HomeMy WebLinkAbout80-00366
-Ii""
....,
.\.'
, ,,':
':'1'
,
,,'
.~
'!;ij
"~ ,
"
~ i' ,
.......~
.. . '.
><
" .tI) 11< ~
~ ~
. .~ ~
.1=1 0 ~
12; E-l
I ~ 11<
,I ;, .
H
.
~
-
o
"
:i ~
all.
(-t
21.80 :.H';f;
No.
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
In the Estate of ;:::;;..d J II il'v D . D () (7. J (' M
.
, deceased.
To Register of Wills for the County of Cumberland, In the Commonwealth of Pennsylvania.
Petltloner(s) Is (8'Ill-the execut 'l?./)( named In the Last Will and Testament of ';:;..d. vlll,-tJ
p. D.ftt~pw. dated ()A~ .:J~ /'~77
Decedent was a citizen of the United States and a resident of '>lI.b /n&iu
Township (5'orc~!jll), Cumberland County, Commonwealth of ennsylva la.
Decedent died on tJJ~'.J L.. the 2 2A~ day of A (.) 9' A.D. 19..2.2, In the
County of l)..s. (J il t, :.., ( , State of -1) A at the age of .LI!::-. years.
Decedent has (has nolI been married and has (has not) had children born to him (her) since the ex.
ecutlon of the above described Will. gg
Decedent was possessed of personal property to the value of / ~. ' 0 (J 0
and of real estate to the value of -<) (J A.JE
as near as can be ascertained; said real estate situated as follows
Therefore, your petltioner(s) respectfully apply(les) for the probate of the said Last Will and Testa.
ment and for Letters Testamentary theron.
Dated )'t?AY 1(,( / f !?'6
N~.~;t:O~:.'8;:~Ijl.p~,{~ ~ 1?;::: :-
~ ?viNJe,.. 'On.
~~~ '4 "" eJ j lIlA.~ rJ?a..
COMMONWEALTH OF PENNSYLVANIA } I
COUNTY OF CUMBERLAND SS
004'...../11 V P.fn~f'/'t Q //iI../-th4,f-r.:J
. , ,
named in above application, being duly S tv , 11.,;:) . pccordlng to law say(s) that the
statements set forth in this petition are true to the best of M^ knowledge and belief.
S---'tlJiI,.) and subscribed before:~a ," \1 ~" , \'c , ,~-- r\~ 0 ,_ ~ "
m May ,6 80 ..
e.__. 19
~14.- (!. . ~
~ Register
/ ) (jS-,j
(p olc
72_LJPL,. C?I
tf'7 . 0 0 l.J 4)( 9'
Xllorney )./ hY1 /)a..
@V
Filed: June
2,
1980
/ 71 ~tf
i
~ . .'t
.
.
M
~
0
u.. .....
C. ~
s: ....'"
LLI OJ'~
:;: ::E: OJ . OJ C
cI: LLI ... u...'"
t- :c .~ ""....>
Vl Vl ::l ~Vl~
LLI c< CT >,
t- LLI VI . ... VI
0 UJ U') OJ CO
0 UJ> CO
z u a QJ c::t
cI: 0 VI I-lCo...O'l
~ >'" I
...l "" ~ C<::C oM
...l ~ OJ LLI OJ.,.
~ ...l :;,: V1.cr-N
::: "" ....VI
"" '" ...l s..o..-_
t- cI: "" Cl: o~"'"
Vl "" C c.!:lzs.......-
cI: u.. .~ UJ "'.....
...l ...l -lr--..u-
,
"
.
.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ss:
COUNTY OF CUMBERLAND
Before me, the Register for the Probate of Wills and granting of Letters of Administration in and f
Cumberland, perS~nallY came V. ... DoIll ~ f'
who, being duly ..t:. ttJ IIll,/'\:.rdo l' ~ depose and say that as
of the Int Will ~nd Testament of ,.,.-. ,..J It ~ '" deceased
.J)( ~' ~;II well and truly administer the goods and chattels, rights and credits of said dec.eased according to law. And
also will diligently complr with the provisions of the law relating to Transfer Inh~~itances.
and subscribed before me.
May 16
80 .
A.D., 19_
c...~,' ~ ,-", ,I \L, ,\; .'. . ('\~ n~ <Lc ,.>G,.'",
'22f ~~.
'. ~ WAy ~ ., '",1/'"(4./ .
Register
:..; 0:
:lll to:
:os Ol
:Q) .....
:"
:Q)
l~
E: r<l:
ell:
U. ,c:: to:
Ill: *l
0 ~:
ell:
Qi ..!ll
\D: ..J ': 8 ;
\0: Q: ~
r..t;. r<l: ..J zl ..... Nl
rJ) I: ..... ,.
- .~ t.l: eIIl
C'j 0' 1-4: :::
to' ~ ~I ~l d:
I: I'i ~i
.-4: .~
Nl 't:t
e Ql 1tI:
CO ~ ~! 1: .-4:
I ~ N:
- *'
N ~ ill> 'i
0 't:t ....
I'i ~ ~
Z ril al
DECREE
Be it remembered that on the
2nd
day of
Franklin D. Dershem
June
80
,A.D.,19_, there was probated and
recorded the last Will and Testament of
late of
Hampden Township
,Cumberland County, Pennsylvania,
Jean V. Dershem Pepperman
Deceased. Letters Testament/lry were granted to
Witness my hand and official seal the day and year aforesaid.
~;2 ;)
'/bt-:; ('-..
1~
Register
.------- -- ---.- --- --..---- -- .---- --._- ---, _. --_.-- _.. - -- '-- -- - ----
I .._...... __ """" __ ""-"L
! .II.'REV.11 BHX
'~'~:,:" ., COMMONWEALTH OF PENNSYLVANIA
, 4 ,'NO; 0 DEPARTMENT OF REVENUE
;:;':i:;~PO 287 OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
I ) ;,~, .f~J ,,:~, "., '", \. '. ;' ,
..
;
II
a
I~
\
i I RECEIVED
'/ FROM
ADDRESS
-
-- --........ --- ----
.,..
..~... .
-.-.
TAX AT 6%
TAX AT 15%
Jean Peppeman
eio .
P.O. Box 99
,
TAXAT_%
ESTATE TAX
Harrisburg, 'a. 17108
.nes'ti'E INFCiRMATiciN';' AUqUt-22~--i979-----
DATE OF DEATH
21-80-366
DATE OF PAYMENT
Sovember 12, 1980
288.61
TOTAL TAX CREDIT ~
LESS DISCOUNT
m PLUS % INTEREST
(FROM TO_I
i
m i 288.61
I
TOTAL AMOUNT PAID
FILE NUMBER
. 'NAME OF DECEDENT
PlWIJa,IN D. DBRSBBM
CWlber1and
\
, ;OUNTY
.. .------ -------- --------- -----
POSTMARK OA TE
REMARKS: -PAID Olll ACCOUIf'l'-
SEAL
RECEIVED BY
?/!i~~; ~tUVfJ
\ . e~N .
Reg'iater of Willa
I ;
REGISTER OF WILLS
-- -----------.-,-
:
\
INFORMATION
To insure proper credit to your account, tho namo 01 tho cstJto nnd file number should hn clearly print-
ed on the check or money order.
This assessment is made in accordanco with Section 708 of tho Inl1eritanco and ESlato Ta)( Act of
1961 (72 P.S. 9 2485.7081.
To the extent that inheritance tax is paid within three (3) months after the death of the decedent. a
discount of five 151 percent is allowed (72 P.S. S 2485.7161.
Inheritance Tax, other than tax on a future interest. is due at the date of the decedent's death and becomes
delinquent at the expiration of nine (9) months aftor the decedent's death (72 P.S. S 2485-711). Inheritance
Tax on 8 future interest is payable within three (31 months after the transfer lakes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. 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 '0 months .050
2 months .010 5 months .025 8 months .040 11 months .055
3 months .015 6 months .030 9 months .045 12 months .060
1 days .00017 11 days .00186 21 days .00352
2 days .00034 12 days .00203 22 days .00369
3 days .00051 13 days .00220 23 days .00386
4 days .00068 14 days .00237 24 days .00403
5 deys .00085 15 days .00250 25 days .00420
6 days .00101 16 days .00267 26 days .00437
7 days .00118 17 days .00284 27 days .00454
8 deys .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, n01 satisfied with
the assessment may object thereto within sixty (601 dllYS after receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961 172 P.S. 9 2485.10011.
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below:
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurrm! 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 exrenses 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 S2,000 may be claimed by a spouse of a decedent who died domiciled in Pennsylvania.
If there is no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of
the same household can claim the exemption. In the event there is no such spouse or child, the exemption can be
claimed by a parent or parents who are members of the same household as the decedent,
C 'tl " n > t"1 :> :5
:> 0 0 " tIl "
Z Cl n c:: " ;; z :::: z t'"
1"1 t"1 ;;>; Z " 9 - 9 t'"
Z Z 1"1 ...., 1"1 ~ z
9 ~ -< t"1 -
9 tIl tIl
Z 0 tIl 0 ...,
0 '::I '::I iI:l ....
~ ~
:s: 111 0
() CD f-' "':I .."
c:: (J 0 :;; 0 '::I
53 ::>' 0 Z n
III z -
t>:I ;l t>:I ;;>; :>
~ 1-" III t" t""
(J Ul H
:>' Ul rt' Z C
Z t1 tIl
t:l C t-3 t:l t>:I
'i 'i . 'CD
<0 f-" Z
;l t:l t"
P, t>:I -< -< ~
''0 f-' ::0 ~
~ CD Ul t"1 t"1
::r: :> :>-
::0 t>:I ;;: ::0
0 :s:
III
p,
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.
';
PEN.t:JSYL'yANIA1~_HERITANCE TAX GENERAL INFORMATION
-- -
1. PERSONS RESPONSIBLE FOR RElURN
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 in 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 reluln 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-law and at the rate of 15% as to all others.
6. PAYMENT OF TAX
The tax assessed on the transfer of property reported in the return is due 9 months after the decedent's death. Interest
at the rate of6% 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 aRains! any real property in the decedent's
estate or against any property belonging to a transferee liable for the tax.
a, FILING OF FALSE RETURN
Any person who willfully makes a false relurn or report required of him shall, in accordance with Section 793 of the
1961 Statute, be guilty of a misdemeanor and, on conviction thereof, shall be sentenced to pay a fine not exceeding
$1,000 or undergo imprisonment not exceeding one year or both.
INSTRUCTIONS FOR COMPLETING SCHEDULE "B"
Schedule "B" must include all tangible and intangible personal property
owned individually by the decedent at the time of death. Property owned
jointly with another party or parties should be listed on Schedule "E" - - Jointly
Owned Property. Intangible personal property, titled in the name of the decedent,
but payable at death to another party or parties, including but not limited to
P. O. D. U. S. Savings Bonds and Tentative Trust Accounts, must be listed on
Schedule "B",
Tangible personal property should be listed first. Examples of tangible
personal property are jewelry, wearing apparel, household goods and furnishings,
books, paintings, automobiles, boats, snowmobiles, aircraft, etc.
Intangible personal property includes cash-on-hand and in the bank, stocks,
dividends, bonds, mortgages, treasury certificates, notes, together with accrued
interest, salaries or wages, insurance payable to the estate or fiduciary in said
capacity, partnership interest, etc. An interest in any undistributed estate or
income from any property held in trust under the will or agreement of another
even though located outside of Pennsylvania at the time of death should be
listed on Schedule "B".
A completed Partnership Interest Report (REV-894) must be attached for
each partnership or joint venture, and a completed Closely Held Corporate Stock
Information Report (R EV-893) must be attached for each closely'held business
interest or sole proprietorship reported on Schedule "B".
"
'.
QUESTIONS CO~~ERNING rROPERTY_1B~NSFER~
1. Did decedent, within two years of death, make any Ilill1slel of any matelial part 01 h'ls estat!': wilhout receiving
valuable and adequate considemtion? (Answer "Yes" 01 "No".) No
2. Did decedent, within two ,'ears of death, transfel property flOlI1 himself/ herself to Idmself!hersell and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) .Jl.o_
3. If the answer to one or two above is "Yes" and thr trilnsfers are claimed to be nontaxable, provide the lollowing
information:
a. Age of decedent at time of transfer.
b. Copy of death certificate.
c. Affidavit by the a!lending physician indicating the stale of decedent's health at time of transfer.
d. All other information supporting nonlaxabilily of transfer.
. 4. Did decedent, in his/her lifetime, make any transfer of property without receiving <I valuable or adequate consideration
therefor which was to take effect in possession or enjoyment at 01 after his/her death? (Answer "Yes" or "No".) Nn
a. Was there any possibility that th~ property transferred might return to transferor or his/her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No".) NO
b. What was the transferee's age at time of decedent's death? --
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" 01 "No".) ~
b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".) No
6. If the answer to five b. above is "Yes," state whether the right was reserved in decedent alone or others.
7. Did decedent in his/her 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".) No
8. Did decedent, at any time, transfer property, the brmficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".) No
9. If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Yes" or "No" ,)
....
'.
LAST WILL AND TESTAMENT
OF
FRANKLIN D. DERSHEM
BE IT REMEIo1BERED that I, FRANKLIN D. DERSHEI~, of I~echanicsburg,
Cumberland County, Pennsylvania, being of sound mind, memory and understandin
do make, publish, and declare this as and for my Last Will and Testament,
hereby expressly revoking any and all ~Iills and Testaments, or writings in
the nature thereof, heretofore made by me.
FIRST
I direct that all of my just debts and funeral expenses be paid and
discharged as soon as may be convenient after my decease by my executrix or
(
~
,..
,~"\l
"
.'
'"
'..i~
\j~
~""\..
'5
)
,
<:'
~
.~
i
-:
~
alternate executrix hereinafter named.
SECOND
All of the rest, residue, and remainder of my estate, of whatsoever
nature and wheresoever the same may be situate, whether real, personal, or
mixed, I give, devise and bequeath unto my beloved wife, HELEN M. DERSHEM,
to be hers absolutely and forever, provided she survive me by thirty (3D)
days.
THIRD
I do give, devise and bequeath unto my grandson, SCOTT E. PEPPERI-t!'~j,
one (1) plank bottom chair, all my guns, one large china vegetable dish,
and five hundred dollars ($500,00) in cash, to be his absolutely and forev:r,
FOURTH
I do gi ve, devi se, and bequeath unto my grandson, DENNIS F. PEPPEK'!;"'j,
one (1) plank bottom chair, my gold watch with chain and two gold fobs, on:
glass, antique, covered candy di sh, and five hundred dollars ($500.00) in
cash to be his absolutely and forever.
FIFTH
. I do give, devise, and bequeath unto my granddaughter, LORI JEAN
PEPPERI1AN, one (1) plank bottom chair, one glass, antique covered fruit Gisr.
on a pedestal base, one antique cane chair, and nine hundred dollars
($900.00) in cash, to be hers absolutely and forever.
Page One of Three
.\.....
'.
SI XTH
1 do give, devise, and bequeath unto my grandchildren, SCOTT E.
PEPPERMAN, DENNIS F. PEPPERlo1AN, AND LORI JEAN PEPPERlo1AN, all my woodland
situate in the Township of White Deer, County of Union, Pennsylvania, as
tenants-in-common to be theirs absolutely and forever,
SEVENTH
I go give, devise, and bequeath unto my daughter, JEAN V, DERSHEM
PEPPERMAN, three (3) plank bottom chairs to be hers absolutely and forever,
EIGHTH
I go give, devise, and bequeath unto my son-in-lavl, GERALD PEPPERMA:~..
my diamond ring. In the event he should fail to survive me, I do give,
devise and bequeath my diamond ring unto my grandson, DElmIS F. PEPPERMAN.
NINTH
I do give, devise and bequeath unto my daughter, JEAl1 V, DERSHEI4
PEPPERMAN, and my granddaughter, LORI J EAiI PEPPERlo1AN, a 11 my wife's jewel ry,
to be divided between them in equal shares, with the choice of specific items
)
~
"'
~
"'"
~,
....,
".,.\
~
to be left to my said daughter and granddaughter.
TENTH
~-,,:,,-
~
1
.",
~~""
'"
~
,.l
....
;.
\
c-~
In the event that my wife, HELEN M. DERSHEM, should predecease me, or
that we should perish in a common disaster, or that she should fail to
survive me by thirty (30) days, I do give, devise, and bequeath all of the
rest, residue, and remainder of my estate, of whatsoever nature and
wheresoever the same may be situate, whether real, personal, or mixed, unto
my daughter, JEAN V, DERSHEt1 PEPPERW\N, present'ly of 123 Wi ns ton Dri ve,
I'iechani csburg, Pennsyl vani a, or to her chi 1 dren in equal shares in the event
that she should not survive me, to be hers absolutely and forever.
LASTLY, I hereby nominate, constitute and appoint my beloved wife,
HELEN M, DERSHEM, to be the executrix of this, my Last Will and Testament.
Page Two of Three
'.
In the event of the renunciation, death, resignation or inability to act
for any reason whatsoever of my said wife, I do hereby nominate, constitute
and appoint my daughter, JEAI~ V. DERSHH\ PEPPERI-\AN, to be the alternate
executrix of this, my Last Will and Testament. I hereby relieve my
Executrix from the necessity of posting security in connection with her
duties as such in any jurisdiction in which she may be called upon to act
insofar as I am able by law to do so.
IN WITNESS WHEREOF, I, the said FRANKLIN D, DERSHEM, have to this,
my Last Will and Testament, written and contained on three (3) typewritten
pages, subscribed my name and affixed my seal to each of the three (3)
pages thereof, this
")7r-.L
:;"0"
day of .J, ,. ,','/' /",.(....-
/. .;7
.,/
A.D., one thousand
nine hundred seventy-seven (1977).
f) 1/1, .../11;) I
'f..-y<>?,/)1.f.i 111-..51::< q;::...t.~,')f:th {SEAL)
Franklin D, Dershem
The aforegoing instrument written and contained on three (3) pages of paper
was subscribed by the said FRANKLIN D. DERSHEM on each of the three (3)
pages thereof, and sealed, published, and declared by him, the said
FRANKLIN D. DERSHEM, as and for his Last Will and Testament, in our
presence and in the presence of each of us, and we, at the same time, at
his request, in his presence, and in the presence of each other, have
hereunto subscribed our names as attesting witnesses, this ,'j '7:>/. day (if
. ,
A,D., one thousand nine hundred seventy-seven (1977),
i.
~''''I'''--
" ~
./ ~/
_v' .J a
.- /. ~ ' ~ I " ..-:'~..--
,,'f. __............" ,..",-"
/I / '
,--,-')t-l {/.:;~d
I
i
-=>/ -/, ,'. /, .. .1
Address~,-~<"'~- >- .~.d.~L<.'-<. 7-.. "I
.. '-'~/"'~..t'fi?",.c.c..::-t....,?<..r .//>. I
, ,- ...-: . /.. I
- / -. I
/, /"/) f../" I /1' .
Address /7/.~;;r(.J!,:;i ; (> I,). '.' ,.
/
I
/,.~_/. /
(/.
/L//
Page Three of Three
i
I
, 1
I
ORE:V.454 (1.S0)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT DF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNEO PROPERTY
\-1.
(1:,. ,... ~
",'v?~:":~~"",,.., .
'- 0 'lS" -1r .
t;/;- ";.~,'r.~ \
h,.~,':!."''f",.l
~"liS',:S'
(lnsrructions on Reverse Side)
Estate of
Franklin D. Dershem
, - .
IT
ITEM TOT AL ER '''"' "j DEPARTMENT
NO. DESCRIPTION MARKET ce DECEDENT'S VALUATION
VALUE N INTEREST (Official Use On/vi
T
.. . -- -
1 commonwealth National Bank Checking
Account No. 162-106989-5
Balance date of death - $2,365.56
(see bank letter attached) I'
I.
I
2 Commonwealth National Bank Savings ,
I
Account No. 16-0010796-3 I
Balance date of death - $383.19
(see bank letter attached)
3 West Milton State Bank Savings
Account No. 3797-7
Balance date of death - $1,566.78
(see bank letter attached)
Certificate of Deposit No. i
4 1183 I
I
West Milton State Bank I
Value date of death - $6,064.17
(see bank letter attached)
5 certificate of Deposit No. 1355
West Milton State Bank I
Value date of death - $3,510.57 I
(see bank letter attached) i
i
6 certificate of Deposit No. 1857 i
West Milton State Bank i
Value date of death - $7r194.54 i
i
(see bank letter attached) !
Certificate of Deposit No. I
7 2358 !
West Milton State Bank I
yalue da~elof deat~ - Slar074.92 I
see ban etter a tache I
I
8 Certificate of Deposit No. 16-1868 I
I
commonwealth National Bank
Value date of death - $13,671.23 I
(see bank letter attached)
9 Certificate of Deposit No. 16-1834 .
Commonwealth National Bank
Value date of death - $6,008.46 I
(see bank letter attached) ~
TOTAL THIS PAGE
!
INSTRUCI!2NS FOR COMPLETING SCHEDULE "S:
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included, List real estate first.
1, Describe all real property as indicated in the instructions for Schedule "A". Describe all personal property
as indicated in the instructions for Schedule "B". I nclude the name, address and relationship to the
decedent of the co' owner {sl and the date the joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3. I ndicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest.
C .." 0 n >- r-1 > :5
z ::>- 0 0 ;:; Ul 0
C'l n c 0 ...., z ,.. Z I'""
rrl r-1 ;r. :z; ;;;l ::>- 9 - 9 I'""
Z Z r-1 ..., r-1 ...., Z
p 0 ...., -< Ul r-1 Vi
Z 0 Ul 0 ::J
p ." b I '':1 ,. ~
In l~ I~ > 0
...., .."
11l 0 .."
Is g- 5
'e IZ Z
,Eli ~PI Il'l ~ >
'l'l P t<
::0 1-" I~ H I'""
t< (l Z C
~ lJl Ul
0- i: r:l
0 s:: '>'3 I 0
'1 I" z
\0 II-"
- ,~ t'j :<
,
, 10. ::0 0< -<
g; 't-' Ul ~
r:l rrl
ICD P: > ;.-
t'j ;;;l ::0
:::0 -
~
0 ,
PI I
0.
FlEV.454 1].80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
. A,
,$ ,<,,,~
'.........-..."'':"Y''. "
.:" \
I ... n~l
~~,!.~"""""j
tr~:~=P*,;\r.
(Instructions on Reverse Sic/e)
Estate of Franklin D. Dershem
DESCRIPTION
TOTAL
MAR KET
VALUE
P
'k VALUE OF
1, DECEDENT'S
N INTEREST
T
DEPARTMENT
VALUATION
IOfficial Use Only}
10 Certificate of Deposit No. 16-1143
Commonwealth National Bank
Value date of death - $4,542.19
(see bank letter attached)
ALL OF THE ABOVE PROPERTY IS NOT TAXAB E AS
IT IS OWNED BY HUSBAND AND WIFE AS TEN NTS
BY THE ENTIRETIES. THIS PROPERTY IS
LISTED FOR INFOffi.ffiTION PURPOSES ONLY.
THE FOLLOWING TWO ACCOUNTS ARE LISTED OR
INFORMATION PURPOSES ONLY AS THEY ARE OT
TAXABLE AS DECEDENT WAS TRUSTEE AND NO
THE BENEFICIAL O\~NER OF THE SlUlE.
COmmonwealth National Bank Savings
Account No. 16-0010717-9
Balance date of death - $518.77 J'"/Jj 17
(see bank letter attached)
Commonwealth National Bank Savings
Account No. 16-0010716-1 {., (, '1,.s-P
Balance date of death - $667.58
(see bank letter attached)
TOTAL THIS PAGE
I
.-J
#'~/f{'..JS t
t
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include al\ property, real and personal, owned by the decedent jointly with another
party or parties as joint lenants with right of survivorship. 80th tangible and inlangible property are to be
included. List real estate first.
,. Describe all real property as indicaled in the instructions for Schedule" A". Describe all personal property
as indicated in the instructions for Schedule "8". 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.
c '" tl I"l ;J> r-l ;J> :::
z ;J> 0 0 u '" tl ...
Cl I"l c:: 0 ..., z :: z t'"
r-l r-l " Z > ~ ~ t'"
Z ;::;l ..., ~
Z r-l ..., r-l
~ ~ ..., -<: '" r-l
'"
Z 0 '" 0 ...,
~ --=1 \ '':'1 ::::: ~
. ~ 0
(') ~ U1 "':I .."
c:: (I) I-' I~ - .."
~ g 0 0 5
Iii '0 Z
t'l It'l \5 >
;~ ~ t'"
1-" 'PI c::
I:>, ~ I~ '"
12: lJl r-l
0 tr 18 \: 0
j::
!il I~' z
:<
. I~ -<: -<:
! .0. ~
r-l r-l
.'0 1tD" Ul ;J> >
~ 0::
! t'l ::::: :::::
'::;:I ~
\0 -
.PI
10.
__ \,r,:O('C?;:-l fV} r~n El:~(,'~) r\r]
lJYA\jJ !l~~) II r.Jv~'iI1\.::]Ll ~lj\J
VAl! ~):[!Y~\lIT~ [0klG\J~~
WEST MILTON, PA. 17886
Harch 20, 1980
1'1/1c"y h \!right
1', 0, lIox 99
Hurrlshur!;, I'A 17108
A'I"J'N: Rfchnrd L. Placey
HE: Estate of Frnnldin D. Derslwm
Dna I' Mr. Placey:
Please be Ildvlsed that the above decedent had the following accounts
wi Lh our hank at hi s death on August 22, 1979:
PnsshClok Savings No. 3797-7 in the name of Franklin D. Dershem
or Helen M. Dershem with a balance of $1,554.93 at 5-1/4% interest,
opeoed April 5, 1974. Accrued interest was $11.85.
Certificate of Deposit
or Helen M. Dershem in
1977, at 7% interest.
No. 1183 in the name of Franklin D. Dershem
the amount of $6,000.00 dated January 28,
Accrued interest was $64.17.
Certificate of Deposit No. 1355 in the name of Franklin D. Dershem
or Helen M. Dershem in the amount of $3,500.00 dated August'7, 1977,
at 7-1/4% interest. This ~as rewritten from a certificate dated
August 7, 1973, in the same names for the same aruount. Accrued
interest was $10.57.
Certificate of Deposit No. 1857 in the name of Franklin D. Dershem
or Helen M. Dershem in the amount of $7,000.00 dated April 6, 1978,
at 7-1/4% interest. Accrued interest was $194.54.
Certificate of Deposit No. 2358 in the name of Franklin D. Dershem
or Helen M. Dershem in the amount of $12,000.00 dated February 22,
1979, at 7-1/4% interest. This ~as rewritten from a certificate
dated February 21, 1975, in the same names and the same amount.
Accl11:d Interest was $74.92.
If you have any further questions, we would be happy to be of assistance
to you.
Very truly yours,
. fZ. ~1A >. fj~j~
~ty J. I!auck
Aast. Secretary
717-568-6851
~ ---- - -~---,.=- .
. \
.~ ~"
." ..... ').. ,
.;tJ~.II- ,A/I.'
--.~
t'" ~ tl !'1 ~ t"1 ~ ~
- 0 0 Ul
Z z i
t'l !'1 ~ tl >-l s:: Z t'"
t'l ~ ~ 9 9 t'"
Z G;1 -
Z t'l >-l Z !
9 9 >-l -< Ul t"1 -
Ul ,
Z 0 Ul 0 '" >-l I
9 "l "l ~ ~
I ~
if In "l '" 0
b ~ 0
'" '" ~ ~ ~ I - "l
'" ~ 0 0 0 "l
("l w z fi
~ ::l t<l .... '"
I'- ~ .. '" -
n " ::l :l>
III " rt t'"
11 c- o t::
... '" .., .
'" \ll ~ ~ Ul
;,.! ::l I'- l? t'l
n. 6- ~ -< 0
~
W ... " t'l Z
III Ii S; :l> ~
. ::l:I
~ &' s ~
.... III
0 n.
In
In
Rcc.n (9-(081
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
'*
COMMONWEAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby mode for CQ1sent to the transfer of the following securities of 0 Pennsylvania
Corporation or 0 Notional Banking Association located in Pennsylvania:
(a) 19 sharp.s (b) Buffalo Vall P.y 'I'p.1 p.phonp. company (c) Cumu1 at; vP. Prp.fp.rrp.d
(NOTE: In describing securities enter in (a), ab Ole, either the number of shares of stock or the face amount of
registered bonds, in (b), the nome of the issuing compony and in (c) the closs of stock or the stated interest rate
and maturity dote of registered bonds.)
Cert. No. 1370
ISSUEDON Feb. 10, 1977
(Da'.)
as of the dote of death of the decedent, Franklin D. Dershem
(Home of Decedent)
, and having a TOTAL MARKET V AWE OF $ 3130.00
on August 22, 1979
,
(Date of death)
who was late of 5100 East Trindle Road, Ilechanicsburg, Cumberland county, PA
(Street and Humber)
(Po.t Offlc.)
(County)
(Sta'.)
The securities are registered os follows:
Franklin D. Dershem
(Hame or name I In which certificates are reglltered)
~;RX;~R) Jean V. Dershem Pepperman, 123 winston Drive, Mechanicsburg, PA
EXECUttm RrX) (Nam.) (Add,...) 17055
NAME OF APPLICANT Jean V. Dershem Pepperman
'" . " 123 Winston Drive
COUNTY FILE NUMBER cX,'I-/iJ ~ ~(" f., ADDRESS OF APPLlCANTllechanicsburq , PA 17055
~~~~~~ F:;;~~~~~RTO PROPERLY FIL~\~N:N~U~;R~io~~~L~~tsNAr;l~(fRT~/\if+i~i~~i~~~man ~
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES DATE !/'. /~ /ffiJ
I hereby consent to the transfer of the above securities now registered in the nome of the foresaid '
Decedent and waive the filing of a certificate certifying to the payment of the tronsfer inheritance tax to which
the property of said Decedent is made subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521,
as amended ond the Act of June 15, 1961, P.L. 373, os amended. This is also in accordance with the provisions
of the Act of April 9, 1929, P.L. 343.
This Consent to Transfer the herein described property operates only in reference to the estate of the
above.named Decedent.
'*
Signed far the Secretary of Revenue
t/)' /}~.
By ~/lLt..I 1.:.. 't.(..>!. L)
(Igno~.) c1"
" /. '/1'; / "
l:l1, ,.J ';(.( .!../!dtl':u,,,A.-
.1.) (County)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
*'
COUNTY FILE NO: ;;( , - f: ( ) - ,~ ('... i~
To:~_D,,(^~ V ~",.J'1"~X'\, e()rr~'-Uh1I.'r',
7 ,i (JV;'~ O:'h~ j . (O~"':j','" [,,-'1
~. l~ '}~'o-L-. '1 ~ 7
~tfJonJ'~ ,~. 1'7/0)'
Appraised Value of Estate:
Real Estate
DATE
'n ;-,1) }? }1} Pu
..~ I 1 Q ~ v.J
1.- _ '_.' I v .
I,ll,,.... t"' J../V,... \ I,.li'w
ESTATE
FILE NO. ,l;( /. K()_ :3 (.... b
COUNTY t.. , "rv' ~1 (} ~ .~ _ ,~
~ ,/:!,
DA TE OF DEATH (77 f/l r- . /? I 11 .I<j
s
Personal Property
+
Jointly Held PropertylTransfers
+
Total Gross Estate
$
Total Approved Deductions
Clear Value of Estate
s
Less: Approved CharitB:Jle Exemptions
Clear Value of Estate Subject to Tax
s
Amount Taxable @ 6% Rate
s
tax due
s
Amount Taxable @ '5% Rat. lex due
. '-. f -+TOT/,I;. PENNSYLVANIA INHERITANCE, TAX DUE
JV"'\l9'\jYo) l.:,J --'< ';"-k-J .. I I "';l .\-1.)
, C. c,.sO
. . '* * . . A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
s ;;J.?'dr;;-d"",
f!.I./? r'^"'"
--;., 0;/ W
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
= $ .,,('t~ Co /
= ~ $-3-
=
) I.. 1 ~ - f( U
} /.- } '7 VII
$~ X/X
?I
,
+
$
- s
0.. V;;; +
+
Interest Bccrues ot the fate of six (6) percent per annum
on tha unpaid balance of Inheritance Tax from
to doto of payment. Interest due if paid by
is
ij] \-j U
.~_/ 3v - ),~
\
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
"::2/..' <:/,'.,. )
As....edby: .I ///.(/ ( . ..../,/,...:/.-/
See In!ormation on Reverse Side Agen1l0r!h~c;omr'~~_~,. 1/
,/ 7'.>/<.--.'1-,(</L/
'(I
,.,.
INFORMATION
To Insure proper credit to your accounl. the name of tho estate and file number should be clearly print.
ad on the check or money order.
This assessment is made in accordanco with Section 708 of tho Inherilanco nnd Estate Tax Act of
1961 (72 P.S. 9 2485,708).
To the extent that inheritance tax is paid within throe (3) months after the death of the decedent, a
discount of five (5) percent is allowed 172 P.S. ! 2485- 7161.
Inheritance Tax. other than tax on a futuro interest, is due at the date of Ihe decedent's death and becomes
delinquent at the expiration of nino {91 months after the decedent's death (72 P.S. 9 2485.711). Inheritance
Tax on a future interest is payable within three (3) months after tho transfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P,S. 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 '2 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 deys .00068 14 days .00237 24 days .00403
5 days .00085 15 days .00250 25 days .00420
6 days .00101 16 days .00267 26 days .00437
7 days .00118 17 days .00284 27 days .00454
8 days .00135 18 days .00301 28 days .00471
9 deys .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 the Inheritance and Estate Tax Act of 1961 (72 P.S. 9 2485-10011.
Make check or money order payable to:
"Register of Wills. Agent"
Mail to the address listed below: