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No 21-80 425
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of
JOjlN C. COPE
I deceased,
MARY E. LEWIS
To R.ittlalxkEo:&J(lt\a1~rx, Register of Wills for the County of Cumberland,
in the Commonwealth at Pennsylvania.
IS
Petitioner(s) lOfl! the execuL2L..---'- named in the Lost Will and
Testament of .John C. Cone ___' doted July 5, 1977,
Decedent was 0 citizen of the United States and 0 resident of Carlisle
'IJowoshi~x
Borough, Cumberland County, Commonwealth
of Pennsylvania.
Decedent died on lU[:t)NE'SlNI _the 71 day of TU.l./t~
A. D. 19k, in the County of C(.'/Vl/B,-t\tf/AtD
r 2 A; N S 'yLV 11 A' I rI at the age of 1ft,. years.
-Aes- -he!;. .~
Decedent has not been married and has not hod children born to him
since the execution of the above described Will..
Decedent was possessed of personal property to the value of
[iItJES7'IMA7'(,.'() and of real estate to the value of
State of
"
U,vESTIMo1 7 l"P os near as can be ascertained; said real
estate situated as follows 7 () I -- 7o'J rv. Pn r ~T'J (' IJJel_1 S Lt.::
apply
Therefore, your petitioner(s) respectfully applies for the probate
of the said Last Will and Testament and for Letters Testamentary thereon.
Doted Jtt WE 20, 15 ~o
Nome and address
of Petitioner(s)
;;,,& 1tk
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'VI L F,r<.S1- ST
f3~Il,INC rpl<.lwC I, J'f.
/7(}07
named in above application,
say(s) that the statements
best of N I 'i
knowledge and belief.
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SW~'~N 1'(.
and subscribed before
me, JOrVt:,2 d 19i~
,G{\t '/27'1, If} ~ ,J
i ~4u. <!- . ;; ~<./VV"
'1\'/' ~iO"J' E. A.;;-' 'A. Register
June 24,
19BO
Attorney:
H YIVIA iJ . ~"~{)$nlrJ A ~-::c;1.
;r~/oIit<' IX, HlItv.t.f?, J~
.
. . , .
OATH OF SUBSCRIBING WITNESS
COMMONWI~ALTI-I OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND \
. 24th June 80
TIllS...................,... .................. ...................."........, day of ,.." .......,....,..,.."......"..................... .......". A, D., 19........,
Mary c. Lewil
. before me R:~L.J I!J. A..!!......I', 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 ..............
........H..Y..M/!.!.\!...........G.~..~..!?..~.!...~~.~.tj .....,......~..~~.~? ..,... ...:f.....~~.~~.1... ....~......0.~~..e,~:.?E!./Y............
the subscribing witnesses to the foregoing instrument of writing purporting to be the last Wi.11 and
Testament of ............~T!?f.I..~!........., .c.... ......c..0..f..~~....,..............................,. Dated ...:r~~f..Y.....~~;. :.!..~.:('L...
late of ................... .~.~..r.?.A..!.~}..~::....,................ ..........,......... ................. Cumberland County Pa.. deceased
who being duly ......~..~~~.~.f:.,\.................. according to law, depose and say, that ....r:.(:/..\~."1.......~tfJ.!f.......
present, and saw and heard the testa.T.~Ul....................., .....~~T<;';l.LtL....(.:.....C.cy..f!.?~.........................
sign, seal, publish, pronounce and declare the said instrument of writing as and for h./.}........... Testament
and Last Will. and at the time of so doing .........!f~................................was of sound and disposing mind.
. ij-lfJ((" '..... ;':1', .
memory and understanding, to the best of ..............................................knowledge. observation and belief.
.....s..W.?.'3..I)..L.....}:~'........... and subscribed before
.....dkb.~.-
.....~..f!..,......................................................
.~~..e.... ~;:.,,:./...................
RJ.~l.L'u . ....H'.......J=~::-,....
.",........,............."............,.,......,...,........................,...
AFFIDAVIT OF DEATH
cO~.ONWEALTH?F PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND \
, . . e
..............................................B...B:.~~,(S.............fJ.:.Ef:.5,......................................"..............being duly
... ................................................ says that as nearly as can be ascertained the said decedent ..........................
................... ................v.~.!:(.~.............r;.............(.~.f:'..i:::............................................................. ...........died on
...xy.b~.v.Dl.f.;~.e.~..~f............... the ...........!..L................day of .......:;,t:~..~J~................................ A.D., 19.?':(:.,
t b t '1 :UCl .' . 'I k J. M
a or a ou .......................................... 0 C oc ,f.I.. .
.....~.~~.&.!N.......I:~.I................and subscribed this
20th June
................................................ day of ........................
. ;'
..&)L.'!.:.%.............
!t.~, i:;;'(
19.8.9....... before
(/J/ I!)~J
..:.......:l.22~...<.~.,.: . . ~~........................
R...dHUd B, u, RegiS r
. .
",' I II!
OATH OF PERSONAL REPRESE~JTATIVE
COMl\fONWEALTH Ol~ PENNSYLVANIA}
COUNTY OF CUMl3fmLAND 88:
ullefore me, the Ilegi,t.er f'or the Probute of' \Vill~ and gI'l1l1t.in!( of' Letters of' Adlllini~tl'!ltion in and for
R r~ 1I(" r)t'~i-'f'c;"'"
. the County of Cumbel'land, personally came .........:.....\.......;,?7.........................:,L,~.......................................
who, being duly ...S..l!:-:,r,r:o!,/':.,I......., do ~-.5..... depose and say that a~..........t..X..~'.:,~.~.~.?...<!.~...............".....
of the last Will and Testament of ....................T~.t!..0,I.........C.:.......C..<~,f:~.~~..................................deceased
.....~~................ 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. ...~~.q.~?..v....n.. and ~uL~cl'ju"d
before me.
.............~~.~~...~.~........................... A. D., 19~.~..;....
..:....~21~..a.:..~, .:-~...................
R181.ar. un, Re~~
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DECREE
Be it remembered that on the .......~.~~~........ day of ...............~~~.!........................, A. D., 19 ~.~..., there
was probated and recorded the last Will and Testament of ........~!?~~..~.:...~.~p.!........................................,
late of............c::~.~~~.~.~~.............................................., Cumberland County, Pennsylvania, Deceased. Letters
......................~!!~~.~~.~"J!..~y..... were b'1'anted to ........ ....., ,........~::.~~!...~~.~.~!.~.., ......................................
Witness my hand and official seal the day and year aforesaid.
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..............1J2"U(?t../~<.;.. ..' "0....
R uu~ 'UUG\.h . RegIster. .
PENNSYLVANIA INHERITANCE TAX GENEHAL INFORMATION
I. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inherilance and Estate Tax Act of 1961 provides that the lollowinp. persons shall prepare illld file
a return:
a. The personal representative of the estale of the decedellt as 10 property of fhe decedclIl administ~rr.d by him
and such additional properly which is or may be subject 10 Inheritance Tax of which he/she shall have or
acqui re knowledge;
b. The Iransferee of property upon the transfer of which Inheritance Tax is or lIlay be imposed hy the 1961 Statute,
including a trustee of property transferred in tlIiSt, provided thilt no separate return need be made by Ihe transferee
of property included in the relurn of a personal representative.
2. PLACE FOR FILING
The return is to be filed in duplicate with the Register of Wills of the coullty wherein the decedent resided.
3. TIME FOR FILING
The return is due nine mnnUls after the decedent's death, ullless an extension fOI 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 he 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-Iaw and dau~lter-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 lIlonths after Ihe 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 lIIay be sued for ag~inst 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 oi'him sllall, in accordance with Section 793 of the
1961 Statute, be guilty of a misdemeanor and, on conviction thereof, shall he sentenced to pay a fine not exceeding
$1,000 or undergo imprisonment not exceeding one ye~r or both,
REV04!12 EX+ 13.801
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
ESTATE OF JOWl>! C. COPIl
SCHEDULE "C"
TRANSFERS
*'
INSTRUCTIONS:
1. Answer the questions on reverse side.
2. If the answer to any of the questions on the reverse side is "Yes," provide a description of the property transferred per
Schedules "A," "B," or "E," its estimated market value at date of death, dates of transfer, to whom transferred and
relationship of transferees to decedent. Attach a copy of any trust deed or instrument relating to the transferred property.
--
ITEM ESTIMATED DEPT. VALUATION
NO. DESCRIPTION MARKET VALUE (OFFICIAL USE ONL YJ
None
TOTAL THIS PAGE None . .
.4~-
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, wilhintwo yems of death, nwke illlY Iransfer of any material pari of his estate withoul receiving
valuable and adeQuale considemtion? (Answer "Yes" or "No".) No.
2. Did decedent, withinlwo yems of death, tlanslel property Iromhimself hersell to himself/herself and anolher party
or parties (including a spouse) in joiul ownership? \Answer "Yes" or "No".) ~_
3. If the answer to one or two above is "Yes" ami the trauclers ale claimed lu be nontaxable, provide the following
in formation:
a. Age of decedent at time of transfer.
b. Copy of death certificate.
c. Affidavit by the allending physician indicating Ibe state of decedent's I]();illh 'illimp. of tmnsfer.
d. All other information supporting nonlaxabilily of tl<,nsfer.
4. Did decedent, in his/her lifetime, make any lransler 01 properly willlOullecciving a valuahle or adequate consideration
therefor which was to take effect in possessron or enjoymenl at or aller his/her death? (Allswer "Yes" or "No".) No
a. Was there any possibility that the properly Iransfelled might relulillo transferor or Ilis/her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No",) -HO-.
b. What was the lransferee's age allime of decedent's death? Nj^
5. Did decedent in his/her lifetime nlake any transfer without receiving a valuable ami adequate consideration thereior
under which transferor expressly or impliedly reserves for his/her life or :my peried which does in fact end before his/her
death:
a. The possession or enjoyment of or the righlto income from the property transferred? (Answer "Yes" or "No".) ....N.o-
b. The right to designate the persons who shall possess or enjoy the property transferred or income lIierefrom?
(Answer "Yes" or "No".)--!II.o--
6. If the answer to five h. ahove is "Yes," state whether the right was reserved in decedent alone or others. NJA
7. Did decedent in his/her lifetime make a transfer, Ihe consideration for which was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No".) Nn
8. Did decedent, at any time, transfer property, the bmeficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could rever I 10 decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".) Nn
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".) _.No-
REV,454 (1,80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEDENT
(Instructions on Reverse Side)
'*
SCHEDULE "E"
JOINTLY OWNED PROPERTY
Estate 0 f
.JOHN C. COPE
j
,j,!
I
P
TOTAL E VALUE OF DEPARTMENT
ITEM R
DESCRIPTION MARKET C DECEDENT'S VALUATION
NO. VALUE E INTEREST (Official Use Only)
N
T
=-
None
TOTAL THIS PAGE None ~
. .48
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included, List reai estate first.
1. Describe all real property as indicated in the instructions for Schedule "A". Describe ali personal property
as indicated in the instructions for Schedule "B". 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. Indicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest.
.J::
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File Number
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
21-80-0425
Estate Name
John C. Cope
III Original
o Supplemental
o Remainder
REV-<484 EX+ tHai
Date 01 Death
June 11, 1980
Sociol Security Number
184-26-3441
I, the undersigned duly appointed Inheritance Tox Appraiser in and lor the County of Cumberland
Pennsylvania, do respectfully report that I haye appraised the real ond personol property as reported in the loregoing
retum at the yalues set Iorth opposite each item in the last column ~ the rl9ht in Sch leo "A", "B", "C", and "E"
Dated: November 9, 1981
REPORT OF INHERITANCE TAX APPRAISER
IHVEHTORY
I I ADJUSTMENTS I
YALUE AS APPRAtSED CODE (HARRISBURG USE ONLY) REMAIHDER APPRAISEMEHT CODE
$ 35,000 00 00+ 92+
400 52 10+
none 2llt
none 30+
35 400 52
40- 93-
Real Property (Schedule A)
Perlonal Property (Schedule B)
Jolnt.Held Property (Schedul. E)
Transf.r. (Schedulo C)
TOTAL GROSS ASSETS
L.... D.bt. and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Estate
o Annuity
RATE
FACTOR
PRIHCIPLE
VALUE
CODE
-
FOR USE OF REGISTER ONLY
Tax on $
Tax en $
~
COMPUTATlllH OF TAX
$
$
$
$-
$
6%
15%
Tax Oil $
T ox on $
Tax on $
Exemptions
Totol Estate
TDTAL TAX
IHTEREST FROM
BALANCE
TO
$
$'
$
TAX CREDIT
$
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PRINCIPAL RECEIPTS
Real Property
701 & 703 N. Pitt St., Carlisle, sale price
Personal Property
1948 Dodge Truck, public sale price
Small amount of tools
Com. of Pa., Rent rebate
Com. of Pa., Inflation dividend
Farmers Trust Co., final income distribution
Estate of Besse C. Peffer
Subsequent receipts
Bankers Life Ins. refund
State Farm Ins., refund
State Farm Ins., refund
I-ledicare refund
Total Principal Receipts
PRINCIPAL DISBURSEMENTS
Register of Wills, Letters & Short Ctfs.
The Sentinel, Adv. letters
Cumberland Law Journal, Adv. letters
Register of Wills, filing Inv. & S/D/D
Hoffman-Roth Funeral Home, balance
Carlisle Hospital, last illness
Masland Associates, last illness
Pa, Dept. of Transportation, duplicate auto title
Spahr's Auction, Expenses
Bureau of Vital Statistics, death ctf.
TV Cable, account
Register of Wills, Pa. Inheritance Tax
UGI, Gas service
United Tel. Co., service
Herman's Oil Co., fuel oil
State Farm Ins., fire ins.
Charles B. Strayer, winterizing property
James Line, Taxes
Gilbert's Pest Control, Termite Ctf.
Cumberland County Planning Com., Subdivision review
Borough of Carlisle, Subdivision review
Stephen G. Fisher, R.S., Subdivision Plan
R. Bruce Peffer, Aluminum siding loan
Phil Ruegg & Colonial Realty Co., Broker's Comm.
Recorder of Deeds, 1% R.E. Transfer Tax
Bruce Peffer. Executor's Comm.
Hyman Goldstein & James R. Humer, Atty. fees
Reserved for closing costs
Total Principal Disbursements
lIB[~ 100 P~C[ 140
$35,000.00
5.00
50.00
204.42
70.00
71.10
43.65
9.75
5.40
32.60
$35,491.92
31. 00
18.00
18.00
10.00
618.16
205.75
20.00
5.00
20.50
3.00
25.20
3,186.56
18.89
21. 27
334.99
149.00
50.00
571.43
40.00
25.00
100.00
350.00
4~500.00
2,100.00
350.00
1,775.00
1,775.00
250.00
$16,531. 75
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REV.455 EX+ 13.aO)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
------------' ,.---
Estate of .JOHN C. COPE Date of Death 6-11-80 File No, 21-80-425
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Ciaimant Reiationship to Decedent -
Claimant's Address al time of Decedent's Death
ITEM ' '
NO. DATE NAME OF PAYEE REMARKS AMOUNT
I R,,,,.i "tAT of Wi 11" ~~~-'-o onrl ",ho'l't " 31 .00
I
I The Sentinel Adv. letTers 1A 00
I
, Cumberland Law Journal Mv. letters lA nn
,
Register of Wills Filinl' Inv. & Appr. & S/D/D 10.00
i Hoffman-Roth Funeral Home Services 1,760.00
Carlisle Hospital Last illness 205.75
,
Masland Associates Last illness 80.00
, Penna. Dept. of Trans. Duplicate auto title 5.00
i snahr's Auction Exnenses auto 16.50
i
Bureau of Vital Statistics Death Ctfs. 3.00
I n.___ of carlisle Water & Sewer 65.51
U.G.I. Gas service 18.89
PPf.L Electric service 88.38
:1TniTPd Tp1. Co. Tele. service 21.27
I Herman's Oil Co. Fuel oil 334.99
TV Cable Account 25.20
State Farm Ins. Fire Ins. 149.00
lr.h"ster G. Raudabaugh plumbing reo. 65.6.Q....
Irh~rles B Straver Winterizing property 50.00
,Tames Line Tax CoIl. '80 Sch. '81 Co. Bor. & Sch. 571.43
r.i1bert's Pest Control Termite Ctf. 40.00
Cumbo Co. Planninl' Com. Subdiv. Review __.-7.1. 00 _
Continued on 2nd nage. - --
I
TOTAl. L-__________
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statomcnt of dobt,>, ["floral
expenses and expenses of administration submitted to the estat s deduct' s [ Inhorit'llleo Tax purpmc5, '
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DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ / L/ 'I 1:"'. '~i';;, AT _-1.:j,,-,-- % T/lX liATE
,
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ij'REGISTCH or WlI_LS
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GENERAL INHERITANCE TAX INFORMATION
Unsatislied liabilities incurred by the decedent priar to his/her death are deductible against his/her taxable
'lstate. In odditian to debts incurred by the decedent or estate, other items are claimable including the cost 01
administration, attarney lees, fiduciary lees, luneral and burial expenses including the cost 01 a burial lot, tombstone
or grave marker and other related burial expenses.
All debts being claimed against an estate are subject to the approval 01 the Register 01 Wills with whom the
Inheritance Tax Return is liled. Evidence.to suppart the decedent's or the estate's liability lor the debts being
claimed should be allached to this schedule.
A lomily exemption may be claimed by 0 spouse 01 0 decedent who died domiciled in Pennsylvania. II there is
no spouse, ar if the spouse has lorfeited his/her rights, then any child 01 the decedent who is a member of the same
household can claim the exemption. In the event thero is no such spouse or child, the exemption can be claimed by
a parent or parents who are members al the same household as the decedent. The lamily exemption is allawable anly
against assets which pass by a will or by the Pennsylvania Intestate Laws. '
NOTE: Compensation paid to an estate representative; namely, an executor or administrator, lor services
perlormed in administering an estate is reportable lor Pennsylvania Income Tax purposes. This taxable income
item should be reported on larm PA.40.lndividuallncome Tax Return.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. II the lamily exemption is being claimed, indicate the claimant's name, address and his/her relationship to
the decedent. Enter "Iamily exemption" in the remorks column ond the amount claimed in the omaunt column.
2. Assign consecutive numbers to eoch item listed.
3. Enter the date on which eoch debt was incurred and/or poid.
4. Enter the names 01 eoch payee.
5. Provide a brief explanatian in the remarks calumn lar each debt claimed.
6. Enter the amount al each debt being claimed.
7. The form must be signed by the persan wha has assumed the responsibility lar paying the debts.
IF ADDITIONAL SPACE IS NECESSARY USE 8\1," x 11" SHEETS.
.......
REV,455 EX+ (3,80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
Estate of JOHN C. COPE Date of Death 6-11 - R 0 File No. - 21:8.0~,1~.s___
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant
Relationship to Oecoclr.nt
Claimant's Address at time of Decedent's Death
- _ _ ..____.....,_..n'_. I ..M~.'..___
ITEM OATE NAME OF PAYEE REMARKS AMOUNT
NO.
BorouQ:h of Carlisle Subdivision Revi.ew --JQJl~
---...
C:fo"nn"n r. Fish"r R.S. Subdivision P1.tn ..-- 350.,Q.lL
D 1',ruce Peffer Aluminum Sid i.n" I.olln 4 ~nnnn
Phil Ruegg & Colonial Real y - Real Estllte Ilroker's Comm. -L100.00
IDorn~der of Deeds H R,E Tran,,(QL Tux .- 350.00
Bruce Peffer Executor's Commission I 1.770.00
Hvman Goldstein and James . Humer - ^ ttorney~ Fcc 1 770.00
Reserved for c10sinQ: costs 250.00
'I
-
.
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-
--
- TOT AL 1
14 702 52
1 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 ded c~o or. Inheritance Tax purpo es. /
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SIGNA' J I: OF Ilnur.l/~nY lJAT[
OFFICIAL USEONLV
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ /,1' 11), 'I J AT
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DATI:
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GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedent priar to his/her death are deductible against his/her taxable
estate. In addition to debts incurred by the decedent or estate, ather items are claimable including the cost of
odministration, attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone
or grave marker and other related burial expenses.
All debts being claimed against an estate ore 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 may be claimed by a spouse of a decedent who died domiciled in Pennsylvania. If there is
no spouse, ar if the spouse has forfeited his/her rights, then any child of the decedent who is 0 member of the some
household can claim the exemption. In the event there is no such spouse or child, the exemption con 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 Lows.
NOTE: Compensation paid to an estate representative; namely, an execvtor or administrator, for services
performed in administering an estate is reportable for Pennsylvania Income Tax purposes. This taxable income
item should be reported on form PA-40-lndividuollncorne Tax Return. .
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the family exemption is being claimed, indicate the daimont'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 0 brief explanation in the remarks colulTon 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.
IF ADDITIONAL SPACE IS NECESSARY USE 8\1" x 11" SHEETS.
INFORMATION
To insure proper credit to your account. tho namo of tho ustalO nnd ilia number should llll donrly print-
ed on the check or money order.
This assessment is made in accordance with Section 708 of tho Inheritanco ann Estllto Tox Act of
1961 (72 P.S. 9 2485.706).
To the extent that inheritance tax is paid within three (3) months after the doath or lll~ decodent, II
discount of live (5) percent is allowed (72 P.S, S 2485.716),
Inheritance Tax, other than tax on a future interest, is duo at tile date of the decedent's death and becomes
delinquent at the expiration of nine (9) months after the decedent's death (72 P.S. S 2485,711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer takos eflect in possession find
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:
---------~--------------------- --- -------------- - ---- ------------ -- -- -- - -- --
, month ,005 4 months .020 7 months .035 '0 months .050
2 months .010 5 months .025 8 months .040 11 months .065
3 months .015 6 months .030 9 mor'll1s ,045 12 months .060
I 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 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 days .00152 19 days .00318 29 days .00488
10 days .00169 20 days .00335 30 days .00500
--- -------- ---------- ------ - - - --- --- - ------- ---,---- - - ----------- ------
Any party in interest, including the Commonwealtl1 2'nd the personal representative. not satisfil!d with
the assossment may object thereto within sixty (60) days aiter receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961 (72 P.S. S 2485-10011.
Make check or money order payable to:
"Register of Wills. Agent"
Mail to the address listed below: