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~ OATil OF SUIISCRIIIING WITNESS
COMM~,~LTH or PENNSYLVANIA I ss: //
COUNTY or COMBERLAND
,.~, ///
This ""', day of / A.D.,19 ,
before me, Register for the Probatc'o~\\(iIIs and granting letters of Administration in llnd for' said County of Cumberland, in
the Commonwealth of Pennsylvania, p~~onally came /
~ ,/
""'"'" //
the subscribing witnesses to the foregoing instrument Of~irlg pUl'porJing to be thc.last Will and T~stllmcnt of
_ i>at d/
/
/
//
late of
/
__according to law, depose and say, thaJ'/
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/
/
instrument'of writing as and for h / Testament and Last Will, and at the time of sO dOl
was of sound and diSPOSing~' memory and understanding, to the best of
knowledge, observation,(nd belief.
/
/
land County Pa., deceased who being duly
blish, pronouhce aud declare the said
..
and subscribed before
/
/
/
/
Register
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA l ss:
COUNTY OF CUMBERLAND \
Sally J. Wi.nder
being duly
sworn
says that as nearly as can be ascertainerlthe said decedent
WRNA M. RADCLIFF
died on
Saturday the 17th day of May
at or about 3:30 o'clock, -LM.
Sworn to and subscribed this
9th day of June
A.D.,I9~,
19.~, before
3J(fLI f? r{tux4/
?1i/~ J /));8
a y. . 11inder '--"
Register
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 for the County of
Cumberland, personally came Sally J. Winder
who, being duly
sworn
,do es
depose and say that as
Executrix
of the last Will and Testament of
Lorna M. Radcliff
deceased
she 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. Sworn and subscribed before me.
!2f J~ ~A'D" ,,~
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'07 . REGISTER
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DECREE
Be it remembered that on the
lOth
day of
June
,A.D.,19~. therc was probated and
recorded the last Will and Testament of
Lorna M. Radcliff
latc of
Borouqh of Carlisle
, Cumberland County. Pcnnsylvania,
Deceased. Letters Testarrentarv were granted to
Witness my hand and official seal the day and year aforesaid.
Sally J. Winder
-.
2t;::fi
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~.' laA/y f!. .1~
f , Rcgister'
...-.----------.------ --------- .._--------- --.--------------
=-u
';~\M~t~J,~li~~'fYk::~'!'i.'," ..' C'OMMONWEALTH' OF PENNSYLVANIA' ",:"';":"\)1:;
OBa2~3(i:;',>: ;,::'; 1':',:',. ,.' ' DEPARTMENT OF REVENUE '.,' :,:,';",
J' ,!I~(r:iI1jl'it\}\'."I~),'iOF~I.CIAli'RECEIPT'. PENNSYLVANIA INHERITANCE AND ESTA!E 1AX ,,' '.
a RECEIVED
~ F~m'
~ dress
ij ,
~ File No,
----------------~x~~ ~RID ~~IIQH~ 8i/100-
representing Pennsylvania Inheritance or
Rally J. winder. ..q. Estate Tax duelrom the following eslole,
.daJ!g~
Name of Oecedenl LOIUIA M. RADCLII'I'
9(; lox on $
Estate Tax, Act of
May 7, 1927
s
s
S
$
$
$ 88J.04
24 w. ~ina Street
29,loxon $
Ilhfpp.....1m"'9.
Plll.
11251
6%Tox on S
21-e""O
Date of Oeolh 5-17-1980
15<;', Tax on $
Date of Poymenl Adid.~ 15, 1980
County
CUIlIbedan4
TOTAL TAX CREDIT
Less fIve percentum of tox if
paid within three months after
dole of deolh
Plus Interest 01 the rote of
_%from
to
$
44.15
Remarks:
,
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.;
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I
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\., . Received by
I \ NOTE: In occepllng Ihe Ironsfer lnherllonce to. on future estotes. prior 10 the death 01 Ihe 11Ie
tenant or lenonl for years, os evidenced by Ihis receipl. II Is understood thaI the Commonwealth .holl
\, .'. I not be precluded or prevented from hereoher oueulng oddltlonollnherltonce to. 01 the death ollhe
. llIe tenant or tenant lor years whenever II appears Ihol such additional 10. may be legally due and
, 1\ collocUbl. to, 0'''''''' who"o.",.
IL________________________________________
I
I
I
J
-'AID OR ACCOUNT-
$
'IT 00 ~ ~ [l,~ @ill'ITrn
5 E A l
TOTAL AMOUNT PAID
$
838.89
NOTE: This Triplicate Receipt to be retained for audrt purposos.
.:~..... _m_ _ __ ~ ----..- .----- n -"
lI.'A'Vljl.2E~" ...." " ' '
i~~ji~{"'l\~,:".,:~ '. .' . COMMONWEALTH OF PENNSVLVANIA ,
4 :NOKo00272 . DEPARTMENTDFREVENUE:'
";l~ ' '... OFFICIAL RECEIPT. PENNSVLVANIA INHERITANCE AND ESTATE TAX
If" '
;
It
~
'''''I
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t!
-
TAX AT 6%
TAXAT '5%
\
I
RECEIVED
FROM
TAXAT_%-
1&11 OJ. Winder
Cl 0 IIccrea.. Dav I,
24 W. J:in; atreet
Attytl.
ESTATE TAX
1,334.03
ADDRESS
TOTAL TAX CREDIT
'Ia. 11251
'--~~~~Tg[~~:~ATKlN~--i7---i980------------
21-80-390
LESS DISCOUNT
PLUS % INTEREST
(FROM To_I
FILE NUMBER
HoV.mber 6, 1980
LOIUlA M. WCLlPl'
C\IIIIberland
DATE OF PAYMENT
G
m
. NAME OF DECEDENT
1,334.03
TOTAL AMOUNT PAID
,
COUNTY
.---- -- - -"- -- -- --- --- -- -- -- ----- --- - - --------
POSTMARK DATE
REMARKS -,AID 09 ACCQU\I1'1'-
RECEIVED BY
'.///.'V~~' tvJ
! .' SIGNATU
ry C. .
aegilter of Wil18
SEAL
REGISTER OF WILLS
'I
---- -, - - -' - - - - - - - - - -' -- - - - - -- - ---,----.
PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of 1961 provides thai the following persons shall prepare and file
a return:
a. The personal representative of the estate of the decedent as to property of tile 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 knowledge;
b. The transferee of properly upon Ihe Iransfer of which Inherilance Tax is or may he 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 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. FAILU RE TO FILE RETU RN
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 mte 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, 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 DISCOUNTOF 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 both.
'.
REV..,1 ('.80)
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDeNT
SCHEDULE "B"
PERSONAL PROPERTY
.
(Instructions on Reverse Side)
Estate of
LORNA M. MOCLIFF
ESTIMATED DEPARTMENT
ITEM DESCRIPTION UNIT MARKET VALUATION
NO. VALUE VALUE (OFFICIAL USE ONL Y)
1. Checking A=unt #182-109770-4, Comronwealth
National Bank 902.50
2. New York Life Insurance Conpany, proceeds of
Policy #20926085 1,070.79
3. 328 Shares Connon Stock, Northem Indiana I:J.., '11 U)i (9,264.00) 1f111,15"
Public Service Co. (13.00
4. Ladies Herre Journal, refund 4.64
5. M=di.care, Refund 100.80
TOTAL THIS PAGE (6,342.73) (PI J..S-O, Iff
"
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any material pmt of his estate wilhout receiving
valuable and adequate consideration? (Answer "Yes" or "No".) No
2, Did decedent, within two years of death, transfer property [rom himsel fI hersei f to himsel f/hersel f and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) .Jli:L
3. If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following
information: not applicable
a. Age of decedent at time of transfer.
b. Copy of death certificate.
c. Affidavit by the attending physician indicating the state of decedent's health at time of transfer.
d. All other information supporting nonlaxabilily of transfer.
4.. Did decedent, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consideration
thelCfor which was to take effect in possession or enjoyment at or after his/her death? (Answer "Yes" or "No".) Nt,
a. Was there any pnssibility that the property transferred might return to transferor or his/her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No".) No
b. What was the transferee's age at time of decedent's death? nnt ;o,pplicable
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: No
a. The possession or enjoyment of or the right to income from the property transferred? (Answer "Yes" or "No".) TITn
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.
not applicable
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 b61eficial 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".) not applicable
REV.453 (l.SOl
COMMONWEALTH OF PENNSVLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEOENT
SCHEDULE "D"
BENEFICIARIES
'*'
(Instructions on Roverse Side)
Estate of
LORNA M. RADCLIFF
- DATE OF
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED INTEREST OF BENEFICIARY
DECEDENT BIRTH .
Marie 1;.. t.<luthers Sister .- -,- All iointlv owned
CarlJ.sle ,Pa: 17013 property
Roserrary L. winder Niece yes sui juris Northern Indiana
:,t:ne RIlEICJ.can House pubs!8&ervice
East Waterford Pa. 17021
Charles Radcliff Lauthers Nephew yes sui iuris
Ai.~~&ia';V~. 22300
~vid Edward ~uthers Nephew yes sui juris
El Paso, Texas 79925
John H. winder Grandnephew yes sui juris
~6e
Deborah winder Schultz Grandniece :res sui juris
842~~rro--Rl:t
Savage, . .
Sally J. Winder Grandniece yes sui juris
00 l'. 01:.
Carlisle, Pa. 17013
Andrew L. Winder Grandnephew yes sui iuris
145 a'':llo;wOOJ ,",vo;. IN
Rr' , M~~~ n?'~~
Jonathan C. Lauthers Grandnephew ves sui iuris
l7OtT-E-]J.,,, Fuc.J
Alexandria Va. 22300
Susan M. Lauthers Grandniece yes 5ui iuris
nee Elba Ru"J
Alexandria, Va. 22300
David E. Lauthers Grandnephew ves sui i uris
963 Ct::~~Uo. .
El Paso, Tex. 79925 .
Alice M. Lauthers Grandniece ves sui iuris
~~:;) n~M n~~r~"'"
Fav Ginnher ~- yes ui juris Residue
washington, D. C.
.)J." i:) oc., O. 1>.
,
The above beneficiaries are living at this time except for the following:
NAME
DATE OF DEATH
REV,454 (1.80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEOENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
*'.
" .
,
" .I,
; "
(Instructions on Roverse Side)
Estate of IDRNA M. RAOCLIFF
ITEM I PE ,
TOTAL R VALUE OF DEPARTMENT
DESCRIPTION MARKET C DECEDENT'S VALUATION
VALUE E INTEREST IOfficial Use Only)
NO. N
T
l. Checking Acct. #102-562-8, pierceton State
Bank, Lorna M. Radcliff and Marie L. Lauthers
(sister) Bal. 5/17/80 - $98.69 98.69 50% 49.35
created 5/55
2. Savings Acct. #20-139403, Pierceton State B~
IDrna M. Radcliff and Marie L. Lauthers (sis r)
Bal 5/17/80 - $192.29 192.29 50% 96.15
created 5/55
3. certificate of Deposit #3738, pierceton State
Bank, Lorna M. Radcliff and Marie L. Lauther ,
Jt. Ten. 5/7/70 (sist7r) 9,100.00 50% 4,550.00
.AAdvud:: /'I;:; C, '/. t-f
'I
4. 6 Shs. pierceton State Bank Stock, IDrna M.
Radcliff and Marie L. Lauthe~ Jt. Ten. WROS 10,650.00 50% 5,325.00
7/26/57 , Value 5/17/80
5. Series "R" bond #Vl69531H issued 3/20/56,
IDrna M. Radcliff or Marie L. Lauthers 5,000.00 50% 2,500.00
(sister)
6. Series "R" bond #M8240067H issued 5/21/62
IDrna M. Radcliff or Mari.e L. Lauthers 1,000.00 50% 500.00
(sister)
7. Series "R" Bond #M574803I:I issued 1/22/63,
Lorna M. Radcliff or Mari1 L. Laythers 1,000.00 50% 500.00
s~ster
8. Series "R" bond #M890843311 issued 7/30/63,
IDrna M. Radcliff or Mari1 L. Laythers 1,000.00 50% 500.00
s~ster
9. Series "R" Bond #M925034311 issued 7/17/64,
IDrna M. Radcliff or Marie 1;.. Lauthers 1,000.00 50% 500.00
(s~ster)
10. Series "R" Bond #D8359914H issued 2/25/66,
IDrna M. Radcliff or Marie L. Laufhers 500.00 50% 250.00
(s~ster
n. Series "R" Bond #D8465034H, issued 8/23/66,
IDrna M. Radcliff or Marie L. Lauthers (sister) 500.00 50% 250.00
[(15,020.50) -
TOTAL THIS PAGE /:;; 0;..1, ~ 8
-
2gt(
. .
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 ri!lht 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". Include the name, address and relationship to the
decedent of the co.owner Is) 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. I ndicate the market value of the decedent's interest.
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'1b: Pennsylvania Department of Revenue
Bureau of County Collections
Fran: pierceton state Bank
Pierceton, Indiana 46562
RE: Estate of
LORNA M. Rl\DCLIFF
Deceased
Date of Death:
l-lay 17 , 1980
It is hereby certified that the above-narred decedent had, on the above date, the
following acoounts with us:
A. CHECKIN> J\CCOUNl'S
l\coount No.
102-562-8
Title of l\coount
Lorna M. Radcliff & Marie L.
Lauthers, Jt ten WROS
Date Opened
Balance
98.69
,
/
5/55
B. SAVINGS AaXlUNTS
l\coount No.
Title of l\coount
Date Opened
Ba1. {Prin.
20-1394-3
Lorna M. Radcliff & Marie L.
Lauthers, Jt ten WOOS
192.29
5/55
.,
i C. CERl'IFICATES OF DEPOSIT
Nuni'Jer
#3736
ll224
owners
Lorna M. Radcliff & Marie L.
Lauthers, Jt ten WROS
Marie L. Lauthers and Lorna
M. Radcliff, Jt ten WROS
Book value 5/17/80 .
(6 shares Pierc0ton State Bank)
Date Face Value
5/7/70 9,100.00 11.96
7/26/57
. . . . . . . 10,650.00
Date: July :z / , 1980
PIEOCEl'ON STATE BliNK .
~ f}--./~~~ ca~,
~-:~itle -
'Jlt::""-484 ,eX I b~OI
INHERITANCE TAX SUMMi\RY SHEET
(BUR~-'~~L USE ONLY)
File Number ~1-80-039!l.__________
Estate Nome --LOENlLM. _Rl\DCLIFF
Dote of Death .~!' 17Ll~BO .
Social Security Number _~~?:-lB-1234A
------------.--
REPORT OF INHERITANCE TAX APPRAISER
I, Ihe undersigned duly appointed Inheritance Tax Appraisar in and lor Iha Caunly of . Cumberland
Pannsylvania, do respecllully report that I hava appraisad tha raal and parsonol proparty os rep-;;rlCcJ in the foregoing
return at the values set forth opposite each item in the last column to the right in Schedules llA'" liB", "C", and IjE"
Doted: January 22, 1981
Ph/f/" J-ff'Id.ljil} )
INHERiTANCE TAX APPRAISER
INVENTORY
VALUE AS APPRAISED
ADJUSTMENTS
CODE (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT COOE
TOT AL GROSS ASSETS
None 00+
6 342. 73 10+
15, 20+
30+
. __21,363.- 23-
6,5B2 77 40-
14,7BO 46
~ FACTOR
--
----
-0- 92+
6,250 8
15 027 8
-0-
J21,278 6
93-
Real Property (Schedule A) $
Personal Property (Schedule B)
Jolnt.Held Property (Schedule E)
Transfers (Schedule C)
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
PRINCIPLE
V ALU E
CODE
Valuation of life estates or
annuities. . . . . . . . . . . . . .
~=
FOR IISE OF REGISTER ONLY
T OK on S
~
COMPUT ATlON OF TAX
S
6ni,
1 5~;,
;
Tax on S
s
TOK on S
s
T OK on S
$
TOK on S
EKcmptlC1I150
Total Estate
TOTAL TAX
INTEREST FROM
OALANCE
TO
$
S
S
INTEREST TAX CREDIT
S = $
--
Less Credils
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
s
+ S
-
+
BALANCE
INTEREST FRO"" _--- TO
BALANCE DUE
S _
S
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INFORMATION
To insure proper credit to your account, tho name of tllo estate and file number should be clearly print.
ed on tho check or money order.
This assessment is made in accordance with Section 708 of the Inheritance and Estate Tax Act of
1961 (72 P,S, 92485.7061,
To the extent that inhoritance tax is paid within three (3) months after the death of tho decedenl, 8
discount of five 15) percent is eUowed 172 P,S, 9 2485.716),
Inheritance Tax. othor than tax on a future interest, is due at the date of the decedent's death and becomes
delinquent et the expiration of nine (9) months after the decadent's daath (72 P,S, 9 2485.711 I, Inheritance
Tax on 8 future interest is payable within three (3) months after the transfer takes effect in possession and
enjoyment and Is dellnquenttherealier (72 P.S, 9 2485.712), Calculata interest from tho dalinquent date shown
on the face of this form to tho date of actual payment using the following interest table:
--------------------- - ----- ---- -- - ---- --------- - - --- - --- --.------ -- -- - - - ----
1 month ,005 4 months .Q20 7 months .035 10 months ,050
2 months ,010 5 months ,025 8 months ,040 11 months ,055
3 months ,015 6 months ,030 9 months ,045 12 months ,060
1 days ,00017 11 days ,00186 21 days ,00352
2 days .00034 12 days .00203 22 days ,00369
3 deys ,00051 13 days ,00220 23 days ,00386
4 days ,00068 14 days ,00237 24 days ,00403
5 deys ,00085 15 days ,00250 25 days ,00420
6 days ,00101 16 days ,00267 26 days ,00437
7 days .00118 17 days ,00284 27 days ,00454
8 days ,00135 18 days ,00301 28 days ,00471
9 days ,00152 19 days ,00318 29 days ,00488
10 days ,00169 20 days .00335 30 days .00500
- - - -- ------ .--- -- ---- - -- - - - -- - - --- -- - - - --- -- - ---.---- - - - - --------- - - ---..
Any party in interest, including the Commonwealth and the personal representative, not satisfied with
the assessment may object thereto within sixty {GO; days after receipt of this Notico as provided by Section
1001 of thelnheritanca and Estate Tax Act of 1961172 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 incurred by the decedent prior to his/her death are deductible against his/her taxable estate.
In addition to debts incurred by the decedent or estate, other items are claimable including the cost of administration,
attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone or grave marker.
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.
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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.
Rcc-n {g-&!I1
APPLlCA nON FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
*'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
DATE Feb. 26, 1981
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for c ansent to the transfer 0/ the /ollowing securities 0/ a Pennsylvania
Corporation or a National Banking Association locoted in Pennsylvanio:
(a) 328 (b) Northern Indiana Public ServiCE-.CQnpanv (c) r.omrron stock
(NOTE: In describing securities enter in (0). ab eNe. either the number 0/ shares 0/ stock or the lace omount 0/
registered bonds. in (b), the nome 0/ the issuing company ond in (c) the class 0/ stock or the stated interest rate
and maturity date of registered bonds.)
ISSUED ON 1953, 1966, 1961 , and having a TOTAL MARKET VAtUE OF $ 4,264.00
(Dato)
as a/ the dote of death 0/ the decedent,
Lorna M. Radcliff
, on
May 17, 1980
(Date of death)
(Name of Decedent)
(Street and Humber)
(Pa.t Offlc.)
(County)
Pennsylvania
(Stat.)
who was late of
12 Gobin Street
Carlisle
Cun'berland
The securities are registered as /ollows:
Lorna M. Radcliff
(Harne or names In which certlflcatos aro registered)
ADMINISTRATOR)
EXECUTOR )
Sally J. wifldGr- 66 E. pomfret St.
(Nom.) (Add....)
NAME OF APPLICANT
Carlisle, Pa.
COUNTY FILE NUMBER 21-80-390
ADDRESS OF APPLICANT
BUREAU FILE NUMBER_-- SIGNATURE OF APPLICANT
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATIO , IT WILL NOT BE
CONSIDERED COMPLETE AHD WILL BE RETURNED TO YOU FOR COMPLE N.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES '-OJ ~ ~
DATE r.~ ".....r.
I hereby consent to the trons/er of the above securities noW registered in the name 0/ the of ores aid
, q,pl
Decedent and waive the filing 0/ 0 certificate certifying to the poyment of the tronsfer inheritonce 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 and the Act 0/ June 15. 1961. P.L. 373, os omended. This is also in accordance with the provisions
of the Act of April 9. 1929, P.L. 343.
This Consent to Trans/er the herein described property operotes only in reference to the estate 0/ the
obove.nomed Decedent.
'*,
I
I JOHN McCREA III
ATTOANEVATLAW
\", . NEWVILLE & SH1PPENSBURG
PENNA
FIIlST /\ND FINIIL ACCOUNT OF SALLY J. WINDER,
EXECurRIX OF THE Ll\ST WILL /\ND TESTJlMrnT OF
IDmA M. RADCLIFF, DECEASED, IlITE OF 'Bre BOroUGH
OF CARLISLE, COtNTY OF CUMBERLAND /\ND CXlMM:1\l-
wr.JltTH OF PENNSYLVl\NIA
************************************************
THE ACOJUlT/\NT CHARGES HERSELF WITH THE FOI..I.a'IING:
Checking Acoount, Col1UTOnwealth National Bank #182-109770-4.....
Northern Indiana public Service Company, dividend..............
lvEdicare, ref\IDd.........................................................
Cash. ......... ............ ............................ ... .......
U. S. Treasury, Series "H" Bond interest.......................
Ladies Harne Journal, refund....................................
New York Life Insurance Company, proceeds of Policy il20926085.. '
U. S. Treasury, Series "H" Bond interest.......................
Social Se=ity Administration, Death payrrent. . . .., . . . .. . . .... .
Northern Indiana public Service Company , dividend..............
~dicare, refund.............................................................................................
u. s. Treasury, Series "HIt Bond interest........................
Northern Indiana Public Service Company, dividend..............
Marie L. Lauthers, contribution to pay outstanding acoounts....
328 Shs. CamDn Stock, Northern Indiana Public Service Co.
@$13.00, appraised value... ... ... .. . .. . . . . ." .. . .. . .., .....
Total
THE Aa:oUlTANT CREDI'IS HERSELF WITH THE roI..I.a'IING:
Register of Wills, letters Testarrentary..... . . . . . $
Register of Wills, short certificates............
25.00
4.00
cumberland Law Journal, advertise letters. .......
18.00
EV?ning Sentinel, advertise letters..............
18.00
Register of Wills, Filing inh. tax appraiserrent,
inventory and debts staterrent...................
9.00
Ll....J\
0U 1 ,,~t 50.1
.
,.,
$ 832.50
123.00
19.60
465.00
97:50
4.64
1,070.79
32.50
255.00
123J;OO'
100.80
195.00
123.00
7,162.89
4,264.00
$9,869.22
JOHN McCREA III
ATTORNEVATlAW
NI:Wytll.E & SHIPPENSHURG
PENNA
.,..' '.
Belvedere r.1:!dical Corporution, book account. ... $
143.00
139.00
35.00
671. 64
36.94
188.40
~,173.92
7.00
1,068.16
1,068.16
$ 5,605.22
4,264.00
$ 9,869.22 $9,869.22
Carlisle Radiology Associates, P.C.. accoW1t...
Carlisle Ambulance Fund, account...............
Hoffman-Roth Funeral I1orre, Account $1206.00
less Burial Trust of $534.36................
Louis Burger, esc,P.C., account...............
Carlisle I1ospital, accOlmt....................
Register of Wills, Agt. for Corrm::>mvealth of
Pennsylvania, inheritance tax....... .........
Cumberland CoW1ty P.ecorder, record Release.....
Sally J. Winder, Executrix Commission..........
Sally J. Winder, Attorney Commission.... .......
Total
Bal. for Distribution
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