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COMMONWEAL TH OF PENtlSYL VAHIA
. DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEDENT
~~"HJtIJ
AFFIDAVIT OF
FIDUCIARY
(Instruction:; .:.In Reverso Side)
Harrisbur~nnsv1vania 17101
(CITY) (STATE) (ZIP)
Date of Dea ih
Now deceased
Saci 01 Security No. 23-6222729
Tax Identification
Bureau :=i1e Ha.
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9/23/34 Frederick IHeseman, Sr-.
5/6/80 Frederick IHeseman, Jr.
Trust under lUll of
EKffifK~ Frederick A. Wieseman, Sr., Deceased
For the 8enefit of Frederick A. IHeseman, Jr.,
Last Address 213 Market Street
County File No. <,2 (. ,f~: . '/')0
1. Decedent died:
( ) Intestate (without a will)
( X) Testate (leaving a last will--copy attached)
2. Is the filing of 0 Federel Estete Tax Return required far this estate? Yes_ No X
3. ) E>:ecutor/Executrix Administrator/Administratrix (X) Trustee under Will
Name Dauphin Deposit Bank & Trust Company (Formerly Dauphin Deposit Trust Co.)
Address P. O. Box 2961
Harrisburg, Pennsylvania 17105
ICITY) (STATE) (ZIP)
4. All correspondence should be mailed to ( ) Attorney
(X ) Fiduciary.
5. If an attorney is representing Ihe estate, indicate:
Name
N/A
Address
(CITYI
~::;TATEl
(ZIPI
"
.
List all safe deposit boxes registered in the decedent's individual name or jointly with, or as an agent or deauty
of another, or in decedent's individual nome with right of access by another 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 whic~ the box
is registered and the relationship of the joint holders to the decedent.
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT MAunAINED A SAFE DEPOSIT BOX
NAME OR NAMES IN WHICH
SAFE DEPOSIT BOX IS REGISTERED
RELATIONSllIP OF JOINT
HOLDERS TO DECED,ENT
N/A
Under penalties of perjury, I declore thot I hove examined this return, including occompanying schedules ond ~
statements, ond to the best of my knowledge and belief it is true, correct and complete. /~ 13..-1
c{'LA/c I., ,).91" Dauphin Deposit Bank & Trust Company, V
, -:J J , ,;' , , ' Trustee unaer "'1 of Frederick A. l<ieseman / I
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, '7( fi' ",," 7 '-"-'
I ~ i-rb" JCI ~J ,;;' I ~l . SIGtlA RE FIDUCIARY DATE
I' II -1;-/ - 3 Trust Officer
REV~4!10 (1':SOI
COMMONWEA~ TH OF PENNSY~VANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
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(Instructions on Reverse Side)
Trust under Will of
~ Frederick A. Wieseman
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ITEM ESTlMA TED DEPARTMENT
i NO. DESCRIPTION MARKET VALUATION
I
VALUE (OFFICIAL USE
ONLY)
l
-
l
TOTAL THIS PAGE -0 -
..&~
REV.451 (1.80)
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "6"
PERSONAL PROPERTY
'*'
(Instructions on Revorsll Sido)
Trust under Will of
~_ 'Frprlp:dc.k A. WieJ:;em;tn
I:
.
ESTIMATED DEPARTMENT
ITEM DESCRIPTION UNIT MARKET VALUATION
NO. VALUE VALUE (OFFICIAL USE ONL Y!
1- 1,134.00 Units of Fixed income Collective in-
vestment Fund of Dauphin Deposit Bank & Trust
Company 8. 7067 $ 9,873.40
2- 24 Shares of Pennsylvania Power & Light Company
4.50%. Preferred 37/ 888.00"-
3- Principal Cash 10.69
\
.
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TOTAL THIS PAGE $10,772.09V #,10, 7'11.. ~ 7
~-M
ReV.454 (l.aO)
. . .
COMMO~JWEAL TH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
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(Instructions on Roverso Side)
Trust under Will of
~ Frpn~ri~k A. Wieseman
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TOTAL E VALUE OF DEPAR'rMENT
ITEM R
DESCRIPTION MARKET c DECEDENT'S VALUATION
NO. VALUE E INTEREST (Offici,,1 Use Only)
N
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TOTAL THIS PAGE I -0-
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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 Wi lis with whom the
Inheritance Tax Return is filed. Evidence to support tl,e 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. It 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.
.~_.... . __~__ -=>L rJ::II. ......... __..z:lL..:_._"'_ "'"""" __::::::::::.... ----
~\I,l~~8J4!!!F~':""";::," . 'COMMONWEALTH OF P'ENNSVLVANIA .
NoJI"631,~21 . ., . . DEPARTMENT OF REVENUE
~Ji''f;;...;:;,;;:..:.:, OFFICIAL RECEIPT.' PENNSYLVANIA INHERITANCE AND ESTATE TAX
lr~!~"\''''.''}''''~'':I'i.".l1,I':!:!':''' ~.__u_. .- '
II
; RECEIVED
II
~ From,
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= ldress
/II
II
~ File No.
_______________TMD
HmlDRRft POUR
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WlOO----------------------dbllars
Da~hin D.po8it Bank .. ~
representing Pennsylvonla Inheritance or
Estate TolC due from the following estate:
P.O. RI\..
2961
29C Tal( on
$
$
RAPpfabuq,
P..
17105
6% Tax on
s
s
2l-8o-43~01. of Deolh9-23-1934
15'lt, Tax on
s
s
Date of Payment
June 26.
1980
% Tal( on S
Estote T ox, Act of
May 7, 1927
$
~
Name 01 Decedenl
I'RlDBRICK A. WIBSBMAN, Ilr.
$
Counly
t'!1'II..'hapl.rut
TOTAL TAX CREDIT
Less five pertentum of 10l( if
paid within three months after
dol. of deolh
Plus Interest at the rote of
_%from
10
$
204.84
Remarks:
$
MPAID ON ACCOUH'l'M
$
lfOO~[p[L~@liriJrn SEAL
TOTAL AMOUNT PAID
204.84
s
NOTE: This Triplicate Receipt to be retained for aUdit purposes<
Received by
NOTE: In acceptIng Ihe lronder Inh.rllance tax on fulure ellales, prior ta Ihe death allhe Iilo
lonanl or lonont lor voars, as ovldoneed by this receipt. it h underslaod that the Cammonweollh sholl
not be procluded or prevenled from hereoher oueuing oddWonallnherilonc. lox allhe deo!h ollhe
hie lenont or tenant lor years whenever It oppears Ihol such additlonal tall may be legally due and
collecUble for ony'reoson whalsaever.
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(Tille)
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To) in~:LJr.! i'f(lfH,'1 r.ll!dll 10 1'(1:,lr n :.)tll'l, t!,:, 11,1~t,,' 1,1 t!.. ":,1,11.' .,:11 hh~ n\ln,hcr !.;l1ult~.! (;;' .I",lll', prlllt
ed on thn clll'ck ur ll1U1t('Y (Iu!er
"fllt<, ,\~.~e';:,il:I.'1l1 I': Ilhidl' in :H:;(Jlil ".;., ':",ilt .;'
:C': of til' ild~~:r:l,1I11'l~ dlld L~;I;I:t' L.l( ^r:t of
15131 ("1'1 PS ': 2~!Ej IllS).
T ~1 ; 1 't~ po, :C~ ill 1:) ,It t 11')1' i:
O' ~,,\ 1:0 !J:,iiJ 1/,I:rl:'1 ';,0' {' l~i(;ll1!t'; "f:!'; t!i(~ 0",;11, of ,he' tl"cl'lll.'nt, <l
cir.Cfiunt \)t !:ve (t)) pt'r,:erllls allm-,J\!d (7:' P~; -:i ;UlH:l-ilt.;j
Il'fu::1'I1ilnct:' TiIX, other t~~i:lq 1:1.( (J1'I d t,:!"HC IIl!ere:-;!. I~; c.u.' ill 11~\~ d,i:~ u! lh<.; dect.'d(~n1 ~~ eJi:;jttl :rr,(\ bHcornes
delrrHjl/l:rlt at llH~ I'Xfllr1lltnrl of 11ll\t.' nJj rl':(Of1ths alTer the d!J.,~\'rl'~nts dt';lltl 172 PS '(I :1485.'/11) Inherlt,IIlCP
TilX on a future In\Ut:st 15 payable \Vl!hm lho!e 131 months llfl'!r the tranSftH la!l.e" effect jJl p05~t':lsion and
enJo~'rnent iHld i:; c1ellrHllJent ltwrUillter (/2 [',S !j 2'-lf3!i 712) CiJ:r.\;litll' inlt~ll:~:t 1.0ln lilt! drdrnq:Jt'fll ddlO sho'.......n
on the tilce of thi'; 10rm 111 the delle (;1 ilct lliJ I P,"IYIlWIlt Ij~,111Y the f0ilU'.....IIU 11Il(:I,~',: tabl.:'
1 month ,005
2 months .01U
3 months 015
1 days .00017
2 days .00034
3 day::; .00051
4 days ,00068
5 days or,08f,
6 days .00101
7 days .00118
8 d,ys 00135
9 days ,OO1!,2
lOdnys 0016~
4 monlh:,
5 month5
G rn01\;11:;
I rriN'1I1~;
(j II \ lJl \ 1 : 1 ~,
9 f1wr~lh~;
1 () months
11 months
12. lTlonths
020
.025
.035
o'~o
.04fi
030
1 1 day:; .()U1i)i;
12 ddYS 0020:1
13 dilYS 00;120
14 dijY~; CiG2~':7
15 d:1YS U:)2~iO
16 d;l\iS O(;2C;7
1 7 ddY~ .oo:n::'4
It' dil~5 OO~~CJj
, 9 dij'{~~ 003 1 f::
2\) i!lJ\-,'.i Ol.'~!:!:;
:,1 days
~2 days
23 dflYs
2<1 day:;
25 days
26 days
:!."i days
28 Ui.lYS
29 days
30 dnys
Any p,uty in ir.:'!!e~;l, <t1cludin~l 'Iw C"n~r1\lJnVJI "lith i;nd :t\,~ pnf~;una, fl'~j"C'~,f:l'.t:11IVi~, not Sdlisfied wtlh
the Q5SC5sment n'.i1y d!)jUct lh(:rclo wlthlJl :;i:-:ly (fi0,1 (1.1,/$ ;Iflt:r fl;n'i!Jl (,I Hw. Nutie': ,1S provided by Section
1001 of the InhcritJllCe and !:stille Tii', Act of 19Gi (72 P S ;iili~~J.1I,:1J1)
Milke dH:;;J., Of r1\('I;I',;' UI',:'" ,JI'r~J~lt' I'l
'"/luDi..,ll:f (.,/ \1"/,: I,,; ,\~; :(,1"
M;'JlllO th' ::rJdfo"~_, :'~ L,'I! h,;
050
.055
060
.00352
.00369
,00386
.00-103
.00420
.00437
,00454
.00471
.00488
.00500