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NO. 21-80
PETITION FOR LETTERS OF ADMINISTRATION
IN THE ESTATE OF .....Mlc.HAEL..,B,...,SHANK....................... DECEASED.
To ..."."MMY,."C..,..LJ:.W1S"....""",..,..",..",..,""",..,......,.."""..",.,...."..",..........,.
RegiBter of WiIlB for the County of Cumberland. in the Commonwealth of PennBylvania.
The Petition of "...""..MllRRAY,..D....,S,HANK... .......,..""..",...",..,..,""'" """,..,..",.........""..,..""",.,,..,..,.....
..... .....""............,..,..,....," ....."..." ...... reBpectfully Bhowelh that ,..Hi l;,ba e.l. ..B,... ..Sh ank....."......."".., .........
'1'0 i4Iri . Macon , North
waB.a reBident of .........F.r,aJ:lk.lin...................'........BO~~lghP ,oO!tmlll!r1I!1'1\\ County, State of Pelffill)'l-
Carol~na
VaRia, and a Citizen of United StateB, Bnd departed Ihis life iatestate in the County of ...Bunc.ombe....
....,.....,.".... ......" .....",...... and State of .",.. ..1:\0,1:,1;. b., ,~.ar.o.l ina..,.... .....,."...".""."",..""",..".,..,',..,......, .............
on ........Satur,day......... the .............1.0,1;.b.............., day of ..............Ma;r.......,....,..............., A. D" 193.0.......
at the age of .....J.?..... l'earB,
That the Baid .......MI,CHAEL..B...,S,HANK.....,...............,......, deceased, left surviving the following
named widow or hUBband, heirB and next to kin. to wit:
,~, 3'~1
..!t:\ I
Name
Relationship
ReBidence
..."...,~:;:~,?:!:l:.,~~,~~~.~.~"..,~~~~..".. ...............S.QI)."",.."......"....
...........:r.R.9..9:...9.hr.,t.!i.!;9.p.h.~Li?h,l;~nk ,..."""..."S'OI)."",.."..".."....
.... ..11\JX:J:.ay.. JL.,. ,ShaD!$., ............"". .,..', .."f.il.);h~,r.,....,..,."..",.,
......l:lele.n..,L..,.Shank...,..,......."..." ,.........l1P.t.~J:,..,......"....,"
,~,~.t.~,~E!g"..~p..-;:~.n,!!;~,I,",?.~"..........,
,)}.Q ,iJ.J,X'lli., ,S.p:r:ingfi,.., .1?A. ..,........,
..?~,1.~.. Xlil. ~.UMJ:;,,,)},9. ,t.J;:.9.ffi.. ,R,9....' ,."
"arl~sle. J:'t\
..25.1,3.. Wa lnut,,,Jio.t 1;.om..,Rd......
"arl~sle, t't\
................................................................ ............................................ ................................................................
................................................................ ............................................ ................................................................
................................................................ ............................................ ................................................................
................................................................ ............................................ ................................................................
......................................."....................... ............................................ .........................................."....................
That thoBe above named include all of the next of kin, BO far as known.
The Baid decedent waB pOBBeBBed of perBonal property to tlte eBtimated value of $.6,.,0.00..,00,............
and of Real EBtate, leBB incumbrance. to the estimated value of $....."...NmlE............. aB near aB can be
aBcertained.
That the Baid Real EBtate in BO far aB iB known is located in ..................NjA......................................
................................,........,..............,......................................................................................."j"...................................
Therefore, your petitioner(B) reBpectfully apply(ieB) for Letters of AdminiBtration in the above
named eBtate.
Dated ...........-!.~~.~..,~.......................... A, D" 19..~.~..,
Signature and Address
of Petitioner(s)
....).;;'(2ft(,.:i:,~L~'::f.lf.i../&".,~
",Mux:r,ay." ,D,.." .Sh Uk....., ........,.....",." ..................,
.
..,~,~13,J:lalJ:\ut...B.Q,l;.t,Qrn...Ro,ad"......................
",Gal: lis. ie". ".P.A.....11.013..", .......' ........" .....', ..... ,
COMMONWEALTH OF PENNSYLVANIA lBS:
COUNTY OF CUMBERLAND
"'........................................MJ.l,l,\JM\.'l:...D,.....Sfu\WJ.<......................................................................................., named
in the above application being duly ..................,swO'L"tI................ according to law, Ba)' that the factB Bet
forth in the above application are true to the beBt of ..It,is...... knowledge and bel~, .If #
.........................,~~.;~......,"",..,..".. and BubBcribed 1..L}:1.J..("c...{-::f..a.;/."..,f.."",A{q;;(,,(,(i:~
before me, ..",...,L,.".,....&'....,."...........,',..,',..."..,....,",....,......
..........2'.......'~~.~~..,~..,.."...".."'.. ,A. D" 19~,~,..,' ..,.,..,.."..,..............,."",......,',.....,..,""",.."......,'""...........
"{ .:::'}f7".(!.....J.f'~;; .................................m.......................................@a]
Ii \ Filed: .....i!.\1,l.y:.....~~..~......~,~~~,...................."....... Attorney: ,WLLLlAM..F"....MARTSON.;..,:p..,.(;',..
(over)
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Estate No. 3,~,~.~.~..........:~~.?
BOND
I
KNOW ALL MEN BY THESE PRESENTS, That we, HH"HMURRAY..,D..H,SHANK.H,HH,.,HHHH.HHHH,..H.
............................................................................
................... principaL......,
and ..............
.........................................................................
..........................................................,...,..................................................................
......................................, surct............,
arc held and firmly bound unta the Commonwealth of Penn,}'h'ania, in the sum of HHH,Tw.el:v.eH...HH...H,..,......H..
HTho,uiumd.H,an.dH,o.OI1QQ.HHHH.HHH... Dollars ($,1.2,,0.0.0.,.,0.0.,.), to be paid to the said Commonwealth,
her (ertain attorne)' or assigns, to which payment, well and truly to be made, we do bind ourselves, joinfly and
St;\'crally, and our and each of our heirs, executors, admini stralors, successors and assigns, firmly, by these presents,
for and in the whole of the said sum,
SEALED and dated the .......,......3...!LH....,............,..........day of ....................,,!.@.!;L,.,...............,, 19...BQ,
WHEREAS, the above named ".,MURRAY..D.... ,.8HANK.,..,.."....,...,..,...,..........,.....................,.......................
..................................................................................................................................................................................................
has or have made, or is or arc about to make, application to the Register of \~ills of Cumberland County,
Pennsylvania, for the grant of letters .o.L,Adminis.tra,tian...,.......................,....,..,...,...............................,...
"
on the estate of ,MichaeL,B......8hank.,..,............,.....,....,..........., late of ..,f..r,ankl;i.n,J~oJ:,Q,Ugh.....,
Macon North Carolina
€ambcrlotml County, i't....,.I.""il, deceased:
THE CONDITION OF THIS OBLIGATION is, that if the said personal representath'e ...,....,... or an}' of
them shall well and truly administer the said estate accord ins to law, this obligation shall be void as to the personal
representative or representatives who shall so administcr th e said estatc; but otherwisc, it shall rcmain in force.
SEALED and delivered in the presence of
--7)~,~--~L-iJrJ~~---,,----_.,.-
----------------~------------------------_.
'JlA
~'~~~if:~~:u:-:-~::~:
_ _u_________ _______., uu___ ___u______ (SEAL)
1:'l)e_A~1!.lA-Qi>I;1!l-'!.J.ty__8dJ1JrJ<,t.:i-r:.P.. __ (SEAL)
~y;_J1J'1U~J--m,jf():T?."~r-(SEAL)
Attorney-In-Fact
-----------------------.-------------------.
~~i~~:~N0~-c~~~~:::::~:
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND 55:
Personalll' appeared hdore me, a. ,.....Notary.. P.,ublic, ........, ..,........H'........,........ in and for the count}' and
state, aforesaid ,..,.,NURRAY,..D,...,SHANK...,.........,..,... .",.........,....,.".."..,
2513 Walnut Bottom Road
of" H'." Car 1 isle,.. J? A",.. 1.7.0 13 ......., ,........,.,....' ..., and ,.
...............,....,.......................................................
..........................................""................................."..
,.,. ,. .......,., ...,...,..., ..." ,....,.."..' ...... ,.. ..,.. H..'..' .... .....,.......,.,...".., ,of ,."...."..,....." . ,...,.... H" ..,... ,.... ..... ..,....,...., ,."...."...... H ,.. .,...... ,..,..
surities on the above bond who being dull' sworn (affirmed) according to law, depose and say that the}' each own Real
Estate worth the whole of the penal sum named in the above bond, over and above their debts and the debtor's exemption.
Sworn and subscribed beforc me this
.....,..............,..........., da}' of ......,..,................
, H"..' H' ............. ...... ...,.,..... ,.....,........" ,.... ..... ...' H" H.." (Seal)
,...',.. ""..........,......,............................... ......' ,....,....,...... (Seal)
..""" ..,. ."H ...... ......, .....,..,.........,... ...' ........' .........,.. H' H'" (Seal)
,.."'.'"'' ..........' ............'....' ........... ............ ........ .....',...., (Seal)
A. D, 19..........
..........................................................................."..,..............
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LIFE &. CASUALTY
THE ICTNA CASUALTY AND SURETY COMPANY
Hanford. Connectlcul 06115
POWER OF ATTORNEY AND CERTIFICATE OF AUTHORITY OF ATTORNEY(S).IN.FACT
KNOW ALL MEtl/ BY THESE PRESENTS, THAT TH[ ..ftt~A Ct..SUA,ln' I,ND S'J'lETY CCtJiPANY. " c01pO';tII()f\ dul~ rJl?Jnl:f'd ur'ld~ \!'o{: I~....~ ot Ihe
Slale of CMnecllcul. ilod hih'IOg "~ p'lnclpal of lice to trle Clly 01 Halttord. Coun1y 01 H:.1IlJord SlaH' (It ('M,r.ec.lieul nail. m~dt: D)rl!>~"utl-a allO 3:'[lOlnIUC ..nd
does by Ihefoe fJesenl~ milke. constlluH: ;'110 i1;lpOlf'll Donald 11.. EopcrF.ft or Davjd W. Ho?craft
of Carlisle, Pe:rills:."lvania Il~ Hut: ,"ld !(j..{tul :'11tJtr.eys.,n.fl:tCI, witt'llull f,)....t." itl,e ;",~!'.ll'lt.,. I'Jreb~ c...:mlerle'd:O !..grt,
c)ecutl: bno a:"n("),\l.:-dge. al iln~ plilce wrttlln lht U'ntt'O S:<ite~. Clf. il 1ht lollCl\o\mg line be Illled In, ....'~r\ln Ihe a'f"c. 1f,IHC: de~'r;r.i1te(\
tilt' 10llt....ing inSHu~l~nllsl
by his !>ole signature and act, ilny tlno all b:mds. rr.cc~;Inl:<,nces c.~mlrilcl! 01 inCl~mnily. and o:hm wll~lr'9!. Ob!'Qil:CXY in Ihe r.i1t.JI~....1 C b:inc Il:'Cc..g"lI:ance, ()/ con.
dlliol"lal undt:."taktrog. and any and all c(.n~tlnls IncIdent thf:telO not e:):ce:eding the SUI!; of FIFilY THOUS.~ND (*;50.11000,00)
DOLLAP.5 -
ilno 10 blr'ld THE .€TNA Ct..SUALTY ANi) St'REiY C:U,PANY. thcre:by It!. ful1t' cr,d to ~he ~i1rr,(. f:dtf11 as I~ the: ~r:rne we'c: slg."lc:d by HIt July C1...l!l:}:I;>('d otkers
of THE ,(TtJA CASUALTY AND SUnny COMPANY, and all tfl!:' acts of Mid AItOlTlc\'s.in.Fa{;t, rodl~uantto thl.' au!hOl'll~ tlerl'1O give"l. "re rlereD;' rat,f,,'!d and con-
fIrmed
This uPtlJlrnment is m<ide undel and by au~hori1y at the follcwing Slandlng Rt'solut,ons o! saio C:,T1pany wh,c.n Rc~olutic.ns illE: flOW In fulllo,cE' on(l cHect:
VOTED Tha: cilch 01 lh€ f(lllov...,ng oHICt:'rs, Chairman, Vlc.e C"allman. Pre:SICt:nt. Any b~cutlVe ViCe: Ple:>.den~ Anv S~nror Vice PIC:~ldt'r.1. An~' Vice PrC:SI~1:!nl,
An\' Asslslanl Vice P,t-sldenl. Any St>clt:ary. An~' ASSISlant Se:clrtary. may fIom time 10 limE' i:lppotnt R\?sldtlnl Vice Pu"sldenIS, Re~ldent A.~sls:anl SecrellHleli.
AIIClrney&.m.Facl. and Agenls to act for and on behalf of lht C{,mpanv ilne may give bny !;uc.h ilppOlnlef: S~JCt'l ilulhofltV as hiS ceftlf'l.:ate 01 aultlOllly may
pre&CtlbE' 10 s'gn With the Company'!> flilme and seal wilh the Company's ~ealllCfnds. :~c:{'grll:;HI;:e~. conHaCl~ of InOemM..... an(\ ethel .-.tlllngs Obligatory m lhe
nahJle 01 a bond, It'wgm:ilnce, or COTldlltonal underta~,lrIg, ilnd an.... 01 siud o!1,ctlrs or lhe BOi:lrd of Dllf'ctors mily at an~ lime remove any such "ppo,nlet ilnd
revoke Iht! po... t:r and i1ulllorlty given him
VOTED: ThaI any bona. I(<cogn,zance. conlracl 01 I:ldcmnlly, 0' ....nlrng obligalor~' III ttll nature 01 a bond, recogo,,;lIIce. or condItional unaeltil~lng ht1all be ~alid
aod binding upon the Company when (al signed by the ChQItITlan, Ihe VIce Ct;ilirman. Olt' PreSident, an E)eculr.'E: .IICf,: Fle~loenl. a Sen,or VIce PreslOenl. Ii Vice
PrtlSldenl. an A!;slslant VICE' Ple~idenl O~ by a Ae:sldtlnt Vice P'esldenl, P"fSuflnl 10 Iht: powe: ptl'~crir.ed 11\ 11;. r.ertd,calf- of i:Iulhollt~ of such R~~ldent VIce
Presiden~. and duty alH.-slt>O and scaled Wilt, lhp. Compi:lnv'~ !.ea\ b\' iI Secret;trr o~ ;'S~lstant St'C!elc.l~ or by il !;c&lot:n: AssIMiln1 Secte\ar~'. p;;I!;UClnl to Ihi' power
presclibed In me cellif,cat~ Olflulhollly 01 such Rt-steent Ass!stont SE:cretat\,. Of Ib) nulr C)~cul~d IUr,jel ~('81, d 11'.QUlrelj) b~' one or mOle t..1HJ/f.eys.in.fac.l rUT.
Suant 10 ltle po...'er plescrlhed 10 hIS or thell cettif,catt or c;erlillr(jtc!> 01 toulh0t11y
This PO....ef of Attorney and C~nific~~e ol AUlhotl:y IS !:.'gneo hnd !,~alf"d by lacslmile undlt' and by i1uthoflly ollhe follOWing S~nP.dlng Resolulion \-oled b\' Ihe
Board o~ DlreclOlS of THE .$.TNA CASUALTY AI-,jD SURETY COI"PANY which Rcsolulion III now m ful110rce and effect.'
VOtED: Thai lhe signature of each of the following officers' O'lglrman. VIce Chairman, Pl(>llid~t, Anr t~ecutive Vice Plf>Sldent, An\, SE:!\iOf VICE: Plesidtlnl.Anv
Vice Pre~idenl, Any As&istant VIce F'fesioent, An;' Sec:'f:tary, Any Assistam Secretary. (jnd the ll~al 01 the Company may ~ aHI).ed bV fac.:simile 10 ion;' power of
aHorney Qt Ie a~, ccrtif;c;;~{: relating thereto appoinling R~lden1 Vice Pre!'-iotlnU.. Hr.sidt$"l\ A!:.!.I!;liinl Secre~allcs or /.t\Qrne~'~.in.Fac1 lOt purposes On1r of
e~eculmg and attes11ng t.:Jnds c.nd unCH::rtal..mgs and other wrilings obligatory m Iht- nalwe tt'w:'eoL and 01\\' SuCh rtOwer 01 allorney Of certificale bear 109 such lac-
simile signalUle or facsimile SEal shClll be valid bnd binding ufXln \he Compnny and an\' such po....(r !>o e~rcu:ec and ct::'f1if'ed bv such facsimile sig:"LaturE: and fac"
simile seal shall be valid aad binding upon the Company in the fulure with respect 10 any bund or undf."fti1klng 10 whld\ it 1ft attilf.hed
IN WIl NESS WHEREOF,
Secretary
THE .ETNA CASUALTY AND SURET\' COMPANY has caused thif, inSlfument to be s,gned b\' lIS
. i1nd lIs corporate seal 10 be htlreto afl.red thl~ 4th da~' of August
. 10 78
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THE
"_~:~]It,[Q
S~cret.ary
l:;:~':' .~'~~,.;;~....
l,t:;,~~~:.~;~:~)
By
SlatE: of COOfleC;llcul
I
r
S~ HartlOfd
Counly of HartfOfd
On thIS
4th
A~fUst
, 1978
VINC:JIT A. WHSH
~,ecreta..."1.
o'
d"y 01
. t.d0lEc nK pe'!>Jr1;!I:., ,-"me
t(J me l..rlOwn, whO tot-Ing tJ\ mt: aut, toworl\. dip ('1e;",:.e "nO ~.ai.'. H.a! tw IS
,.HE ..fTN.t.. Ct..SUALTY t..~~D S'JRf.TY COMPANY. 1!1f: t"Oll~');ii'IO", O~'S;I'~"..C :f, "nrj o"~"d', \:'l<.u;('d \"[:
;.t.:'",(, "'!'-llurl'tln~, t~ln~ 'Ii' ..nl:.'....~
~r,t: ~l:i", 01 ",'.C co'
f)\Jlilllon. mat the sual ilff'~ed to lIW sa,a l!1~llurnt-n: I~ suc;t, t"'rD!,,~l: ~<:a~. "no :1.3: 1..;. (le,.hoC V't' ~~'C ms,tlw!flent r;r, h~I~<dj 11! l~L ,,"',"f':J~i!t,()f1 tJI' i1<J~rK"", at hi!,
oHici' under the Stflnd'!Ig F.!::;O\U\I(lnS lhcltlof
.;'<,
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URl\fICATE
I, tht unoel!>lll'.ed. J..ssi ~ta.nt 55cretf.!"y 0\ 1"f- A;:TN', CASUAL 1 '( A'~O SUR[l Y CO!.',PANY ~ !'.1C\'.;1, (:o(..:)'all\11'1 c.ll~lt S:,~l(.' o'
Connectltut. DO H[RFBY CERTIFY lhal \tIC- 1Ofegoir,g Cine Olt<lt!,f'C PO.....t!r u~ A:ttunl.'v ,\'\d CtJ'ld,calt" 01 (..uthClrlt\' Ii'~ltlll'~ In 1\.I111,,,u' i.n.j h.~~ I\:'l~ IM't'l, 11:0('''1''(1
and furlhen'Tlore. that -the SH.nd,ng Rl'solullOl1!> 01 tt-.e 80il'd oi Dllt!CH)'!:. C!& ~e\ lcwth In ll)€ CI!fllllt,ilte Of Aul11C/1I1..... b't" O~J'" ii, l{,,(~'
. Slpneo and Sealed at lht HoI1l(>SOf!lC:c- 01 1"~ C{J,"";'odll~' In HlC: Cll\, ol hilf"!t{1I0. State 0' Ccrlfl!!tllCUl ()ble~ thiS
June ,1. 0
3rd
aa\, oj
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I
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J:1UR~YJ~., SHA~~_ _,_ _
being duly ...-SWD.rIL-.....___._._ according to law, deposes and says that he __,is-1:he__,__,__
_AdminisJ:rator-----..---..,---------- of tho Est.te of Mi C'haeLJ3--.Shanl<
late of Franklin. North Carolina --"11!CiftltHIt.tm:I=Goti~?h;, deceased .nd that the
within is.n inventory made by , Murray.D._Shank_.. ..__ ____.,_, the said-Administrator
of the entire estate of said decedent, consisting of all the persenar prop..fy and real estafe, except real esfate oufside
the Commonwealth of Pennsylvania, and that the figures epposite each item of the Inventory represent it's fair value
es of the date of decedent's death,
~~~~~ -t, , and subscribed before me, I
"4-1:,......'-<'-....-,, I!l 1981
CJ.:.tL~~ d. :t~L;
'zzt'V<k1fi AI Jl""L
E cutor. Acfministretor
_251~ Walnut Bottom Road
WilliAM t. EARP. Nolary Public
Carlislp, Cuml:cr!and co., Pol,
My Commj!;~jon Expires Aug. 13. 1984
__Carli ~1 a,--1'A 1701~
Addreu
D.te of Death ---l-Ot-h-,.-
Day
M"y 1 QRO
Month Vur
INSTRUCTIONS
r. An inventory must be filed within three months after appointment of personal represent.tive.
2. A supplement inventory must be filed within thirty days of discovery of .ddition.1 ."els.
3. Additional sheels may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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REV-lito EX+ 17-BO}
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
INHERIT ANCE TAX RETURN
FOR INSOLVENT EST A TES
(Instructions on Reverse Side)
STATE NO.
COUNTY NO. 21-80-0437
( ) Exec.
(xl Adm.
Other
Estate of Mi "hap1 R Shank
Name -Murray
D. Shank
18j ._12. - '{(,.('2-
Last address Route 6. Box 1037
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Date of Death
{STREETI
Social Securi ty No.
Nnrrh r.~rn1in~ ?R714
(STATEI {tlPI
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Carlisle PA 17013
(CliYI (STATE) (ZIPI
Under penalties of periury. 1 declare that I have examined this return and
to the best of my knowledge and belief it is true, correct end complete.
Address ?~13 W~lmlt Rottom Road
(STREET)
May 10. 1980
195-38-9844
Social Security No.
TYPE OF ASSET
Personal
Property
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USE
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DATE
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51 n ture of FiducIary
Date
DESCRIPTION
ESTIMATED MAR~E r
VALUE
DEPARTMENT VALUATION
(OFFICIAL USE ONLY)
1. Checking Account No. 7-330-771,
Wachovia Bank and Trust Company,
Franklin, North Carolina.
Date-of-death balance $ 2,375.60 , <:Xl
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2. Chicago Rawhide Manufacturing Co. : ,"'; I~
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Payroll check dated 5/1/80 482.86 /"1 ' ." 80
.::1 ,." 1'):0
Payroll check dated 5/15/80 482.86 "" .,0
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Group Benefits check dated 4/10/80 75.20 t.....: ,.,C)
',."
3.1978 Chevrolet Monte Carlo-Sale Price 2,200.00 .,""'"1
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4.Refunds: 1979 Individual Income Tax: -. ",J
(a) State of North Carolina 4.72 ..,
(b) Commonwealth of Pennsylvania 81. 92
(c) Internal Revenue Service 664.21
TOT AL $ 6,367.37
I do hereby certify that the above assets were appraised in accordance with Pennsylvania law.
il'll""lo )-li't~tJ;,,"j)
APPRAISER
April 1, 1981
DATE
NAME OF PAYEE
NATURE OF CLAIM
AMOUNT CLAIMED
(See attached Schedule 0 Debts and Deductions)
TOTAL
7 556.78
.
755~.1Ir
DEbuc. TIONS ALLOWED
-tf -?J
DATE
INSTRUCTIONS
ASSETS:
TYPE OF ASSET _Indicate whether the asset is real estate, personal property, transfer or jointly-owned.
DESCRIPTION. _ List all assets owned solely by the decedent or owned jointly with another party or porties as tenants in
common or os joint tenonts with right of survivorship at the time of death. Include the decedent's percentage of ownership,
the name (5) and relationship to the decedent of the surviving joint owners and the estimated market value of the decedent's
interest as of the date of death. Include intangible personal property titled in the nlJmc of the dcccd(!'nt but payable at death
to another party or parties including but nof limited to P,O.D. U.S. Savings Bonds and tentative trust accounts. List any
property transferred by the decedent within two years of death for which he/she did not receive valuable and adequate
consideration.
Describe all real estate located in Pennsylvania by lot and block numbN, street address, number of acres and include a
general description of the land and buildings. Also, include the book and page number in which the deed is recorded and the
e'l(oct title os indicated on the deed.
DEBTS & DEDUCTIONS _ Unsatisfiod Iiabilitios incurrod by tho docodont priar to his/her doath ore doductible against
his/her ta'l(able estate. In additic.n to debts incurred by the decedent, other items ore claimable including the cost of
administration, attorney fees, fiduciary fces, funeral and burial expenses including the cost of 0 burial lot, tombstone or
grave marker. List the dote on which each debt was incurred and/or paid and the names of each payee. Provide a brief
explanation of the nature of each debt claimed and the amount being claimed.
Evidence to support the decedent's or the estate's liaIJility for the debts being claimed should be attached to this return
A family elCcmption 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 elCcmption. 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.
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INFORMATION
PLACE FOR FILING _ Tho roturn is to be filed in duplicato with the Rogister of Wills of the county whorein tho docedent
resided.
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.
FAILURE TO FILE RETURN _ Section 791 of the 1961 Statuto provides thot" , . .any porson who willfully fails ta filo 0
return or other report required of him shall be personally liable. . .to 0 penalty of 2500 of the talC ultimately found to be
duc or $1,000 whichever is the less to be recovered by the Department of Revenue os debts of like amount are recoverable
by law."
NOTE: Fees paid to on estate representative; namely, an executor or administrator, for service~ performed in ad.
ministering an estate is reportable for Pennsylvania Income Tax purposes. This taxable income item shoud be reported on
form PA.40.lndividual Income Tax Return,
ESTATE OF MICHAEL B. SHANK
FILE NO. 21-80-0437
DEBTS AND DEDUCTIONS
Nantahala Power and Light Company, Franklin, N.C.: Past due account
Days Inn Motel, Candler, N.C.: Lodging for parents while making funeral
arrangements
The Bank of Toccoa, Toccoa, Georgia: Account payable, overdue payment
on automobile
U-HAUL Moving & Storage: Moving decedent's personal effects from
Franklin, N.C. to Carlisle, Pa.
Best Western Inn, Asheville, N.C.: Lodging for parents while attending
to estate matters in North Carolina
Register of Wills: Probate costs
Donald M. Hopcraft Insurance Agency: Premium, Administrator's Bond
Register of Wills: Short Certificate
Register of Wills: Short Certificates
Westminster Cemetery, Inc.: Grave monument
Cumberland Law Journal: Advertising Administrator's Notice
Georgia Income Tax Division: Account payable, 1979 Individual Income Tax
Hoffman-Roth Funeral Home: Funeral Services (see attached invoice)
The Evening Sentinel: Advertising Administrator's Notice
The following expenses incurred during the illness prior to death have been
paid by the Administrator:
5/10/80
5/11/80
5/19/80
5/26/80
5/23/80
,
6/ 2/80
7/ 1/80
7/ 1/80
7/ 2/80
7/11/80
7/17/80
7/17/80
7/21/80
8/ 6/80
1. E. Brown Crosby, M.D., Asheville, NC
2. St. Joseph's Hospital, Asheville, NC
3. Angel Community Hospital, Franklin, NC
4. Drs. Moser, Crews & Elmore, P.A., ASheville, NC
5. Diagnostic Radiology Associates, Baltimore, MD
6. Memorial Mission Hospital, Asheville, NC
7. WNC Internal Medicine Consultants, P.A., Asheville, NC
8. WNC Arthritis Clinic, Asheville, NC
9. Stephen M. Busky, M.D., P.A., Baltimore, MD
10. Jerry N. Ariail, M.D., Asheville, NC
11. William F. Wilson, M.D., Asheville, NC
12. Henry A. Spindler, M.D., Baltimore, MD
13. Good Samaritan Hospital, Baltimore, MD
14. Joseph W. Kahn, M.D., Franklin, NC
15. American Ambulance and Oxygen Service, Baltimore, MD
16. Frank C. Arnett, M.D., Baltimore, MD
17. Daniel R. Synkowski, M.D., Baltimore, MD
Register of Wills: Fee for filing Insolvent Appraisal, Inventory,
Debts and Deductions '
William F. Martson, P.C.: Attorney's fee
Reserve Account: Reserve for Closing Costs and Miscellaneous Expenses
TOTAL
$ 79.65
24.80
178.70
294.39
105.82
21.00
56.00
1.00
2.00
446.00
18.00
5.82
4,394.00
18.00
$ 78.52
76.51
162.61
164.00
44.00
38.97
133.34
16.00
50.00
6.00
96.00
57.95
16.50
2.20
35.00
80.00
95.00
9.00
650.00
100.00
$ 7,556.78
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jNFORMATION
To insure proper credit 10 your account. the namo of the estate and file number should be clearly print-
ed on the check or money order.
This assessment is mado in accordance with Section 708 of tt\C Inheritance and Estate Tax Act of
1961172 P.S. 92485.708).
To the extent that inheritance tax is paid withm three (3) months after the death of the decedent. a
discount of five (5) percent is aHowed 172 P.S. 9 2485.716).
Inheritance Tax, other than tax on n future interest. is due at the 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 takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. 9 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 1 1 months .055
3 months .015 6 months .030 9 months .045 12 months .060
1 days .00017 11 davs .00186 21 days .00352
2 days .00034 '2 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 Commonwealth and the personal representative, not satisfied with
the assessment may object thereto within sixty (GO) days after receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961 172 P.S. 9 2485.1001).
Make check or money order payable to:
"Register of Wiils, Agent"
Mail to the address listed below: