire knowledge;
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 in trust, provi ded 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 with 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
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 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,"
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.lawand at the rate of 15% as to all others,
6. PAYMENTOFTAX
The tax assessed on the transfer of property reported in the return is due 9 months after the decedent's death. Interest
at the rate of 6% per annum accrues thereafter until payment is made, All payments received are first applied to any
interest which may be due with any remainder applied to the tax. IF TAX IS PAID WITHIN 3 MONTHS AFTER THE
DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED,
All checks should be made payable to the Register of Wills of the county wherein the decedent resided and are
received subject to the final determination of the Department of Revenue,
7. FAILURE TO PAY
The taxes imposed, together with any interest thereon, are a lien upon real property, which lien remains in effect until
the taxes and interest have been paid in full. The taxes may be sued 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 imprisonment not exceeding one year or bOtll,
U, S, DEI'AI1TMEIH OF HOUSING I,NO URBAN DEV~lOI'MlNT
,_. ,-_. -,-, -,"-" -- .- --..' - ,- -- -,,' - ...- --.-,--" ----.-.- -..-.--' -....-... -,..,..-..- --'---'
B, TYPE OF LOAN
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" lJ n1A ,/, IJ rmllA 3 n CONV. Uf~INS,
4, 1'1 VA 5, [') corN, IllS.
-~"Lr~'U"'~R.-==-=~~J~..:Arj tlU~~I(R;===~~
8_ ....01l1GAGE Ul5unAtlCE CASE HUMBER:
OHM AI'I'HOVED ",' ,.
~~_.!l~,~ ~_n_____._'_'_ ------..-~
------,-
C, NOTE: This form /s lurrllshed to giva you a slatamant of actual se//lement costs, Amounts paid 10 arid by Iha sa//le.
ment agenl ara shown, Items marked "(p,O,c,)" were pilid olll"ide tha clo"/ng; they are shown here for
informational purposes and arc not included in the totals.
--- ---...,' --..' -",_. ..._..-.." --........ -.---.,....'-..-' -,-,,"- .-...-.------....-...------...-----.. -.--
; 0, NAME OF BOI1ROWER: E, NAME OF SELLER: 1', NAME OF LENOER:
, ~a/5 f: ). v'f/::hYt::1i/J Cs!/;l ();:: V''JiIIlA (?,
\ '1:/ .~J,,,, /I~ " /...5 A
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SETTLEMENT STATEMENT
I
..---_.. --_.......~-~ .,.'- ..- -- -, ,--. .----.-,
--.------..-.. ..
-----,---,,---_.,'----
-----------"-..---.. --'
.. -------.----.,--------------
,.---,--------' .----------..-
I. SETTLEMENT DATE:
I
i G, PROPERTY LOCA nON:
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J, SUMMARY OF BORROWER'S TRANSACTION
I 100. GROSS AMOUNT DUE FROM BORROWER:
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H, SETTLEMENT AGENT:
..:.r;.) ..JJ,
PLACE OF BE TTLEMENT:
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SUMMARY OF SELLER'S TRANSACTION
400, GROSS AMOUNT DUE TO SELLER:
Tip, ."" ,,"
101. Contract Sales price
102. Personal property
103. Selllement charges 10 borrower (line 1400)
104,
105,
i'7 .'; w~ 1\ \,C' 401. Contract sales prices
402. Personal property
I 7 :l'l ,IJ:. 403,
404,
405.
Adjustmenls 101 items paid by selier in advance Adjustments (01 lIems paid by seliel in advance
i-=-~
106. Cilyllown laxes 10) "'Iiel 1" _ \:>'-'!,f"<' 406, Cilyllown laxes 10-) 'c.:r,;;rrc - IZT~,110
107, County taxes to \' \ \ 'J.. dCI bL- _!:I!l.JL2.. 407. Counly laxes 10\ ill.. ,i-.(JU
108, Assessments to 406, Assessments 10
109. It! 1" 1;,) -o;,'~ J 9/;071,' ,. (;h,IZI_~.d::il. 409,...i.i.!....~' 1<!fl JofH"L'//tC/ k~ t: f.kI..i..t Jp;;i3
110, . 410,
111, 411.
112, 412:
120. GROSS AMOUNT OUE FROM BORROWER ,Iic, q l/.oS 420, GROSS AMOUNT DUE TO SELLER
200, AMOUNTS PAID BY OR IN 8EHALF OF BORROWER: 500, REDUCTIONS IN AMOUNT OUE TO SELLER:
201. Oeposlt or earnest money l~ -R,,~ '-' 501. Excess deposit (see instluclions)
: 202, Principal amount 01 new loan!s) 502, Selllement charges to seller (line 1400)
203. Existing loan(s) taken subject to 503, Existing loan!s) laken subject to
, 204. 504, Payoff 01 firsl mortgage loan
205, 505, P~yolt 01 second mortgage I?an
206, 506,~~),.df ,t., (:"J".I~,~I"/"'(!.; Ihr,\ --:J()73.-IS
207, 507, 1/
, 208, 508, F" l' VoW Jj <' ..'< ,1 A .' . ;;-,
!m. ~.
;.; 1/, ~,_
119: ~2,'5
~ )"" ou
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t., c-r~'''<
i
\ Adjuslments lor lIems unpaid by selie!
I' 210, City/town taxes to
.\ 211. County taxes ' to
212. Assessments to
'\' 213,
214,
\ 215,
216,
\ 217,
,
\ 218.
,
219.
I
Adjustments for Hems unpaid by seller
.
510. City/town taxes
511. County taxes
512. Assessments
513,
514,
515,
__ 516,
517.
~
519.
(' ~ " u' 520, TOTAL REDUCTION AMOUNT OUE SELLER
( , I 00(' ....
10
to
10
I:; 2; 3('(. J7
220, TOTAL PAID BY/FOR BORROWER
301. Gross amount due ham borrower tline 120)
302, Less amounts paid by/lor borrower (/ine nO)
303. CASH (0 FROM) (0 TO) BORROWER
600, CASH SETTLEMENT TO/FROM SELLER
lit, o./ll, oS 601. Gross amount due to seller (line 420)
( /7/ ["" tt 602, Less reductions In amount due seller (/ine 520)
r 6 )., l:U,,' ,~3. CASH (0 TO) (0 FROM) SELLER
11f W.((,
(;l[ 51.~.'"
150 2,.(,.2
300, CASH AT SETTLEMENT FROMiTO BORROWER
,
,
.'-----;-OfjIlT-^~t,....,...,I~t '('f lh.l/'l tlf 1.1\:0'1. Jll.!Il',
lkllrt ~~..Il. Ill!"" :/1.111\11", 1'""
,~ I'hd.. CIA~J"'_
"
,
-(jf.f 'rqti6"~Gi' t[1lt (ill nr~~~)1 ~"Y\lt'll3":"
,Z.1i . nUl. /ij; ,a,~ tu~~~h
I
in tll(! -ycnr
I
I
,
JJ}~TH'NEN .JACK II. SCOTT nnd VIRGI:-;1A R. SCOTT, his "ife, of ].1onroe TmOllc,IJip,
,
,
MA1JN ~'JJM c:h."",f.....,
of Ollr DUl'd OlIO tl107IscwcL nino h7lndrcd,
,';, dUlIu!
-::.e 'Jell ty.-t h rce
7?Z.7f',4....d-?
(1973)
'.
,Cumb"rlnnd County, Pennsylvania, hercinaft"r c:alled Parties of t\le FlrHt fart,
,
'.
AND
,
\
Party ~
DEAN T. SCOTT, single man of Anno::dale, Virginia, heroinafter called
,
i
I
I
,
of the second lJ([rt",
lI'ITNESSETH, that Ow wid, liart ies of the first, 2,al't, in cOllsiduaf:iun oj tile COvclllwts and
agrcement,s hel'cinaft,er cUlltdi/ed, on the ;lal't of the said'l111l'ty of the ""COI1<1.1',Ol't to be 7.olJt
(t?uL pcrfo'rilled, have "'!I)'ec!! (~nd do h(I'ebll ('!lree to sel! (1'11(1, COlll'ey '/Intu U", snid
l)al't y oj t.:w sccow! llart, his 7wirs 01' assigns, alt the 7and and jl1'cmi~cs herein",
aflcl' mcntianc~, Ctlll! f1l/1.1I dC8cribed, jor the SlL?n of '1\<0 HIll1<lred Eighteen Thousand and '
00/100 (5218,000.00) Doll"rs, 1,0 bc llCtid, (/s jollows:
There shall be nO dO\m-payment and the principal part of this obligation shall be
, liqui dated at such time and in such manner as the parties hereto shall agree, pro-
v1.ding, hO\,ever, that interest shall be payable at the rate of 6% per annum and
shall be paid monthly 1.n the ar.'.m:11t of $450.00 as interest only and the balance
o"ing as against il1tercstfor ,,:o.y calendar year at the end of said calendar year.
In no ev"nt shall Party of the Second Part pay to Parties of the First Part during
the first calendar year from the date of the execution of this abreement, a sum
against ?rincipal in excess af $~O,OOO.OO.
I'
anc! the "aid l'CLI'I,y uf I,he secolld p~rl, also agree to lJay alt taxes that, Ill"!l be 7evied upon
sa,i,L l([nd, fro Ii! (Inti after the date of Ihei:c lJresents, ani t.o heep Ihe builiings t1lcrCOJl. ill,,"rcd in
Ihe slmt of (as the parties may ai;r2e, if applicable)
Dollars, lJQyable to the sc;:,; part ie!'f the first llart" as intaest mall a!,peal'. '
And !Ipon tllC paZlme~lt of the sai,! ~:mt, the sait! part ies oj the first lmrt, wilt, at
the Office of Quigley & Quigley, ."ttorneys-at-Lm,', Lemayne, Pennsylvania
make, exeel/te ani ,Lc/irer 10 the said I'c.rt, y of the SCC01HL part, a. good, alld "".tficient Deed for
the jll'opcr cliiLlleyill!l cwd, as,ncdllO of t';,' ~aill, llrcmi..cs in fee simple, jree from on incwllbl'llllee
and doll'u, or !'i!lht of dowel', sllelt ct': :'cyrrnee to conlain the uSl/al eOI'ell(lllls of
general 1~..:rr(Lnt1,1.
All,L the sr.id, part y of the ~'cc~r.C ;](L1't, "grees !dOI, the saitL l)art ies of the fi,'st 'Part, tn
pllrch<lse tho sail! ptcmises alld pall ihr~forc tllC su.m oj
Two Hundred Eighteen Thousand a..,,, 00/100 (S218,000.00) Dollars,
ilL t~c 7Ila"llcr (Ilid at the times I,er/.'ir.b,forc provided.
AND iT I~: FURTHEr: AGNEr-D, by am! ~ct1t'CelL tltc said pnriie,., iiwl, l"",scssiOl' oj ,.aid
pr,~miscs s,~a!1l)c ddiracd, to the ilOrt of ihe SCCOll(/, part, his heir., alii' cs..iom', Oil the
REV.451 EX-+- (3.S01
.cOMMONWEALTH OF PENNSYLVANIA
, OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT OECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
(Instructions on Reverse Side)
Estate of VIRGINIA R. SCOTT
ESTIMATED DEPARTMENT
ITEM DESCRIPTION UNIT MARKET VALUATION
NO, VALUE VALUE (OFFICIAL USE ONL Y)
,
1. Savings Account Dauphin Deposit Bank No.ll 60730 5,910.53
, (Interest to date of death) 311 .98
2. Checking Account no. 76 36068 7, Dauphin Dep. Bar k 2,431. 70
.' 3. Sale of 1980 Chrysler cordoba 6,000.00
4. Patriot News Refund 7.65
5. Sale of clothing 50.00
6. proceeds of public sale 16,488.25
7. Chrysler Corp., refund on car purchase 50.00
8. stor-mer, security deposit refund 48.00
9. Additional check from public sale 20.00
10. Cash on hand 17.00
11. Sale of Cumberland Valley Co-op Stocks 1313.49
12. Tax proration of sale of real estate to Lehnnan 632.05
13. Tax proration of sale of real estate to Dean T. ~ cott 73.85
\
TOTAL THIS PAGE 33,354.50 .J J; :1 Stf. SO
",'L
REV-453 EX+ (3.00)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
. TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "D"
BENEFICIARIES
*'
IInwuctions on Reverse Side)
Estate of VIRGINIA R, SCOTT
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY
DECF.DENT BIRTH
-
Dean T. Scott son ves lenal l/hrh r,,"irl""Y'\r
Grenorv J. Scott son ves lenal 1/5th residuaY'\!
Micheal L. Scott son ves lenal 115th residu"rv
Roxann Eisenberaer dauahter ves leaal 1/5th residuarv
Patricia S. Scott c1aunhter ves leaal 1/5th residu"rv
- Diane S. White daunhter ves lenal l/hth residuaY'\!
,
,
,
The above beneficiaries are living at this time except for the following:
NAME
DATE OF DEATH
REV-454 (\.80)
" COMMONWEALTH OF PENNSYLVANIA
. OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEDENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
'*,
(Instructions on Reverse Side)
Estate of
VIRGINIA R, SCOTT
P
TOIAL E VALUE OF DEPARTMENT
ITEM R
DESCRIPTION MARKET \ DECEDENT'S VALUATION
NO, VALUE INTEREST (Offici.11 Use Onlv)
T
,
TOTAL THIS P.L\.GE 0- -0- !J?M
-
i
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, Soth tangible and intangible property are to be
included, List real estate first,
1. Describe ali 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 (s) and the date the joint ownership was established,
2, Indicate the total market value of the jointly owned property.
3, I ndicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest,
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To insure propor credit to your lU:counl. t1w nome 01 thu m;ln\(! Hnd Iilu number should he clonrly print-
ed on the chock or money ordor.
This assessment is mBdo in accordnnce with SoclllJn "/09 of tho lntwrilanco and Estllto T.ox Act of
1961172 P.S. 9 2485.7081.
To the extent that inheritance talC is paid wiHlin 1/1100 (3) monlhs aller tho death of tho decedent. a
discount of five 151 percent is allowed 172 P.S. 9 2485.716).
Inheritance Tax, other thon tax on a future inlerest. is duo al tile date of tho decoden!'s death and becomes
delinquent at tho expiration of nine (9) months aflor tho docedent's death (72 P.S. 9 2485-711). Inheritance
Tax on a future interest is payable within three (3) months after tho transfer lakes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. 9 2485- 712). Calculato interest from the delinquent dale show'
on the face of this form to the date of actual payment using tile following interest table:
--...--------- -------- - - --------- --- ---- -- ------- - - - - - - --- --.------ -- -- - - - -- --
1 month .005 4 months .020 7 months .035 10 months .050
2 months .010 5 months .025 8 months .040 " months .055
3 months .015 6 months .030 9 months .045 '2 months .060
1 days .000 17 11 days .00186 21 days .00352
2 days .00034 12 days .00203 22 days .00369
3 days .00051 13 days 00220 23 deys .00386
4 days .00068 14 days .00237 24 days .00403
5 days .00085 15 days .00250 25 days .00420
6 day. .00101 16 days .00267 26 days .00437
7 days .00118 17 days .00264 27 deys .00454
8 days .00135 18 days .00301 28 days .00471
9 deys .00152 19 days .00318 29 days .00468
10 days .00169 20 days .00335 30 days .00500
-- --------- ---------- _._- - -- - -- --- -- --- - -- - - - --- - - - -- - - - --------- --- __a
Any party in interest, including the Commonwealth and the personal representative, not satisfied with
the assessment may object thereto within sixty (60) days alter recoipt of this NOlice as provided by Section
1001 of the Inheritance and Estete Tax Act of 1961172 P.S. 9 2485.1001).
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below:
HEV.455 EX.. (J,1l0!
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER IN~IERtTANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
-- ---===:au
---';~""'----_...'-........."".~
,
Estate of VIRGINIA R. scan Date of Deatll~ay 28, 19~~File No/-
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant
Claimant's Address
ITEM
NO.
DATE
1 . 5/28/80
2. 5/28/80
3. 5/28/80
4. 6/1/80
5. 5/28/80
6. 6/11/80
7. 6/13/80
8. 6/21/80
9.L/1::6/25/80
10. 6/25/80
11. 6/26/80
12. 7/80
13. 7/80
14. 7 80
15. 7/80
16. 7/80
17. 7/11/80
18. 7
19. 7
20.
Relationship to Decedent
NAME OF PAYEE
REMARKS
AMOUNT
81.00
59.07
18.00
100.00
20.00
71.27
897.40
180.37
4.74
5.26
89.90
712.32
1,780.00
2 070.02
5.00
4,000.00
63.19
9.23
184.18
9.54
5.35
16.16
TOTAL THIS PAGE 10,391.63
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral
expenses and expenses of administration submitted tOd1'kJEt<g~ ~ctions for Inheritance Tax purposes.
/U-IM,,'4,:f. lid:!;; .>Jill? /
SIGNATURE OF ATTORNEY/FIDUCIARY DATE
OFFICIAL USE ONLY
Register of Wills, Cumb. Co.
Patriot News
Cumberland Law Joumal
Diane S. \'.hi te
Glenda Wethington
Met Ed
Personnel Pool of Hbg.
R. Kennedy Sales
Murphy Mart
Keefer's IGA
Bell Tel. of PA
Elizabeth P. Arnold
Recorder of Deeds CUmb. Co.
CCC ASC
Probate Estate
Advertise Estate
Advertise Estate
Assorted expenses
witness fee
electric bill
Nurse
transport trailer
trash bags
Gas for tractor
phone bill
1980 school taxes
Transfer stamps
debt owed for rain bin
Prothonotary, Cumb. Co. Satisfaction fee
Sam Andes, Att'y for Dean T. cott, debt owed
Met Ed Electric bill
CV Co Do food
BT Credit VISA Debt owed
Harbold Ford inspect Pinto
gas
e ense
nse
DE8Ts AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S J/g %1) I. H
,
AT
&
PERCENT.
i-,~-?/
DATE
GENERAL, INHERITANCE TAX INFORMATION
Unsatisfied liab1l1tles Incurred by the decedent prior to his/her death are deductible ageinst his/her taxeble 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 exoenses Including the cost of a burial lot, tombstone or grave marker.
All debts being claimed against an estate are subject to the approval of the Register of Wills with whom the
Inheritance Tax Return Is filed. Evidence to support the decedent's or the estate's liability for th8 debts being claimed
should be attached to this schedule.
A family exemption of $2,000 may be claimed by a spouse of a decedent who died domiciled In Pennsylvania.
If there is no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of
the same household can claim the exemption. In the event there Is no such spouse or child, the exemption can be
claimed by a parent or parents who are members of the same household as the decedent. The family exemption Is .
allowable only against assets which pass by a will or by the Pennsylvania Intestate Laws.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the family exemption is being claimed, indicate the claimant's name, address and his/her relationship to the
decedent. Enter "family exemption" in the remarks column and the amount claimed in the amount column.
2. Assign consecutive numbers to each item listed.
3. Enter the date on which each debt was incurred and/or paid.
4. Enter the names of each payee.
5. Provide a brief explanation in the remarks column for each debt claimed.
6. Enter the amount of each debt being claimed.
7. The form must be signed by the person who has assumed the responsibility for paying the debts.
Estate of VIRGINIA R; SCO'M' Date of Death May 18,
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
~~~<No.
'*'
I
IlEV.4S$ EX' p.,O)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER tNHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF OEBTS
AND DEDUCTIONS
.__. :-=.;:;..;; ___.n.n...'"",'-'
-
Claimant
Relationship to Decedent
Claimant's Address
ITEM
NO.
DATE
NAME OF PAYEE
REMARKS
AMOUNT
24. 7/80 Star-mor rent 48.00
25. 7/80 corrmonwealth National Bank Certified check 3.00
26. 7/80 Keefer's lGA expense 5.40
27. 8/80 Knisley Sunoco, Inspect Chrysler 48.47
28. 8/80 Weber Hardware expense 1.97
29. 5/80 Roxann Eisenberger sale help 192.50
30. 5/80 Daryll Eisenberger sale help 56.85
31. 5/80 Kim Reiser sale help 23.00
32.. 5/130, be'; ,i<Cari Lingenbrink sale help 31.50
33. 5/80 Jim Tilton sale help 46.50
34. 5/80 Lucia Price sale help 31. 50
35. 5/80 Brenda Shaw sale help 5.75
36. 5/80 Rob Davis sale help 17.50
37. 5/80 Stephanie Farnsworth sale h lp 53.25
38. 5/80 Masland Assoc. last illness 253.75
39. 5/80 David Sileo truck rental 15.00
40. 5/80 David Sileo sale help 14.00
41. 5/80 Rolling Greens Memorial Garde monument 850.00
42. 5/80 Myers Funeral Home funeral bill 6653.30
43. 6/80 Masland Associates last illness 150.00
44. 6/80 Carlisle Radiology Assoc. last illness 15.00
45. 6/80 Pat Scott sale help 28.00
46. 6/80 Daryll & Roxann Eisenberger sale help 44.63
page -2- TOTAL TH IS PAGE 8,588.87
I hereby certify that to the best of my knowledge and belief the foregoing is a just and trlle statement of debts, funeral
expenses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes.
D.IJ\f'l!> S. WHI~ J . .J-"}} /
U!t0f/ J././ "-A./ ./ .L..- J-// 71 fI
SIGNATURI!: OF ATTORNEV/FIDUCIARY DATE
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S Jj ~I j /) I, IJ-f) AT
~
PERCENT.
0;/[1"o~:4tt~
;J-~ ' !I
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities Incurrod 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.
All debts being claimed against an estate are subject to the approval of the Register of Wills with whom the
Inheritance Tax Return is filed. Evidence to support the decedent's or the estate's liability for the debts being claimed
should be attached to this schedule.
A family exemption of $2,000 may be claimed by a spouse of a decedent who died domiciled In Pennsylvania.
If there Is no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of
the same household can claim the exemption. In the event there is no such spouse or child, the exemption can be
claimed by a parent or parents who are members of the same household as the decedent. The family exemption is
allowable only against assets which pass by a will or by the Pennsylvania Intestate Laws.
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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.
. ---.--. - ~
.'
ItEV.450 EX+ 1:).HOl
COMMOI'lWEAL TH OF PENNSVLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF OEBTS
AND DEDUCTIONS
Estate of VIRGINllU3., scarr Date of Death~_18, 1980 File No.
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant
Relat.ionsh ip to Decedent
Claimant's Address
ITEM
NO.
DATE
NAME OF PAVEE
REMARKS AMOUNT
sale hel 110.25
sale hel 6.00
sale hel 6.00
sale hel 228.25
sale hel 165.75
sale hel 46.00
sale hel 438.38
sale hel 15.00
e ense 50.00
service 45.00
last illness
nurse
47.
50.
51-
52.
53.
1
Howard C. White III
Andrew White
Shane White
Howard C. White Jr.
Hu Plautz
Diane White
er.
Carlisle Radiolo Assoc.
'faxes for 1979
Le al Fees
Insurance remium
hone bill 25.46
Bricker
Auctioneer E nse
3 460.00
Page -3- TOTAL THIS PAGE
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral
expenses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes.
DI~. S. WHI1J: I.. j : ."'1 / ;:
,tj!.(tl/.J(~ ,/.!tuj'7f, .>'//7 8/
SIGNATURE"OF ATTORNEVfrl"DUCIARY DATE
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF 5 Jj~ ? (l /,;H) AT
/
t,
PE RCENT.
tfJJ"J {}. ~u'"'_
~EGISTER FILLS
Lj-~- n
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxeble estate.
In addition to debts incurred by the decedent or estate, other items are claimable including the cost of edminlstration,
attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone or grave merker.
All debts being claimed against an estate are subject to the approval of the Register of Wills with whom the
Inheritance Tax Return is filed. Evidence to support the decedent's or the estate's liability for th8 debts being claimed
should be attached to this schedule.
A family exemption of $2,000 may be claimed by a spouse of a decedent who died domiciled in Pennsylvania.
If there is no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of
the same household can claim the exemption. In the event there is no such spouse or child, the exemption can be
claimed by a parent or parents who are members of the same household as the decedent. The family exemption is
allowable only against assets which pass by a will or by the Pennsylvania Intestate Laws.
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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.
11EV.455 EX" (:H~O)
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
,---"--"'--'.-'-
Estate of VIRGINIA R. SCOTT Date of Death May 18 fi~~.
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE "rHE FOLLOWING:
Claimant
Claimant's Address
ITEM DATE NAME OF PAYEE
NO.
70. 2/81 Register of Wills
71. 2/81 Register of Wills
72. 2/81 Register of Wills
73. 2/81 Notary Public
74. 2/81 Seligman Friedman & Co.
75. 2/81 Diane S. White
76. 2/81 Jan M. Wiley, Esquire
Relationship to Decedent
REMARKS
AMOUNT
filing inventory
Add' 1 letters
filing release
Notary Fees
Fed. Estate tax return
Executrixes' fee
Attorney's fee
6.00
160.00
75.00
60.00
1,500.00
21,000.00
21,000.00
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page -4- TOTAL THIS PAGE 43,801. 00
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral
expenses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes.
/~~;." WrjTI):(ALh _" ~.;; 1/ 8/
SIGNATURE OF AT-TORNEY/FIDUCIARY DATE
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF 5 1 q, 'i /)/. H) AT
t,
PERCENT.
tJz;;1.1f O. {/fP~
R GISTER OF' IS,
/j-~ -81
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedsnt prior to his/her death are dsductible against his/her taxeble 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.
All debts being claimed against an estate are subject to the approval of the Register of Wills with whom the
Inheritance Tax Return is filed. Evidence to support the decedent's or the estate's liability for the debts being claimed
should be attached to this schedule.
A family exemption of $2,000 may be claimed by a spouse of a decedent who died domiciled in Pennsylvania.
If there is no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of
the same household can claim the exemption. In the event there is no such spouse or child, the exemption can be
claimed by a parent or parents who are members of the same household as the decedent. The family exemption is
allowable only against assets which pass by a will or by the Pennsylvania Intestate Laws.
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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. 1547EX (1-B3)
J
BUREAU OF EXAMINATION
PENNSYLVANIA DEPARTMENT OF REVENUE
P.O. BOX 8327
HARRISBURG. PA 17105
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS. AND ASSESSMENT OF TAX
ACN
101
DATE
ESTATE OF SCOTT VIRGINIA R FILE ND. 21 80-0354
DATE DF DEATH 05-18-80 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YDUR ACCDUNT SUBMIT THE UPPER PDRTIDN OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS OF THE ABOVE COUNTY. MAKE CHECKS PAYABLE TO "REGISTER OF WILLS.
AGENT II .
3
JAN M WILEY EsQ
PO BOX 288
19 N 8ALTIMDRE sT
DILLsBURG PA 17019
PLEASE RETURN THIS
PORTION TO REGISTER OF
WILLS IF PAYMENT DUE
CUT ALONG THIS LINE
----------------------------------------------------------------------.
TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
NOTICE OF INHERITANCE
REV. 1547EX (10-82)
ESTATE OF SCOTT
VIRGINIA R FILE ND.21 80-0354
ACN 101
DATE 02-14-83
TAX RETURN WAS: I X I ACCEPTED AS FILED I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: 1 SUPPLEMENTAL RETURN
1. Real Estate Ischedule AI I 1 I
2. Stocks and Bonds ISchedule BJ I 21
3. Closely Held Stock/Partnership Interest (Schedule Cl ( 3)
4. Mortgages and Notes ISchedule Dl I 41
5. Cash & Miscellaneous Personal Property (Schedule El ( 5)
6. JOintly Owned Property (Schedule Fl I 61
7. Transfers {Schedule Gl I 71
8. Total Assets
.00
.00
.00
.00
.00
.00
.00
181
.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/AdmInistrative Costs/Miscellaneous
Expenses Ischedule HI I 91 7,690. 37
10. Debts/Mortgages/Liens (Schedule II 11 OJ 19,329.21
1'. Total Deductions 1111
12. Net Value of Tax Return (12)
13. Charitable/Governmental Bequests (Schedule j) (13)
14. Net Value of Estate Subject to Tax (14)
NOTE: If an assessment was p"evlously tssued. ltnes 14. 15 and/o" 16 and 17 will
"eflect ftgu"es that Include the total of ill "etu"ns assessed to date.
ASSESSMENT OF TAX:
15. Amount of line 14 taxable at 6% rate
16. Amount of line 14 taxable at 15% rate
17. Principal Tax Due
TAX CREDITS:
27,019.58
27,019.58-
.00
358,533.92.
(1S1
1161
358,533.92
.00
X.06=
X.15=
1171
21,512.04
.00
21,512.04
PAYMENT
DATE
RECEIPT
#
DISCOUNT (+1
INTEREST (-I
AMOUNT PAID
02-18-81
000497
.00
23,133.21
. IF PAID AFTER THIS DATE SEE REVERSE FOR CALCULATION
OF ADDITIONAL INTEREST
RETAIN THIS PORTION FOR YOUR RECORDS
I TOTAL TAX CREDIT 3
~ALANCE OF TAX DUE 1, 621.17CR
I INTEREST .00
I TOTAL DUE 1,621.17CR
(If Balance Due is less than $1.00 no payment is required)