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Home My WebLink About80-00480 -:-."; '::~ ,".\ :/" . "i"".'; ~~~~tr::~ ~' ,.t;'<",:~:: ... ;",(.c''J ,:", .. .~-~.~;(, .:,: ~~~"~~':~',:-:, '".>--C-;:;", '-'., ~:~. ".,;. .. . " . . .: ,~'.';. i,.' :~~t~l: ,,' Ifj~,;t: 'i~i' ...... ".,.., ,~:.\, .0 ~4ro:: (.l!'.!:(l)'/ I,tt~t!, , ~!;/I-":;i~::,""":" . ;R~~~r.~~ .'~~'.:: riM't'",QO.> ..'J.'; Il~';'i)i , " , e:'" ..-'" .'.. "'j' I I '. . ",' .. ,~ ., ti . '. ,. . ,. _. 0 .-.... taJ .. . CD ~ .. LlI . . , < ....',.;..: '.' ' "'~':'" . 8 I:) ~ r ( tI) L m r ., 'c ~ ":I , ( ! .olJ I I 1 ( I ~ .~ i: r .~ .. I ,. .. I ~ f . . .. & i t : r . I:) r ,.," ,:-" ,,~. '=. .' . 11<0 ,,; '..' .-." "I>' " No. 21-80 480 PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY in the Estate of HELEN F. COOK , deceased. MARY C. LEWIS To 1fW~~~mteos:on, Register of Wills for the County of Cumberland, in the Commanwealth at Pennsylvania. CSX Petitioner(s) are the executORS named In the Last Will and Testament of HF.T.F.N F. COOK dated November 6, 1979 Decedent was a citizen of the United States and a resident of liowPlplip Borough, Cumberland County, Commonwealth Camp Hill of Pennsylvania. Decedent died on Saturday the 5th day of July A. D. 1980 , in the County of Cumberland , State of Pennsylvania at the age of ~ HQl( her Decedent has not been married and has not had children born to mtilk since the execution of the above described Will. Decedent was possessed of personal property to the value of $25,000.00 and of real estate to the value of $70,000.00 66 years. os neor as can be ascertained; said real estate situated as follows 2951 central Avenue. in the Borouqh of Camp Hill, Cumberland County, pennsylvania apply Therefore, your petitioner(s) respectfully ~~~I1~!l for the probate of the said Last Will and Testament and for Letters Testamentary thereon. Dated July 15, 1980 Name and address of Petitioner(s) 9 tl Delores A. Smith 14 7 Peach Lane 1) n ~p~ Carlisle, Pa. 17103 c~mr J.f;ll. 'D:a 17011 COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND GEORGE B. COOK and DELORES A. SMITH named in above application, being duly say(s) that the statements set forth in sworn according to law this petition are true to the best of their knowledge and belief. sworn to and subscribed before ~o/a me July 15, 1980 , ~)~ I/, Y'" ..<,: , J t-L l.l_. .'/ .-1 t.-'L~ ~ Ii'fix~~. Register MARY c. LEWIS I"'. DELORES A. SMITH rPfl Filed: OL/-t'tJ - ~5"tJ 17, 1980 Attorney: My~.e:, Flower I4.A. & Johnson '/G~ " r WILL AND TESTAMENT. No. 163 7f, ..:!J /It=/-.6d.C: e",,'1( in thc County of C. () 1>1 /3 ,:.IC '- /1 IV 0 ami Stalc of Penlls"!v . b' I' llIelllul'~' and ullllerslalldin" do IIlllk. I II' I . .i anm, elllg u sound mind. . 0'. c all( pilI IS I tillS ml' I 'l .'11 I . and Ilmkmg \'aid 1111 fOl'llIe!' wills b . .. " . liS \\ I Ill\( testament, hercby revoking .. ~ llIe .It .1IIY tllllc heretofore llIade. And first, I direct 11m!: 1lI~' fllnernl he eond 11'1 I' situation in life lllld !:but alllll\' just d 11" I j' C Cl IIIll1llllllel' clll'!'esponding with my estate und . .' e I S Mil lIIlCl"t1 expenses b f' 11 . I I conveniently ma~' be after my dccellse. . . . e u ~. pUll 1lI1l satisfier! as soon liS As to such estatc as it huth p1euscd Go It' viz: / .6'Etl.!/.:-fr.ff,,1L. <,c ~ I ~) II1tJ'IIS~ ~ with. I dispose of the same us f'ollows, L' /~ ~J?".7": /c? /Vy /;/'vf6'"n"L) /l4,f~ IY-ep",j;'~ #t?u<."".=,e" /,c /IE /5 /v<>r ,,(,0,,'k9 .4,T'///': ///,;,d' <'r /""v //0- '7 - "" .,-=- /"1" S'L' /~y ESTl'lr-= S/I'4,<.t. /.5'': L)",.,/A..:O ,..;(,')<.-"I"':J P~T.I1".:cN lit;' O,..lVQ,IV,T'/.,e 'P()1..0~E~1 MY ,5'..q' Geo.eq,,: ,,41Y() I')' G.(J.4lYcJJ"IY, /'1A.eK 4,{?A~ .f/IAtJ. /11 T//E ErE;V/ /~ i!J,.pt"C;HT...:.-<1 j)",L.",.ec,f) (l.eMY .Jo"y Geo..eQ-f, 1!7.4 /'1( 6'.<'I'I/y,t) .f""'" ('7/9,.(!.K 4,(J,4~ ,f/l..tJ ).-r',,,I./.-,p /.S'E' vEe-o."1.s e.o /IT T,tIE T/~"''' <i9r /'7j'" .iJ..:.=-/17/fC" T//~/,e ~Er~,.:T/YE of CI1rl1P/i/l.l. /11::/1(.:5 )4/{)t,I;:'/J .-f'Ece"..'~ 'T/7/c-",e. e.f//d.~.ES:J S:~9 .. And I hereby nominate, constitute :lIld lip point !lA,.flf.y JY. e"",~ ;It, #tI.s~-?#IJ~ ~IVGi/";!!, Ir- /;I E/$ NoT ,{:./V,,v6, /III'/"w,'T' />1y i7.1U6IYT':~ ",'L"""c'" ,.'1,.,,,, ,..,)' .f<J,y Ge~.ea-c;) Exeeut o.es of this my IlIst will and testllluent. In Witness Whereof, I /lELc /V F- (:'c7C"e: the 'l'estllt..<'/l' ,have to this, my will. writtcn on one shcet of paper. set my 1111nd 111\(1 seal, tbis 6!P rillY of /V(JV'c m4G'.-c A. D. One Thollsand Ninc Hundred llnd 5/~ ry ,v,-,lV.:' , y // / . ,;r:-- /:? ,J .' v)t...C.-l.t-~...;:.7.:?......k.~~SKAL) Signcd, sealed, IJublisbed IInd dcclllred by the IIho\'e named .h'-: L~: # r=: Coo IG liS IIlld for h' E.e.- last will and testament, in the presence of us, who hn\'e hcrcunto subscribed our names at h' L.."',<2./ ",,~l U W;1n~M therein, in the p""= .r ".. ::'7~~::~~~1g~i~:frfi .....u.u...............~..i~...................... SWOR~O AND SUBSCmaED llEi'Or'F(iE THIS h 7 DAY OFAOtJ;;.q,6~ 19~ ~r.EudL~ ROY EARLE COO:{, NOTARY PUBLIC MECHANICS BURG BOROUGH CUMBERLAND COUNTY MY. CQMMIS.S.ION EXPIRES JULY 24, 1972 ,; ~ '" ..... I! ::: 0 ~ '\\ -l1 ;: ~ 'S ~ :i: - lSl <if ~ eo. \-( Ie ~ ~~ 0'" ;Q .. . ::: .,. c M 0 ~ ",.. .'" 0 - u - t .- ~ ... u 0 '" <Ii ci . '-:":;-.;.}~ :'-;:\~~~S~~~~ . OA TH OF NON-SUBSCRIBING WITNESS COMMONWEALTH OF PENNSYLVANIA l COUNTY OF CUMBERLAND J ss: This, the 15th day of JUly MARY. C. .LEWIS A. D. 19m, before me, ~~tx~~, Register for the Probate of Wills and Granting Letters of Administration in and for the county of Cumber- land, in the Commonwealth of Pennsylvania, personally came GEORGE B. COOK and DELORES A. SMITH who being duly e~rorn according to law deposed and say that they are well acquainted with the handwriting of HELEN F. COOK whose name is attached as testatrix to an instrument of writing purported to be HELEN F. COOK the Last Will and Testament of late of Borouqh of Camp Hill, Cumberland County , deceased and that the said signature is true and genuine, and that the said HELEN F. COOK is now dece ased ClIIK.m.,ll4lllll Sworn to nnd subscribed before me, thic 15th day of ~#fm ~~;.rd~h' July A. D. 19l11:> 80 ---.;) . I ..... I ./"> i-C:U ~_S!~~i<n Register Mary C. Lewis per Deputy Register ..,....". OATH OF PERSONAL REPRESENTATIVE I i I I i i." , 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, personauy'~ame~ 8 ("" ~ o,J... ~~;q ~"" who, being duly~.-r1h-.. ,do depose and say that as o/-oD...At;r.s of the lalt Will and Testament Of~ P uol<. deceased ~Will weU and truly administer the goods and chattels, rights and credits of said deceased according to law. And also will 11 tly comply with t rovisions of the law relating to Transfer Inheritances. - <i; '~nd subscribed before me. )\ .~,~ 15. 1980 J/ J 1/"/ /,-rt!.-:-: / Register )L ~t? :.,; 0: I :l'A lXI' 'as C> : Ql ~j I 'tJ : Ql I ~~ u.. l"l: I lXI: *: ! 0 I :<:: I ~ i .-J 81 ! 0: 0 r-: lXI' .-J u1 i:Q ~ 0 '<1': - .: >i I .' - 0: - u~ .~ U: \l) ~ ~, lXI' ~ z: ~l =s: ~ I: I': 1')\ ~, r.:I, .~ Nj ~, 'tl en: Q r.:I: Ql ~ :1:: 'E co' I .GO 0 In: . tJ *' - .s Ql N; ... ~ al \ .5 'tl - ~ I': ~ .~ '" r:. r:il as Be it remembered that on the 17th DECREE day of July ,A.D.,19~, there was probated and recorded the last Will and Testament of Helen F. Cook late of camp Hill ,Cumberland County, Pennsylvania, George B. Cook and Delores A. smith Deceased. Letters Testamentary were granted to Witness my hand and official seal the day and year aforesaid. 0) /,'7) '1 J.J c/ / Id/::..J {c:, .J-t?t(/~ ( JI Re~srer ----.---- ------------- --- - - -- - - -- - ---- - ------ ..-.....--- ~ -- -. !".,'i;~ff;~(I!.~~):, ..,.. .. COMMONWEALTH OF PENNSYLVANIA. . H~;&n'O:6' .3'3' 8. .6' '.. .. .. DEPARTMENT OF REVENUE . .. . 9it.:{\1'~~i'.";'.' .'. OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX 11'''',.,',.,.....,.. . . ~ ; RECEIVED ----------------THIR'l'Y-PIVR HUlmRRn DOr.J.AR~----------____________!ft>Hors 1/ S ~ ,. If ~ File No. ~ Z-'K __ r. __ ...". -.,. ---.... - -- ~...~ ..~. m, a B. Cook" Delora. H. A. JOhnaon, ..q. Box 125 A. Smith represenling Pennsylvonia Inherilance or Estate Tox due from the following estale: Gao C 0 iress ----L..O. 2~ Tax on s s r___""",yn.. Pa. 17043 6% Tax on s s 21-AO_48n Dale of Deolh7-5-19BO 15Ck Tax on s s Dale of Payment OatQ!:Ie&' J. 19BO % Tax on S Estate Tax, Act of May 7. 1927 s , Nome of Decedent u.I' WU' 1". "001( s COunly C'--rland "PAID OR ACCOUllT" TOTAL TAX CREDIT Less five percentum of tax if paid within three months after dale of deolh Plus inlerest at the role of _%from 10 s 3.684.21 ""I,emarks: s lA4.21 s lrOO~[P[L~@MTI'~ SEAL TOTAL AMOUNT PAID s ~.~on.nn NOTE: This Triplicate Receipt to be reteined for audit purposes. I Received by NOTE: In accepllng the trander inheritance tax an fulure eslaleli, prior to lhe death or the life tenanl or tenanl far years, as evidenced by this receipt, il is understood Ihol Ihe Commanwoalth shell not be precluded or prevented lrom hereafter aueuing oddilional inheritance lOx 01 'he death of the lifa lanant or lenanl lor yeors whenever II oppears lhat such additional 10. may be legolly due and COllectible for any reDlan whotlaher. lIe ------- -- ---- ----- ------ ---.-- --- --------- --- AE\~' (lod'OI- COMMONWEALTH Of PENNSYLVANIA DEPARTMENT Of REVENUE TRANSfER INHERITANCE TAX RESIDEWT DECEDENT "1'l7ity If /(1 g'( SCHEDULE "F" . STATEMENT OF DEBTS AND DEDUCTIONS Estate of Helen F. Cook Dateo! Death .July 5, ]980 WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING: File No.21-80-480 Claimant Relationship to Decedent Claimant's Address ITEM NO. DAre NAME OF PAYEE REMARKS AMOUNT f W'l1s pr ba 4 5 6 7 Patriot-Evenin Vital Statistics M ers-Hall Funeral Home Communit General Motors Acce Advertisin Letters D s Funeral ex enses Decedent's account 2 eve ue Se Delores Smith Gin rich Memorials Delores A. Smith 9 10 11 12 1 14 15 CCNB Bank N.A. Prudential Ins. Com an Internal Revenue Pa. De t. of Revenue due Loan un oan 504 1980 income tax 1980 Income Tax 17 18 19 20 21 21 outstandin Geor e B. Cook Register of Wills storage ts & Forms Ge Delores A all do urn n one-hal f 's C TOTAL THIS PAGE I 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 st e as ctions for Inheritance Tax purposes. l~L;.z,.-< It' / /:ccC:/ ..r: 'J'~~_ . , SIC URE ATTORNEV FIDUCIARY :'..1 . DATE GENERAL INHERITANCE TAX INFORMATION ~ Unsatisfied liahililies incurred by Ihe decedent prior to his/her death are deductible against his/her taxable estate. In addition to debts incurred by the decedent or estale, other items are claimable ineluding 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. t'" '" 0 rl E; trl E; :il - ;.. 0 0 CIl Z C'l rl c: 0 ~ z 3: z t'" trl trl :>:: Z " 9 - 9 t'" Z Z trl ....j trl Z 9 ....j -< trl - 9 CIl CIl Z 0 CIl 0 ....j 9 'T1 'T1 " ~ ~ 0 'T1 - 'T1 IV 0 - .... Z rl , ;; co 0 t'" I c: n ... CIl C co trl ~ 0 0 t'l Z ~ t'" -< -< ... ~ trl trl ~ ;.. ;.. 0 " " 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. .-------- . . " GENERAL INHERITANCE TAX INFORMATION Unsatisfied liabilities inwrled by the decedent prior to his/her deilth ilre 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 markar. All debts being claimed against an estate ara 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. t"' ." 0 C"l ~ t'1 ~ !l - ~ 0 0 ~ Z C"l ~ t:I Z S5 z ~ t'1 t'1 ?: " 9 9 z Z /l'I .., t'1 .., z 9 9 .., -< en t'1 - N en Z 0 en 0 I-' .., 9 'Tl 'Tl I ~ ~ nN Q) 0 III \0 :Il 0 ." au. t>:l I - 'Tl '01-' t< ... 0 - t>:l Q) Z C"l ::>:n z 0 - > I-' CD t"' ::l "J rt . c:: n . 1-1 Ul c::: III n t'1 ~ '01-' 0 0 III 0 Z t>:l .;x. ~ t"' ~ <: -< -< -< CD t'1 /l'I ~ !:; ::l c: > > 0 CD " " INSTRUCTIONS FOR COMPLETING SCHEDULE "F" 1. .1 f 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. -' GENERAL INHERITANCE TAX INFORMATION " UnSiltistied liallilitil's 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 tha decedent. .. "" 0 (') ~ tT1 ~ ~ z ;J> 0 0 '" C) (') c: 0 ~ z 3:: z ~ tT1 tT1 ~ Z ;ll 9 - 9 z Z tT1 -l tT1 Z 9 -l ><: tT1 - 9 '" ~ Z 0 '" 0 9 'Tl 'Tl S ~ () 0 .., ~ - .., IV 0 - 'tl ..... Z (') I - :I: Cl) ;J> .... 0 .. ..... I c: () ..... ... '" c Cl) rtl fjj 0 0 '<ll-' t>l III Z fl . :J" ><: ><: ~ <: S; I-'CD tT1 rtl ~ ....::1 ;J> ;J> 0 OJ:: ;ll ;ll I-'CD I-' 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. REV."~' (f'aO) .- COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT DECEDENT SCHEDULE "F" STATEMENT OF DEBTS AND DEDUCTIONS .. _.--- Estate of HF.T.F.N P ('()()1{ Date of D(!alh .Ju1v 5. 1980 WHEN CLAIMING THE FAMI L Y EXEMPTION, COMPLETE THE FOLLOWING: Claimant Claimant's Address DATE NAME OF PAYEE FileNo. 2]-80-480 Relationship to Decedent REMARKS AMOUNT Flower & John on Attorney Fee own & Countr Char e Account balance Reserve for close-out costs 6,777 .00 83.39 150.00 Administration expenses - Pennsylvania Power & Light Bell of Pennsylvania Riverton Water Co. Truman E. Horner H. B. McClure Ro E. Cook Ins. o & T Mechanical Inc. Agency Contractor repaJ.r Wesley Fetrow ur 21 eal estate prior to sale ervJ.ce rom u y to final statement 3 5 81 Statements - July & Aug. Service - July - March Trash service - 3 mos. oil Del. & Repairs - July - /oBrch Homeowner's Liability & Fire Service & supplies to a er amage - ro 143.65 57.11 81.44 11.B5 1,606.25 336.00 BB6.30 Repairs - water damage ent of Sale for real estate Real Estate Commission 240.31 4,900.00 799.90 s involved with clos'n (taxes, fees, etc.) Reserved for final closin f real estate 1% Transfer Tax Satisfaction of existing e cumbrances I hereby certify that to the best of my knowledge and belief th expenses and expenses of administration submitted to the e y .c 700.00 14.00 TOTAL THIS PAGE 16 7B7. 20 egoing is a just and true statement of debts, funeral as d tions for Inheritance Ta~ purposes. "{{.,,/<u,, C;~/d J--;'/J-If? v ATTORNEY FIDUCIARY ~ DATE OFFICIAL USE ONLY DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ AT PERCENT. REGISTER OF WIl.LS DATE GENERAL INHERITANCE TAX INFORMATION , ~'. Unsatislied Iiilbjlilics inlulTcd 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 mcluding tile cost of administration, attorney fees, fiduciary fees, funeral and burial expenses im:luding 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. t"' '" 0 C"l E; t'f1 ~ !l z ~ 0 0 '" C"l ~ 0 ...j Z ~ z != t'f1 t'f1 :;0<; '" > 9 9 z Z t'f1 ...j t'f1 ...j z 9 9 ...j -< '" t'f1 - N ~ Z 0 '" 0 I-' 9 "%1 I '" "%1 ~ ON to ~ 0 11>'" P:: 0 '!l aUl t'l I - '!l c.. '01-' I:" ... 0 - .. " t'l to Z ("'\ ,- ;~ - ~_.:. P::O Z 0 > L.'. ~ u l-' CD ...;- :;;: 1..,,1:1 ::s "l t"' . ,OC;) l~_ . :l~a r1" c: 0'-.' Lr\ ......~. () . t1 '" ct:-: - :c':: c:: II> 0 M (l~ -OJ ~ "'I-' 0 0 W~.l.; >- u:- II> 0 O'- e:; 01~ z 0:'" :0:: ~~ t'l . ~ :>: :( oc; ~ -< -< ""w 0::5 CD ~ ~o: - :"ju ~ ::s t'f1 t'f1 fC <..> - ~ > > 0 CD '" '" 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 alllount 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 oj each debt being claimed. 7. The form must be signed by the person who has assumed the responsibility for paying the debts. REV"'!! (l.BO) COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT DECEDENT SCHEDULE "F" STATEMENT OF DEBTS AND DEDUCTIONS .' ---.--- - ------ --- --....------------ Estate of Helen F. Cook Date of Death ,Tul y 5. 19 RD WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING: File No. 21-80-480 Claimant Relationship to Decedent Claimant's Address ITEM i~O. DATE NAME OF PAYEE REMARKS AMOUNT 2 3 News Advertisin Letters 9 10 11 Vital Statistics M ers-Hall Funeral Home Communit ph sicians General Motors Accept. Cor Internal Revenue Service Delores Smith Gin rich Memorials Delores A. Smith Death es Funeral ex enses Decedent's account CCNB Bank N.A. Prudential Ins. Com Internal Revenue W t outstandin Geor e B. Cook Register of Wills Notar Fees Geor e Delores A. Smith all documents one-half Executor's Co iss TOTAL THIS PAGE I 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 th e as ctions for Inheritance Tax purposes. _ /I" ,JI '.;'''' ~ ;^J!.,d.._u~t(.-tln'd'i. ..j "'/3-iI'/ URE OF ATTORNEY/FIDUCIARY DATE OFFICIAL USE ONLY DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S AT PERCENT. REGISTER OF WIl.l.S DATE GENERAL INHERITANCE TAX INFORMATION Unsatisfied liabilities incurred by the decedent prior to hisfher death are deductible against hisfher 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 hisfher 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. t"" ..", 0 n > m ~ ~ z > 0 0 0 VI C') n c: tl ;:; z 3: z ~ m m ;>; z ;:0 9 - 9 z z ~ .., m .., z 9 9 .., -< '" m - '" Z 0 '" 0 .., 0 ." ." '" ~ ~ 0 - "tl N 0 "tl - f-' Z n I - 0) > 0 l'"' I c: n ... '" c: 0) t:l 63 0 0 'llf-' t'l ll> Z ~ .;.. ~ <: -< -< ~ f-'1Il m m ~ -J::l > > 0 o~ ;:0 '" f-'1Il f-' 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. ----. --~---~-- -" ------- *' - REV.455 (l.80) COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT OECEOENT SCHEDULE "F" STATEMENT OF DEBTS AND DEDUCTIONS Estate of HF.T.F.N F COOK Date of Death Jul v 5. 19 80 WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOllOWING: FileNo. 21-80-480 Claimant Relationship to Decedent Claimant's Address ITEM DATE NAME OF PAYEE REMARKS AMOUNT NO. --21. Myers , 1.lvers. Flower & John on Attorney Fee 6,777.00 ?':l Town & Countrv Charae Account balance 83.39 24 Reserve for close-out costs 150.00 Administration expenses - -eal estate prior to sale 25 pennsylvania power & Light ~erv~ce trom JULY tL~~~/ 143 .65 to final statement 3 5 81 26 Bell of pennsylvania Statements - July & Aug. 57.11 27 Riverton Water Co. Service - July - March 81.44 211 Truman E. Horner. Inc. Trash service - 3 mos. 11.85 29 H. B. McClure Oil Del. & Repairs - July - March 1,606.25 30 Roy E. Cook Ins. Agency Homeowner's Liability & Fire 336.00 31 D & T Mechanical Contractor s Service & suppl ies to 886.30 repa~r lJat:.er carnage - J:rozen pJ.pe:> 32 wesley Fetrow Repairs - water damage 240 . 31 ._~~ ,. .-, ..-" with Anre 'ment of Sale for real estate ':l':l Centur" 21 Real Estate Commission 4,900.00 ~A nses involved with clos 'na (taxes, fees, etc.) 799.90 Reserved for final closing :Jf real estate 1% Transfer Tax 700.00 Satisfaction of existing e ncumbrances 14.00 TOTAL THIS PAGE I 16.787.20 I 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 t uctions for Inheritance Tax purposes. .D-('~-l';'" Ct.' ...j;~td/ ,:r;J3!,r/ 51 ATU OF ATTORNEV/FIDUCIARY OATE OFFICIAL USE ONLY DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S AT PERCENT. REGISTER OF WILLS DATE 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. t"" 'tl 0 C"l > t'<1 > :s z > 0 0 0 tIl Z " Cl n c: 0 ;;! == Z t"" t'<1 t:1 ~ Z ;::l 9 - 9 t"" Z Z t"1 ..., t'<1 ..., z 9 9 ..., -< tIl t'<1 - IV tIl Z 0 tIl 0 t-' ..., 0 ":l ":l I ::>:l ~ L .. nIV CD ~ 0 .. .~. I~': ~ ,", PI'" :z: 0 'Il <: E: ;l U1 l':1 I - 'l:l '- :'"L: 'Cl t-' l:"' ... 0 - u..:'. ;-~.~ l':1 CD Z n Ct. ; Lt"l c~ ..~ :z:n z 0 - or.:.. ~ :-.:..~ > W.J.; ~.J ... 11> t"" >- :::s "l 0.... cC (:J,t'!: c: erVl :z= . lu IT . 0- . ,co n , 11 tIl u'" ~- ........ a::~ c:: PI n t"1 era: ~ w- ~ '<jt-' 0 0 5'0 ...JU PI 0 Z u l':1 ~ :>: ~ ~ -< -< 11> ~ ~ :::s t"1 t"1 - ~ > ~ 0 11> ::>:l 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. . RE;V-449 EX. (3-80) COMMONWEAL TH OF PENNS'(LVANIA DEPARTMENT OF REVENUE TRAHSFER INHERITAHCE TAX RESIDENT DECEDENT AFFIDAVIT OF FIDUCIARY (Instructions on Reverso Side) * Eslote of HELEN F. COOK Dote of Deoth July 5, 1980 Lost Address_2jl51 _~e_nJ~J:<!.l Avenue Soei 01 Seeu ri ty No. 175-34-8290 Camp Hilt, Pa. 17011 Bureou File No. (CITY) iSlA T~I (l.IP) Coun ty Fi I e No. 21-80-480 1. Decedent di ed: ) Intestate (without a will) x) Testate (leaving a last will.,.-eapy ottached) 2. Is the filing of a Federal Estate Tax Relurn required far this estate? Yes_ No " 3. ( x) Executor/Executrix ) Administrotor/ Administratrix Name George B. Cook and Delores A. Smi th Address 9 Glenwood Dr., E 147 Peach Lane, R. D. #8 Camp Hill, Pa. 17011 Carlisle, Pa. 17013 (ZIPI n ~ n::;' ",'" C:::tJ ml'T1 ..,.",. ",n 5,' ::.: _0 ",'" ~Cl "'" _.0 _:r' -< ,.,rT'1 . 'V - - ~"J ~:.J:: U1 .',:' c;': .,"" 71 ~:n :El " ,', ~ ;.. -:-:--' " ._~ .r (CITY) [STATE) 4. All correspondence should be moi led 10 ( x) Attorney ) Fiduciary. S. If an ottorney is representing the estate, indicote: Horace A. Johnson Name Myers, Myers, Flower & Johnson Address P. O. Box 125 Lemovne, Pa. (CITY) (STATE) 17043 (ZIP) List all safe deposit boxes registered in the decedent's individual name, or jointly with, or as an agent or deputy of another, or in decedent's individual name with right of access by another as agent or deputy. Include the name and oddress of the bank or other institution where the safe deposit box is located, the nome (s) in which the box is registered ond the relationship of the joint holders to the decedent. HAME AHD ADDRESS OF BANK OR OTHER INSTITUTION IN WHICH DECEDENT MAINTAINED A SAFE DEPOSIT BOX HAME OR NAMES IN WHICH SAFE DEPOSIT BOX 15 REGISTERED RELA TIONSHIP OF JOINT HOLOERS TO DECEDENT None Under penalties of perjury, I declore that I have examined this return, including accompanying schedules ond stotements, and to the best of my knowledge ond b;!Jef it is true, correct and complete. (/ ~. ~ /'J .. ., ,Lj).r.f.~'-u...e (( }(//-j ..J.~/Y-f/ DATE -- -=:::-' "" .' .' REV0451 t'~+ (3.80j l!OMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY '* (Insrrucrions on Reverse Side) Estate of HELEN F. COOK ITEM NO. DESCRIPTION ESTIMATED DEPARTMENT UNIT MARKET VALUATION VALUE VALUE (OFFICIAL USE ONL YJ 3,077.75 120.00 150.00 500.00 109.00 2,455.96 16.85 2.19 3,434.11 6,878.74 729.44 1. Household Goods - Proceeds from sale - 2. Fur Coat - Proceeds from sale - 3. 1979 Oldsmobile Sedan (Junk - totaled in accident) 4. Travelers Cheques 5 . Cash - 6. * CCNB Bank, N .A. - checking account No. 169-888-5 Savings Acct. No. 002-074379-5 7. * Cumberland Valley Savings & Loan Account No. 155738 8 . * Commonweal th National Bank Checking Account No. 252-108766-4 9. * State Capital Savings Assoc. No. 002-00-09107 No. 002-00-08183 10. Nationwide Insurance Policy No. B 542-210 - totaled in accident) - Automobile (autorrobile 10,962.30 11. Insurance - policies on the life of Harry W. Cook, deceased - Helen F. Cook, beneficiary Prudential - Keystone Ins. Co. Continental Casualty Ohio State Metropolitan Life 18,221.61 2,000.00 10,000.00 962.30 510.82 12 National Home Life Ins. - insured Helen F. Cook - benef. Harry W. Cook Payable to estate of Helen F. Cook 1,516.48 13. Woolf Ins. Agency - premium refund 14. Riverton Water - adjustment of account 15. Dauphin Deposit Bank - Christmas Club *Survivor of joint account with husband. Note: Survival Action pending. If said action produces assets, will file supplemental return when concluded. 7.00 34.02 250.00 TOTAL THIS PAGE 61,938.57 REV-4S2.' t-l~OI COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT ESTATE OF HF:T.F:N F' rnnl( SCHEDULE "C" TRANSFERS * INSTRUCTIONS: I. 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 NO. DESCRIPTION ESTIMATED DEPT. VALUATION MARKET VALUE (OFFICIAL USE ONLY) NONE TOTAL THIS PAGE NONE ~ QUESTIONS CONCERNING PROPERTV TRANSFERS 1. Did deceden1, within two years of death, make any transfer of any material part of his estate without receiving valuable and adequate consideration? (Answer "Ves" or "No".) No 2. Did decedent, within two years of death, transfer properly from himsel fl hersel f to himsel f/hersel f and another party or parties (including a spouse) in joint ownership? (Answer "Ves" or "No".) Jla..... 3. If the answer to one or two aoove is "Ves" and the transfers are claimed to be nontaxable, provide the following information: 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 nontaxabili ty of transfer. 4. Did decedent, in his!her lifetime, make any transfer of property without receiving a valuable or adequate consideration therefor which was to take effect in possession or enioyment at or after his/her dea1h? (Answer "Ves" or "No".) No a. Was there lilY possibility 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 lime of decedent's death? 5. Did decedent in his/her lifetime make any transfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end before his/her death: a. The possession or enjoyment of or the right to income from the property transferred? (Answer "Ves" or "No".) No b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer "Ves" or "No".) No 6. If the answer to five b. aoove is "Ves," state whether the right was reserved in decedent alone or others. 7. Did decedent in his/her lifetime make a transfer, the consideration for which was transferee's promise to pay income to or for the benefit or care of transferor? (Answer "Ves" or "No".) No 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 revert to decedent under terms of transfer or by operation of law? (Answer "Ves" or "No".) No 9. If the answer to eight above is "Ves," 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-453 (1-80) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES *' (Instructions on Reverse Side! Estate of HELEN F. COOK BErlEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY DECEDENT BIRTH . oelores A. smith D".."hf-o", Voc: n",,1 f- One-third res;""o 147 peach Lane, R. D. #8 Carlisle. Pa. 17013 Georqe B. Cook Son Yes Adul t (lne-Third n~-'.,t1'" 9 Glenwood Dr. , E Camo Hill Pa. 17011 Mark Bradshaw Grandson YP,," q 1,0 1<;<; n",p_"h;~" o"c:;""~ 70 winter Lane summerdale Apartments U' , . . .,v. The above beneficiaries are living at this time except for the following: DATE OF DEATH NAME . , . REv-4S4 EX+ t3.80) COMMONWEALTH OF PENNSYLVANIA 'OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT Estate of HELEN F. COOK ITEM NO. DESCRIPTION NONE SCHEDULE "E" JOINTLY OWNED PROPERTY (Instructions on Reverse Side) TOTAL MARKET VALUE \ T TOTAL THIS PAGE '* VALUE OF DECEDENT'S INTEREST DEPARTMENT VALUATION (Official Usa Only) NONE M M P:: P:: ~ 0 < <: 0 . ...., ~ ~ 0 al MI ~ :>0 :>0 tl ~ ~ . ~ Z I'. M 0 '" :2:, '" ~ 0 ~I .jJ '" CC s:: ;:J MI ..,. ril. all ..-11 ...l I :>:1 tl :>:1 < 0 - Z CC M ~ U I lfl - 0 ~ - .-{ '" ~ r- N N I 0 <: ~ 0 ~ c.: ~ r- 0 Vl 0 Z 0 '" Vl ;;- r- 0 "'-l Z r- "'-l r- "'-l Z Z ...l 0 - 0 <: c.: z ::.: "'-l ~ ...l Z ~ Z F- Cl ;:J U " Z - Cl Vl Cl 0 0 <: == <: ~ <: u CI '" :J '~saJa~u! s,~uapaoap a4~ ~o anle^ ~a~Jew a4~ a~eo!pul 't> 'ISaJa~u! s,~uapaoap a4~ ~o a6e~uaoJad a4~ a~eo!pul 'E 'ApadoJd paUMO AI~U!O! a4~ ~o anle^ ~a~Jew le~o~ a4~ a~eo!pul 'Z 'pa4s!lqe~sa SeM d!4SJaUMO ~U!O! a4~ a~ep a4~ pue (S) JaUMO,OO a4~ ~O ~uapaoap a4~ O~ d!4SUO!~elaJ pue SSaJppe 'aweu a41 apnloul '"8,, alnpa40s JO~ suo!~onJ~su! a4~ uI pa~eo!pu! se AlJadoJd leuosJad lie aqiJosaa '"1;1,, alnpa40s JO~ sUOIlOnJISu! a4~ u! paleolPu! se A~JadoJd leaJ lie aqiJosaa 'L '~SJI~ a~e~sa leaJ lS!l 'papnlou! aq 01 aJe A~JadoJd alq!6ue~u! pUB alq!6uel 4~08 'd!4SJO^!^Jns ~O ~46!J 4~!M s~ueua~ ~U!Or S9 9ll!lJed JO AlJed Ja4~oue 4HM AI~U!O! ~uapaoap a4~ Aq paUMO 'leUOsJad pue leaJ 'AlJadoJd lie apnloul ~snw "3,, alnpa40S '. " . . ,,3.. 31na3HOS ElNI131dli\lOO 1:10:1 SNOI10nl:llSNI ,",., . ',. ".: ~--.' ...a.~~" '~~'i''-:''_, ." R.I!V..-'" IlX+ (WOl INHERITANCE TAX SUMMARY SHEET (BUREAU USE ONLY) I!] Original o Supplemental o Remainder File Number 21-80-0480 Estate Nome HEllen F. Cook Dole of Death July 5. 1980 Social Securi ty Number ill-34-8290 REPORT OF INHERITANCE TAX APPRAISER I, the und.rslgn.d duly appalnt.d Inheritance Tax Appraiser In and lor the County 01 C~bPf.l r,nd P.nnsylvanla, do respectfully "part that I have appraised the r.al and personal praperty as reparte in t e a..golng ,.tum at tit. valu.. I.t forth opposlt. each Item in the lalt column to the righf In Schedule. "AU, "B", "Cu, and "E" Dated: June 10 , 1981 --tIJ1P." I d / -If 'dh)( j ) INHERITANCE TAX APPRAISER INVENTORY ADJUSTMENTS (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE VALUE AS APPRAISED CODE Reot Property (Schedule A) Perlonal Property (Schedule 8) Jolnt.Held Property (Schedule E) Transfer. (Schedule C) s 00+ 10+ 20+ 30+ TOTAL GROSS ASSETS Le.. D.bt. and Deductions (SCHEDULE F) CLEAR VALUE OF ESTATE OLlie Estate o Annuity 40- RATE FACTOR PRINCIPLE VALUE FOR USE OF REGISTER ONLY Tax on $ CODE COMPUTATION OF TAX $ $ S $ 5 6% Tax on S 15% Tax on $ Tax on $ Tax on $ Exemptions Total Estate TOTAL TAX INTEREST FROM BALANCE TO $ $ $ Less Credits DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST TAX CREDIT 5 + 5 5 = $ + = INTEREST FROM BALANCE DUE BALANCE TO 5 92+ 93_ CODE REV.518 FO (7.BO) ~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF FI ELO OPERATIONS NOTICE OF FILING OF APPRAISEMENT Mr. George B. Cook 9 Glenwood Drive E Camp Hill, PA 17011 Ms. Delores A. Smith 147 Peach Lane R.D. 8 . Carlisle, PA 17013 RE: Estate of County of File No. Helen F. Cook r.umber1and ?1_RO_04RO Deor Mr. Cook and Ms. Smith: You ore hereby notified that the orilZinal appraisement in the estate of Helen F. Cook has been filed in the office of the Register of Wills of Cumber} "nd County on June 10 ,19 6l... Said appraisement reflects the following valuations: Real Estate Personal Property Jointly Owned Transfers Total $70,000.00 $fi1,Q1R 1:,7 NonF! Mnnp $131,938.57 As to such tax that is paid within three months from date of death, 0 five (5%) percent discount is allowable. As to any tax that remains unpaid after nine (9) months (fifteen months when death occurred from December 22,1965 to June 16, 1971, inclusive; and twelve months when death occurred prior to December 22, 1965) from dote of death, interest at the rote of six (6%) percent per annum is charged. Any party in interest who is aggrieved by this notice may object thereto within sixty days after receipt of said notice os provided by Section 1001 of the Inheritance and Estate Tax Act of 1961,72 P.S. 2485-1001, P.L. 373. Date .T11n" 10 /7!/ I Si gned HeM/d) ICf,lttllfi) Title Chipf' App...~;qP'" NOTE: This is not 0 bill. ~.,.~ ~ ~ ~ ~ ".. Z ~ t<l '" 0 >- >- "" c t<l 1I1 '" ~ .... ;l t. C Q) .... .... .... ...l Q) .0 .... <I: .... 3 - Q) u Z :I: '" U - 0 ~ - ~ ~ 0 0 ~ ll::. ~ tz., !-o 0 '" 0 z 0 '" t<l '" >- !-o 0 - ~ !-o ~ Z Z Z !-o ...l 0 - ci ~ ll:: ~ ~ ~ t<l :::: Cl u '-' ...l Z ~ Z ~ 8 0 ~ z - '" ::l ::t t<l Cl COMMONWEALTH OF PENNSYLVANIA i. COUNTY OF CUMBERLAND J ss: being duly sworn GEORG~ .J:t!-. COOK _Al1fLPF=~_ORES A. SMITH ___ according to law, doposos and says thatt ho y. "rp Rxec.utor" _.___.___ ___ of tho Estate of _-HET.F.N p rOOK late of _B_or.o_ugh .of Camp Hill. ______, Cumborland County, Pa., decoased and thet the within is an inventory mado by ____ _______ t;hem___. the said Executors of the ontire estate of said decedent. consisting of all the personal prop.rty and real estate, except real estate ouhide the Commonwealth of Pennsylvania. and that the figures opposite each item of e-1j1ventory represent it's fair value as of the date of decode nt's death. / Sworn to and subscribed before me, ~ a-r } 3 19 YI D.:-'-'~~T~Y PUBUC:?~ -:... <s .~, CollUlll.s1Cl11 wpir., Dec. 21, ~!lS1 . "' 'YO.. Pa. CumberlaDd Cowlot Date of O.ath 5th Day >- 0 0- W ~ ~ 0- ce W ~ ... "" I 0 W 0 VI ~ W 0 I- :r "" ce Z 0- ..J u.. I u.. ..J <( 0 ,-i W 0 <( W N I > z ~ I Z 0 0 ci II VI z ~ z W <( "" ., I ! P Exa or Sl(IWlMI>>~ GEORGE B. CooK.An ~ ~~, 0 _.~ ._t::i:"f. DELORES A. SMI'IH Addr... July Month 1980 Vur INSTRUCTIONS :>:: .... 81 0 t.\ .<:: , ~1 ::l 0 i-l i5 0 ~ ..:l ~ - :z: 0 ~ . ~ ..J ~ I1l U l:: o lJl l:: .<:: g M ... o r-- ,-i I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional .sseh. 3. Additional ,heets may be attached .s to person.lty or realty ;:;1\ 4. ~ See Article IVtfiduciaries Act of 1949. t'. ::;:: 1...._. ~.:. - ~.I...u t.." :.i::c o~ Ll"". <:z. 6,~. - 5:< LaJ~1 ~ Q:;:-' ci- ~ ocr: :Sa :E: ~~ (.)w a:::~ ~Ct: _ 1...J::l - ~ dO I1l ". - .,; ~ ~ ~ ~ u ~ o Q) ... l:: >< i-l 0 Q) S ;3: Q) ~ 0 >o..:l ~ ..... GO a.. ~ E .. Oltl :t:N lJl<(,-i i-l Q) ::;: ~ "" >. . c D o U -0 c ~ -;: ~ -" E D U ... x o ~ o -0 ..! u: -" . o ". ,g ::E1 Invontory ollho roo I and porsonol oslalo 01 ESTATE OF HELEN F. COOK docoasod. 1. Real Estate - No. 2951 Central Avenue, in the Borough of Camp Hill, Cumberland County, Pennsylvania. Sold - Sales Agreement dated March 5, 1981 2. Household Goods - Proceeds from sale - 3. Fur Coat - Proceeds from sale - 4. 1979 Oldsmobile Sedan ( JUnk - totaled in accident) 5. Travelers Cheques 6 . Cash 7. Nationwide Insurance - Automobile Policy No. B 542-210 (Autorrobile totaled in accident) 8. Insurance - policies on the life of Harry W. Cook, deceased - Helen F. Cook, beneficiary 9. National Horne Life Insurance - insured Helen F. Cook Beneficiary - Harry W. Cook, deceased - proceeds paid to Estate of Helen F. Cook - 10. Woolf Ins. Agency - premium refund 11. Riverton Water - adjustment of account 12. Dauphin Deposit Bank - Christmas Club No. 352227 13. Bank Accounts - Joint accounts with husband, Harry W. Cook, deceased - Helen F. Cook, survivor of joint accounts with husband. CCNB Bank, N.A. - checking account No. 169-888-5 - savings account No. 002-074379-5 Cumberland Valley Savings & Loan - Account No. 155738 Commonwealth National Bank - checking account No. 252-108766-4 State Capital Savings Assoc. No. 002-00-09107 No. 002-00-08183 TOTAL Note: Survival Action pending. If said Action produces assets, will file supplemental return when concluded. 70,000 00 3,077 75 120 00 150 00 500 00 109 00 10,962 30 31,694 73 1,516 48 7 00 34 02 250 00 2,455 96 16 85 2 19 3,434 11 6,87874 729 44 131,938 57 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF EXAMINATION OFFICIAL NOTICE OF INHERITANCE TAX ASSESSMENT . C~,~~:E~O:.D ~~~.. 10.,: L} ~9, ().Il;' '!~I_ I ~ ,1\ " TO: G ~ -)yv.I, r,>"'.0 t'Y\J)., (. ;.,.,~ .1 JI ('-i;'!~-, '+ :-'1~ l~.,....r. (7 1\ '" 'J " "('t- 6'crL- I .;l ..,. ~ DATE , j, .l,..;J).....,c .,\1,1. '\ .-'\ 'J--,VV 1 I D, } (1 1'1 C~ ".,k , '- II ~v...; ~.4i , (,'i;~J.' ,'. , {' ESTATE FILE NO. .;( I .' k 0 - I) f (! COUNTY (~ ~.n,JLJ,^J DATE OF DEATH \:'.1 "~Jil rJ 1%/0 'J 7 ,. "I O1'J"(Vl ()-V~ " J r/'/: !/." ... "-:':-." Personal Property $ '7() U Gu O() + &./ c,3'(;5'? + $ j J / Y3f- 57 )4' ?.. '7 y L:;' ' -c $ 7'7 d.'f1 0y Appraised Value of Estate: Real Estate Jointly Held PropertylTransfafs Total Gross Estate Total Approved Oeductions Clear Value of Estate Less: Approved Charitable Exemptions $ r; '7 d"lC, (1? Clear Value of EstBte Subject to Tax Amount Taxable @ 6% Rate $ f7'7 d/S'1.G'J tax due $ %35.60 Amount Taxeble @ '5% Rete tax due will .. .. .. .. .. .. A five percent discount totaling be granted if the Inheritance Tax is paid by I TOTAL PENNSYLVANIA INHERITANCE TAX DUE -J."-:-. ',v II _ r.; '~/ }.-"fJ ~ 1:- '; I L' . . ~ -,... - ~, $ $ I../- (" 35 (J) "- r; u tf(L/J 30 ~!r\Ji'.:t c-" c75 J. 3 "I Less Credits: DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST TAX CREDIT jQ- 3 -//,O 5-IS-x/ $ 3.'100[1(\ + 95/. 3~ + $1':111 ~I - $ = $ 3~kl/. dl (., ,'70 = r; c;g, ()1 + = ___ ;- I / uJ ./),J LI h tj a 3 0 Interest accrues at the rate of six (61 percent per annum on the unpaid balance of Inheritance Tax from to date of payment. Interest due if paid by is $ ('I "L '1. ,,!)I '- BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE Assess.~d by: See Inlormalion on Reverse Side ('~:~? -, , I ...... J ~\' -('.:.... -- \"'\ J<.(l) / t:,J(t-;'J-dl,1 COMMONweALTH Of PENriSYL'IA,,,,I'" DePARTMeNT OF REVENUE TRANSFER INNERITANCE TAX RESIDENT DECEDENT SUPPLEMENTAL AFFIDAVIT OF FIDUCIARY (lnlfruction~ on Reve,.e Sid.) * -----.--.------- Date of Deolh July 5, 1980 175-34-8290 Estate of HELEN F. COOK Lost Addres$ .~~~! c~nt~~.!_~~enue ._,____ Social Security No. Ca~_HiJ,l_._.__ ..p~_ 17011 Bureau File No. lei I.., l~tA rH (ZIPI Coanty File No. 21-80-480 I. Decedent died: ( ) Intestute (without 0 will) ( x) Testate (leaving 0 lost will--capy allached) Is the filing of 0 Federal Estate Tax Return required for this estate? Yes_ No IX ) Executor/Executrix ) Administratarl Administratrix Nome George B... Cook and Delores A. Smith Address 9 Glenwood Dr., E 147 Peach Lane, R.D. #8 ('~mr Hi" (CITYI PA 17011 (STf.. TEl Carlisle, PA 17013 lZIP) All correspondence should be moiled to (x ) Allarney ) Fiduciary. <"'> cD n~ ~ :tl~ S:c ""n ?,;.~ .=., ~o U');::rJ ?l~~ ::-:l .....f::) -~ -q'"T1 ~;~: N .J W ~, ., r' 'J ~ -" " . If on al!orney is representing the estote, indicate: Horace A. Johnson Nome Myers, Myers, Flower & Johnson Address P. O. Box 125, Lemoyne, PA 17043 ICIT 1'1 (STATEI (ZIP) List 011 safe deposit boxes regis!ered in the decedent's individual nameihar jointly with, or os on agent or deputy of another, or in decedent's individual nome with right of access by ana er os agent or deputy. Include the nome and address of the bonk or other insti tation where the safe deposit box i~ located, the nome (5) in which the box is registered and the relationship of the joint holders to the decedent. NAME AND ADDRESS OF BANK OR Oi"HER INHITlJTlOH IN WHICH OECEDENT MAINTAINED A SAFE DEPOSIT BOX - .- -. NAME OR NAMES IN WHICH SAFE ~EPOSIT BOX IS RECISTERED RELATiONSHIP OF JOINT HOLDERS TO DECEDENT None Jnder penalties of perjury, I declore that I hove exomined this return, including accompanying schedules and .tatements, end to the best of my knowledge and belief it is true, correct aod complete. ~~J , /1J J /7 L d ... _. _,<.p-t.!.W ( /. . d, !lIGNAl RE OF FIDUCIARY ~(;r. /~ L?K1 OATE ...'1 FiI e Number INHERITANCE TAX SUMMARY SHEET (BUREAU USE ONLY) 21-BO-0480 REV"U EX+ CHO) Date af Death July 5, 1980 o Original GJ Supplemental o Remainder Estate Name Helen F. Cook Social Securi ty Number 175-34-8290 REPORT OF INHERITANCE TAX APPRAISER I, the underslgnod duly appointod Inhoritanco Tax Appraisor In and far tho County 01 Cumberland Ponnsylyanla, do respoctfully roparl that 1 haye appralsod tho roal and porsanal praporty as roporlod In tho lorogolng retum at the values set forth opposite each item in the 'ast column to . rig In Sche J "A", US", "C.., and "E" Dated: November 10, 1981 ADJUSTMENTS REMAINDER APPRAISEMENT CDDE INVENTORY VALUE AS APPRAISED caDE (HARRISBURG USE ONLY) Roal P,oporty (Schodulo A) S None 00+ 92+ Personal Property (Schedule B) 53,669 06 10+ Jolnr.Hold Proporty (Schodulo E) None 20+ Transfers (Schedule C) None 30+ TOTAL GROSS ASSETS 53 669 06 Le.. D.bts and "Deductions 40- 93- (SCHEDULE F) CLEAR VALUE OF ESTATE o Life Estate RATE FACTOR PRINCIPLE VALUE CODE o Annuity FOR LISE OF REGISTER ONLY Tax on $ Tax on $ ~ COMPUTATION OF TAX $ $ $ $- $ 6% lS% Tax on $ Tax on $ Tax on $ Exemptions Total Estate TOTAl. TAX INTEREST FROM BALANCE TO $ $ $ Leu Credits DATE OF PAYMENT AMOUNT PAID TAX CREDIT S $ INTEREST FROM BALANCE DUE . . REY."S7 EX+ (7-eOt ,*: r~~.~~ . 'H~r~~ ~~ .._\~..!~~;~...t. INHERITANCE TAX APPRAISEMENT COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT rn SUPPLEMENTAL DORIGINAL Estate of Helen F. Cook 21-80-0480 File No. Caun ty Cumberland Date of Death July 5, 1980 In the event that any future fnterest In this estate Is tranderred In possessJon or enjoyment to collateral holrs of tho docodent aher tho expiration of any estate for life or for years, tho Commonwealth hereby expressly reuryes tho right to appraise and QISUI transfer Inheritance 'O)CGS at tho lawful collateral roto on on such futuro Intorost, PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH ASSET SUMMARY DEPARTMENT'S APPRAISED VALUE Total Real Property - SCH. "A" . . . . .. $ Total Personal Property - SCH. "B". . . . $ Total Jointly Owned Property - SCH. "E" $ Total Transfers - SCH. "C". . .-.. . .. $ None 53,699.06 None None 53,699.06 None None None Unreported $ Unreported $ Unreported S Unreported $ $ $ $ $ $ 53,699.06 LIFE ESTATE o ANNUITY TOT AL GROSS ASSETS DREMAINDER TOTAL VALUE $ I do hereby certify that the above approisement is made in conformity with Pennsylvania law and has been filed this day with the Register of WiIlS'~~ C--~ ~_ ~ November 10, 1981 APPRAI CATE , .. -'~ ... III ... "" " 0 <0 ,:: ,... ~ ~ ~ III ... ~ > -< :z: ~ ~ "" -< 0 .-I '" 0 >- >- 0 III ~ CJ H " '1:l '"" ... ~ .-I ,:: '" '" .-I III ;:l ~ III .... .-I ..l CJ :I: H ,:: III <I: Il> ... 0. ~ - .-I III ffi '"' u :z: Il> '" '"' - 0 :Il '" CJ CJ '" '" - 0 ~ 0 ~ i:l:: '" ~ !-o 0 en 0 Z 0 '" ~ en >- E- O - :z: ~ ~ !-o ~ Z Z ..l 0 - 0 !:l:: Z :.:: ~ :E Q ;:l U ~ ..l Z Z " Z - ~ en ~ 0 0 <I: == ~ U Q '" :J , . \' SUPPLEMENTAL Inventory of the real and personal estate of HELEN F. COOK 1. Net settlement of a Survival Action Claim pursuant to 42 Pa. C.S.A. ~ 8302. (Settled without suit being filed by release executed by the personal representatives - October 12, 1981) deceased 53,669 06 {f. <~ ,:; :') (: /~ 1 .,. ~ .:1. COMMONWEALTH OF PENNSYLVANIA 1. COUNTY OF CUMBERLAND J 51: GEORGE B. COOK and DELORES h. SMITH being duly sworn according to law, deposes a"d says that t h. yare Executors _ of the Estate of HELEN F. COOK late of J.QJ;",9_~h_oL~~_mp_Hi.U_.-.-.______._ , Cumberland County, Pa., deceased and that the within is an inventory made by them , the said Executors of the entire estate of said decedent, consisting of all the personal prop..ty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures oppo.ite each item of the Inventory represent it'. fair value es of the date of decedent's death. Sworn to ~~Adu.. t? -lx.tt;-/ ceorge B. k XQli~ lli~ Delores"A. smith and subscribed before me, /b/r-- 19 81 October (), <-' . A'-":;AR~ PU~~-- \S My ColDmiUlOll EsplreI Dee. :no 11181 L.-yDe, PII. Cumberland CoonI1 Glenv.uod Dr._, E 147 Peach Lane R. D. #8 Carlisle, PA 17eB Camp Hill, PA 17011 Address Date of Death 5th Day July Month 1980 Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. , U": . cv- ',.' ,.: c_ "j,:J il_ o c.. ~, . . :~~ c:: C""\ 0; ('oJ ~~ wu.. ~ 0>- E5 0::"': , lu ot:= ::.::~ Uw ~a:; - ~s SO ..JU U M ... I:: 0 0 r- oo .-i .-i I:: .-i .<: .:x: ''; g P< :I: . )- .,; ... III S " I:: I- W ~ '" ?- m " '" :>.. w < U .. III 0 0.. I- u .. ~ S 0 '" .. w w 'l-< C '" 0 >lll J: '" ~ 0 .. .-i ~H 0.. .,j 0.. I- ...J U. 0 r... ~ < 0 0.. 0 U. ...J 0 .<: :t: - 0 < w u >. . <In Z '" ::l - 00 N 0 . 0 c '" .-i C " '" z r... '" 0 III '" 0 0 :>.. ~ w < Z I!I ... ::;: 0 0.. -a fiI c I!I H - " -.: fiI 0 .. 00 . :1:1 ..0 -a "" '" 0 I .. E 0 III - ..!! I " " 0 :>.. . ...J U ii: '" :;:1 P< 0 ~ ~ Q) E-< ... Z I ~ 0 I- Q) fiI Z I H P< W N P< > :::> Z 0 <Il Z .' PRINCIPAL RECEIPTS Real Estate - No. 2951 Central Avenue, Camp Hill, PA Sold - Sales Agreement 3/5/81 Cash - Fur Coat - proceeds from sale Household Goods - Bank Accounts: CCNB Bank, N.A. - Checking Account No. 169-888-5 CCNB Bank, N.A. - Savings Account No. 002-074379-5 cumberland Valley Savings & Loan - No. 155738 Commonwealth National Bank - Checking Account No. 252-108766-4 State capital Savings Association - No. 002-00-09107 No. 002-00-08183 Insurance: National Home Life - pOlicy No. LK61094 Prudential Insurance Co. - policy No. 19-868-723 Continental Casualty - Policy No. SR 248400 Keystone Insurance Co. - pOlicy No. 0013-2053 Ohio State Life Insurance Co. - pOlicy No. 409852 prudential Insurance Co. - policy No. 19-868-723 Metropolitan Life Insurance Co. - Group No. 15500 Nationwide Insurance Co. - automobile policy No. B 542-210 - Net settlement of a Survival Action Claim pursuant to 42 Pa. C.S.A. ~ 8302 - Premium & Utility refunds Woolf Insurance Agency - Riverton Water Co. - adjustment of account Subsequent receipts H. B. McClure - refund - oil account Dunn Insurance Agency - Refund - Homeowner's policy CCNB Bank, N.A. - adjustment - mortgage pay-off Estate of Harry W. Cook - Real estate taxes adjusted at settlement Principal payments - Lebo Sales Agreement - Apr-Oct. TOTAL PRINCIPAL RECEIPTS L1BER iOO rm 131 -2- $ 70,000.00 109.00 120.00 3,842.75 2,455.96 16.84 2.19 3,434.11 6,878.74 729.44 1,516.48 8,101.49 10,000.00 2,000.00 962.30 10,120.12 510.82 7,962.30 53,669.06 7.00 34.02 16.27 212.00 80.82 380.39 631.65 94.92 $ 183,888.67 " ." PRINCIPAL CONVERSIONS INTO CASH Gain Loss 8/26/80 Housho1d Goods-Sold Inventoried at - $3,077.75 Proceeds 3,077.75 -0- -0- 3/5/81 Real Estate - 2951 Central Ave. Camp Hill, PA Inventoried at - $70,000.00 Sale Price 70,000.00 -0- -0- 1980 7/23 8/12 8/12 8/12 8/12 8/12 8/15 8/19 8/21 8/22 8/22 8/22 8/22 8/28 9/3 9/16 9/22 9/22 9/22 10/1 10/13 lc'.."'.".''''.'. .,.,..."....',. TOTAL - Transferred to Summary -0- PRINCIPAL DISBURSEMENTS Register of Wills - Probate & Letters $ General Motors Acceptance Corp. - balance automobile loan - Town & Country Charge - balance due pennsylvania Power & Light - electric service Bell of Pennsylvania - billing 7/1 - 7/31 Bell of pennsylvania - billing 8/1 - 8/31 Truman E. Horner - trash - July, Aug. & Sept. patriot-Evening News - Advertising Letters Register of Wills - short certificates Cumberland Law Journal - Advertising Letters Myers-Hall Funeral Home - funeral expenses Riverton Water - service 5/2-7/21/80 Pennsylvania power & Light - service 7/14-8/13 vital Statistics - addl. death certificates Delores A. Smith - airfare reimbursement Delores A. Smith - reimbursement - card of thank you - humane society charges Bell of Pennsylvania - final statement Pennsylvania Power & Light - service 8/13-9/12 Community Physicians - Helen's account Register of wills - payment on account of Inheritance Tax for 5% discount Internal Revenue Service - 1978 Income tax adjustment 50.00 1,546.82 83.39 32.68 15.99 40.21 11.85 31.20 5.00 18.00 307.50 16.52 26.89 12.00 714.00 27.46 .91 18.60 50.00 3,500.00 531. 30 lIBER 100 PAGE 132 -3- PRINCIPAL DISBURSEMENTS CONT'D 10/27 11/14 11/24 11/24 11/24 11/24 12/11 12/15 1981 175 1/5 1/12 1/12 1/21 1/21 1/28 1/28 2/9 2/12 2/19 2/23 3/13 4/9 4/9 4/9 3/5 3/5 3/5 3/5 4/3 4/7 5/13 5/13 5/15 7/2 7/2 7/2 7/7 7/7 pennsylvania Power & Light - service 9/13-10/14 Wesley Fetrow - house repairs Gingrich Memorials - Markers Riverton Water - service 7/31-11/3/80 pennsylvania Power & Light - service 10/14-11/13 H. B. McClure - oil delivery Roy E. Cook Ins. Agency - homeowner's policy Internal Revenue Service - interest on 1978 return Outstanding checks on CCNB checking account No. 169-888-5 - cleared after death Outstanding checks on Commonwealth National Account No. 252-108766-4 - cleared after death H. B. McClure - oil delivery pennsylvania Power & Light - service 11/13-12/15 Gorsch Plumbing & Heating - plumbing repairs George B. Cook - reimbursement for fur storage H. B. McClure - oil delivery H. B. McClure - furnace repairs D. & T. Mechanical Contractors - repairs (water leak) pennsylvania Power & Light - service - 12/15-1/15 Wesley Fetrow - water leak repairs H. B. McClure - oil delivery Riverton Water Company - service 11/3 - 2/2 pennsylvania Power & Light - service 1/15-2/12 Pennsylvania Power & Light - final billing West Shore Tax Bureau - 1980 income tax PA Dept. of Revenue - 1980 income tax Internal Revenue Service - 1980 income tax century 21 - commission - sale of real estate Anne Keller, Tax collector - 1981 county real estate taxes at settlement Dennis & Alice Lebo - repairs to intercom Myers, Myers, Flower & Johnson - attorney fee & notary fee - settlement of real estate - Prudential Insurance Co. - delinquent payments on mortgage Register of Wills - short certificate West Shore Tax Bureau - balance 1980 taxes Register of Wills - file Inventory, Debts & Deductions & RCC forms Register of wills - inheritance tax Delores A. Smith - executor's commission George B. Cook - executor's commission Myers, Myers, Flower & Johnson - one-half attorney fee - CCNB Bank, N.A. - pay-off balance on mortgage prudential Ins. Co. - pay-off balance on mortgage USER 100 I'AGE ~33 -4- 14.42 198.41 828.00 36.03 6.16 148.52 336.00 67.35 406.50 1,105.48 251.41 10.20 89.46 20.00 259.05 282.88 866 . 30 13.94 240.31 287.46 28.89 14.38 6.38 41. 93 111. 86 1,082.19 4,900.00 396.90 50.00 356.00 1,186.80 2.00 37.50 9.00 958.09 3,138.50 3,138.50 3,138.50 12,328.44 7,455.0.9 '. . PRINCIPAL DISBURSEMENTS CONT'D 1981 10/16 10/16 Register of Wills - file supplemental Inventory & RCC forms on survival action Register of Wills - Inheritance Tax on survival action Notary Fees - all documents Reserve Myers, Myers, Flower & Johnson - balance - attorney fee - Recorder of Deeds - Transfer Tax Close-out costs TOTAL PRINCIPAL DISBURSEMENTS PRINCIPAL DISTRIBUTIONS TO BENEFICIARIES TO: MARK BRADSHAW - Household goods, in kind TOTAL PRINCIPAL DISTRIBUTIONS INCOME RECEIPTS 8/26/80 Cumberland Valley Savings Account No. 155738 - closed 5/16/81 State Capital Savings Account Nos. 002-00-09107 Account No 002-00-08183 Interest earned on estate Statement Savings Account No. 12-60865-3 8/27/80 - 10/1/81 Interest on Agreement of Sale from April to Oct. 1981 - TOTAL INCOME RECEIPTS lIBfR 100 rAGE 134 -5- 10.00 3,220.14 4.50 3,638.50 700.00 200.00 $ 58,662.29 $ 765.00 $ 765.00 $ .02 334.70 35.49 2,082.13 3,218.20 $ 5,670.54 l I ;1 , ,- Ul ., l>:: .. ~ - ~ ~ E-l 0 :.;...: .J ;j 'J Z E-l " ~ ~ r<. I z 0 ::> ::> ~ ~ 0 0 ~ 0 U ... J H Ul U ~ 'J ~ Ul Ul 00: H U X :: ., -'. 00: H ~ H 00: ~ J ~ ; :> U H 0 " 'J H H ~ p:: H Z - .~ '':; P-< 00 0 00: 00: p:: ~ ,J ,J 0:> ~ H E-l :; '. ,- z ~~'f r<. E-l :.: H - .. 0 0 ~ r<. 00: l>:: 0 ::;: ,~ -. :;; ~ ::>0 0 0 U ...: 0 Ul -J , ~ 'J . ~ 00:> ~ 0 Il< '" U c' c, 0 OUI E-< U ~ r<. 0 . U U .-l ...: E-< 0 0 ....: u .. ; - N E-< 00: :ij lXl - .. r<. Ul Ul r<. H p:: Ul .. " " -;;:; 0 :ij . ~ t? ~ ~ ~ ,.. E: 0 z ::> E-l 19 ?, <, ~ ~..- = f;J :z: z ~ li! Ul l>:: 0 , '.-: P-< l>:: 0 H 'J ,. ~ ;~. U ~ ::> l>:: ~ 0 H ~ ~ u ~ ;; ,:J 3 0 0 p:: lXl '" 19 0 :;.0. " ~ -J ? - 'J " U U .<' " :: a 'J - " ;, ~ .. -1"7~~.S" t. 'iY'U ""00 .~ 'J - ,- .... -;;:; ''; .. = ~ .- o ~ . (Sf 4l 8 '41.lMGJa4 UOJ1nqlll~rp JO ill" "pa4oS pasodOJd t'\"M - - '. _ l' 0:-... "f' ~ .~ P;'6J:"ap UOnnqulSlp ,~", -. . U! _ . . f'l.._, ,.;~71'l' ;,. p PiiWJlJWO:) lunO~:J\1""""'" ....,._ ~...._ ......'- ISb!' M: '("au., r')~ 0:; ",'" r-..' ~r::: ",'" ...)e") 1..;:'-, '2 ~.o Ir,,. ,~ ::rJ .~, ... , .D r':. '''I N .., .. 1."J l:-,J. "3 .', 00 E .( t" " t'" ~ . ~ t . ~ = f<l . f<l~ t II< E ~:: m "'" ~ . . b . ~ .. ~ . " z . I!l~ ~ = . ;.< 0 ~,.oj " ~ c ... 0"" '.. " "" ... ~'- =~- ~ ] ~ ~~-~~ ; :g " ';j COMMONWEALTH OF PENNSYLVANIA: ss. COUNTY OF CUMBERLAND GEORGE B. COOK and DELORES A. SMITH, the within Accountants, being duly sworn according to law, depose and say that the Statement of Facts set forth in the foregoing Statement of Reasons and Statement of Proposed Distribution are true and correct. ~ tZ. L,d, DELORES A. SMITH Sworn...uCl)...p'-nd Subscribed ..... ....:I:-J() .... ,,' ,.~'I,ilro.j".. '" _" /ilL P~,~~~~f~:;,~lf q ~ . day :' ,"r1-;., ....-,~ ....~....;. I.J, ,... ," ':. L2.t(~~Ct~#.bei~ '~':'r%., 1981. ~ "',':'1 :";'",'f:t\ "I :'" = '(5~:~~~~ .,{y ...:ollllDiaslOll E.plr.. Dec. 21, Jill} ~'lDOyDe, Pn, Cumberlnnd ComJ" lIBfil 100 fAGE 13'7 ~+) 05 ,- :o~ ~"T.l - ..:;...~ ;rlO I~; .. ColO ,." ~ -;;7.1 "1., ..\J ~ f : t :. :-oJ ,'.:-; . -' ....., E .. ~t tJ. - ~ tI: :;:: -. :; E-t ,- . fj ., :: r... Q Z c; .- Z 0 0 , ~ 0 ~ ~ O~H r... H Ul H C - ~ ~ ~ Ul 0 ~ H .0: E-t '" ~ , ~ < < ofllt; ~ H ~ ::> u -, j . ~ ~ .~ . t ~ tI: ~ U III '';:: ] . U~~~ ~ H E-t ~ r... H g -~~ ~ t r.l . r.l ~ Z Q 0 0:: .. t Il< ~ Il< r... ... E-t ::> E-t - 2 . . ~ ~ o E-tl Ul :<: .0: 0 E-t Ul ~ '. ~ . . . . 00::0 ~ 0 U U .0: Z H - ~ ~ ~ ii .. Z III E-tU::>co 0 H ~ Q ~ ~ ~ . ) :l 0::~01 ~ U r... Q Z " ~ . : ;! ~ ~ ::> U..-t tI: 0 ~ :g: ~ Q " . o N E-t E-t ~ " - .' ~ U - r... tI: ~ H .0: Ul - ,- ~ Ul . Z t.:l ~ E-t 0 ~. c ~ ~~~g H Z ::> ~ Ul Ul p., :-= . j ~ ~ g ~ Z g ;:, - E-t tI: H Z , .. .- - '" U~ ~ 0 ::> ~ p., ~ S " ~ 0 ~ ~ Z tI: III U p., :::. - ~ ; C H [:;0 " ;~ ;: 'l) .. ':: ~ " .. .- == .~~ .. 1 .-. ~ '" .- .. .. ~ " '. ~ COURT OP COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-00-480 ESTATE OF HELEN F. COOK, DECEASED LATE OF THE BOROUGH OF CAMP HILL SECOND AND FINAL ACCOUNT OF GEORGE B. COOK and DELORES A. SMITH, EXECUTORS Date of Death: Ju1v 5, 1980 Letters Granted: J~ly 17, 1980 First and Partial Account confirmed November 24, 1981 SUMMARY & INDEX Pages PRINCIPAL: Receipts Less Disbursements 2 2 $46,184.29 58.00 princi~a1 Balance Remaining INCOME : Receipts Less Disbursements 2 3 $ 3,637.65 185.86 Income Balance Remaining COMBINED BALANCE REMAINING* *combined balance remaining consists of cash. Ll.3EP. 101 pm 300 $46,126.29 3,451. 79 $49,578.08 ".-.~_~r...,~,."",_.....".~,---.~.-- . '. PRINCIPAL RECEIPTS Balance for Distribution as per Pirst and Partial Account Subsequent Receipts Principal Payments - Lebo Sales Agreement - Nov. - Feb. Balance of principal reserve from First and Partial Account TOTAL PRINCIPAL RECEIPTS PRINCIPAL DISBURSEMENTS Register of Wills - File Second and Final Account - TOTAL PRINCIPAL DISBURSEMENTS INCOME RECEIPTS Closing interest - Estate Statement Savings Acct. No. 12-60865-3 Interest earned on Repurchase Agreement Account 10/26 to 11/24/81 11/24 to 12/14/81 Interest on Agreement of Sale from November to & including March 1981 _ Balance of Income reserve from First and Partial Account - TOTAL INCOME RECEIPTS ",3E:, -i01 rm 301 $ $ $ $ 46,000.00 57.29 127.00 $ 46,184.29 58.00 58.00 324.66 597.72 345.97 2,141.62 227.68 $ 3,637.65 . , , r..;:l o;S;z rn~S 1;j ~>< ~ H :> p. ~ z o '8 ~~!3 O~O uou r.. !u _ o rn z a1 :;3 ::>~~Il' o P:: U 0 r.. o ~ 8 ~ rn ~ Cl ~ rn ..; ~ U ~ Cl :<; o o U ~ z ~ H ~ :I: 'cI Tf1 D >1~l: ."1'<:9 '"1''' 'l?:Ja, I.>noO "p~ .'naJa4 00 U f..IY P .4.0'; PSSOdoJd lJ . ''''lqfJJF1P JO 91ft 3,} ",.p 110' '. ,I ." B~IJe"'Jc .. l'i)iI'" Jr lr~ '.1'.-..... f~ "")"1;' tJf -..Jl~" """" . ~~,~ r~J'I .(,_ .1 lunO,'.:.>", .... _. _ ,"'mIO~qll' 'f.>;fl,17i'''oru., ~ o ~ 8 ..; H H H H :I: P. :;, ..; U ~ o :I: t9 ::> al o ~ ~ :I: 8 8 Z ::> o U U ..; H ..; Z H ~ 'tl l::: ' ca:I: 8rn :<;HP:: 0::;:0 Orn8 U ::> Cl r.. . U :z 0 ...; ~ ..; ~ X rn~ Cl ~~ Z ~o:: o P::O U OH ~ ~~ U) CO ., - :... - eJ.::: '- 0: ~ :) ~; '- = ..... ~..:~ ~ .=--- - -' a :: -- ;.' ~ ~ 'C :- ~ - ~ ,~ ~ -' ?J 'j .~ 5 G " '~:J g ~ - ~J .: :;; ~ ~ or " ~] ... c :~ - .;:' ~i n ,", __ ~~~c ~ 0 ,. .', ,. I. > ~ ~ ..... 'Cj ~..c .", ::.J ~ W S :- " ..0 US...:.J -...I.::! ~<;;. <3:'--- ", .... ~ 1: :E ~ ., J z o en ~ ~ l-;' ~~. !"r:.' ;:: ' ~H ~ ! ~ ~ It ~ m t ~ ~ . ~. w . ~ ~ o · 0 ~ ~ '"" qe 0:; "-J .~ = ~ .:':::l dM ~ ~ ~J i ~ ':;;: . r.\ c- ia ~ ~~ . ::30 ~ ".i o ,., ",'" __"tTl :':',0 '.t.. ." co , .';'J IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-80-480 IN THE ESTATE OF HELEN F. COOK LATE OF THE BOROUGH OF CAMP HILL SECOND AND FINAL ACCOUNT OF GEORGE B. COOK and DELORES A. SMITH, EXECUTORS STATEMENT OF PROPOSED DISTRIBUTION Balance for Distribution as per Second and Final Account - $49,578.08 DISTRIBUTION To: Delores A. Smith One-Third $16,526.02 To: George B. Cook One-Third 16,526.03 16,526.03 TO: Mark Bradshaw One-Third $49,578.08 STATEMENT OF REASONS Decedent died testate. Distribution is made in accordance with the Will of the decedent of the item retained for further administration in the First and Partial acc B. OOK Ab~. t? b-t-:r.L DELORES A. SMITH COMMONWEALTH OF PENNSYLVANIA: ss. COUNTY OF CUMBERLAND GEORGE B. COOK and DELORES A. SMITH, the being duly sworn according to law, depose and of of Proposed Distribution are true .......";1...,.. .' ..:~::i~J:..~...~.;:.:.::>::., Sw~~:.~o:a~Q\~~~sR.!ibed bef<?t~ me. th~:s'\:(1 day of'-.:March A;;D.',\T982. 'ri:,i;." ::'</:,/ . .''''........~ ."~:~.~l...... ~ .... .:: '.. '. ',; I)..~.:;.... m'"c '6 .... .........)."nll...., 'I.....:.". . 1.:'{ ('..;.7.~.rr.:.':;lc;} Expires Dec. 21. 1985 L'Jrr.oJ'li.<~. Po. Cumberland Countv tiEL;; '~Oi "\r.r. ?03 ... ..... I........ U ,~ 05 . .r ",'" ~.: ,':. ;...) -, ," P1fT1 ;'; -,.., ....l":} ~ " " ., , ~::'l Ul ::i c '-' " " .~ Z .c - .. - .- .0: H ;: ~ . 0 ;" .. r.l Iz H :L ~ " " Ul H [>.. H ~ C ", '0 ~ - ~ " " ~ 0 ::c -= '0 S. ... Cl Ji 0 " " 0 Z [>.. r.l ~ r.l Cl OJ " 15 " ~ .., ~E .. 0 0 ~ :;: Ul r.l .c " " ~ .0: .0: Ul - ., .~ oll ~ E < ~ .g . r.l H tJ r.l 0 ~ " :;; III j . ~ 0 :> E-t >< tJ ~ Z 0 ~. ~n ~ . t " tl ~~~ .0: [>.. E-t r.l 0 0 <IJ .0 OJ :. .- - " ~ ~ ~ . E-t :.: 0 f3 Cl "" H u 'C " , ~ t E p., .'" ~ ~ 0 r.. Ul 0 ~ E-t 1;; ;: " . 0 c. , .' fil ~ . ~ . ~ 0 E-tl r.l 0 ::c 0 . ::> " i:5 ';.'.- " . ~ w ~ 0 8""0 tJ (..9 tl .0: r.. III .. .. ... :.:2 ~ i E-t Pee r.l P H 0 H " " .:.: 7;' ui ::l <IJ '" . 0 .. ""~Ol ::c 0 Cl Z "" t:: OJ .. ~', :.1 .. " .,. ~ ~ ] .. ,. ... ~ 0 e ~ ::> tl.-l E-t [>.. "" Z ;; E-t E-t .~ j C .:> " ~ o N 0 .0: Z Ul :: - ... .~ . t.l tl . Z Z I!l li'J H ~ H .:.; ~ g Ul . H r.l >< Cl - " c'.\ " " . :1 .. .. gj~~g H r.l ~ Ul ~ .<= :::; ., r.l ::c ~ z E-t - .,. .' ~ 0 'I; .. ... E-t ::c ::c E-t Z es ~, .- .. ., .- ~ - '-' :;'~ ] ~ Ztl~ ::> ~ '€ .. .. tl ~ (J] ~ ~, "C " ... :.. v, HfJO '" 1,; " = ;" 1,; " ~ ... .,. .. " .S! ~. P rii - ~ ... ;.. !'- :: 'C - '- j~ ~ " " .~ p .~~ - " - ~ '" ~ ~ " . I "V Estate of Helen F. Cook Court of Common Pleas of Cumberland County Orphans' Court Division No. 21-80-480 TO TIlE CLERK OF THE ORPHANS' COURT: Kindly mark the claim of Small Business Administration, Suite 400, Onc Bala Cynwyd Plaza, Bala Cynwyd, PA 19004, in the amount of $5,884.93 plus accrued interest thcreon, satisfied. This document is executed pursuant to Delegation of Authority No. 30, Rev. IS, published in Federal Register for 10/16/79, Vol. 44, No. 201, Federal Register Doc. No. 79-31881 filed 10/15/79, effective 10/1/79. . .-P0-Jflid. ? Paul E. Beck, Jr. 'f Assistant District Counsel Small Business Administration ~ REV. 1583EX (12-B6) COMIIOI(Vr.'EAlTH or PEJjNSY~\I.UIlI. DEP,l,lnMENl Of RE\[NUE BUREAU 0' tliDl'o'lDUAL tAXES , ~'~~R~~B~R~~Z~iL 1710&-8327 RECORD ADIolUSTMENT IDATE 05-28-87 ESTATE OF COOK HELEN F FI~E NO. 21 80-0480 DATE OF DEATH 07-05-80 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WI~~S OF THE ABOVE COUNTY. MAKE CHECKS PAYAB~E TO "REGISTER OF WI~~S. AGENT." . , ASSESSMENT CDNTRO~ NO. INHERITANCE TAX 101 H A JOHNSON MYERS MYERS FLOWER ETAL 3RD & MARKET STS LEMOYNE 17043 PLEASE RETURN THIS PORTION TO REGISTER OF WILLS IF PAYMEfolT DUE Amount Remitted to Replster of Wills <!~'!: ..A.!-~~~ _ ,!:HJ~ _L!~E_ _ _ _ _-::_ _ _ _ ~E.:r~LN_ ~Q~~'3 _PP_R.TLO_N_ ~C?'3 _Y_O.!-l_R _13~~~R_D_S _ - - - - - -~ - - - - - - . REV. 1593EX (12-B6) --INHERITANCE TAX RECORD AD~USTMENT-- ESTATE OF COOK HELEN F FI~E NO. 21 80-0480 ACN 101 DATE 05-28-87 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION VA~UE OF ESTATE: 1. Re.1 Est.te ISchedule A) 2. Stocks .nd Bonds (Schedule B) 3. Closely Held Stock/PartnershIp Interest ISchedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule Gl 8. Total Assets (1) ( 2) (3) ( 4) (5) ( 5) (7) 70,000.00 .00 .00 .00 115,607.63 .00 .00 ( 8) 185,607.63 DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Administrative Costs/Miscellaneous Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I 11. Total Deductions 12. Net Value of Ta:'l: Return 13. Charitable/Governmental BeQuests (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) .00 54,678.58 1111 (12) (13) (14) 54,678.58 130,929.05 .00 130,929.05 TAX: 130,929.05 .00 X.05= x'15= (17) 7,855.74 .00 7,855.74 15. Amount of line 14 taxable at 6% rate 16. Amount of line 14 taxable at 15% rate 17. Principal Tax Due TAX CREDITS: (15) (16) PAYMENT DATE RECEIPT # DISCOUNT 1+) INTEREST H AMOUNT PAID 10-03-80 063386 184.21 3,500.00 05-15-81 I 029519 27.37- 958.09 10-23-81 069780 85.57- 3,220.14 10-23-81 I ABATED .00 100.43 INTEREST IS CHARGED FROM 10-24-81 TO 06-12-87 TOTAL TAX CREDIT 7 .849.93 AT THE RATES APPLICABLE AS OUTLINED ON THE BA~ANCE OF TAX DUE 5.81 REVERSE SIDE OF THIS FORK.- INTEREST 1.96 . IF PAID AFTER DATE INDICATED SEE R~VERSE FOR CA~CULATION I TOTA~ DUE 7 77 OF ADDITIONA~ INTEREST I . (IF BALANCE DUE IS ~ESS THAN $1 OR IS REF~ECTEC AS A "CREOn" ICRl, NO PAYMENT IS REQUIRED) PAYMENT: Detach the top portion of this Notice and submIt with your payment to the Register of Wills. --Address Information is listed on page 11 of the booklet. "Instructions for Inheritance T;x Return for a Resident Decedent" --M.ke check or money order payable to: REGISTER OF WILLS. AGENT. All payments received shall first be applied to any Interest which may be due. with any remainder applied to the tax. REFUND leR); A refund of a tax credit. which was not reCluested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (Form REV- 1313). Applications are available at the Office of the Register of Wills. any of the 24 Revenue FIeld Offices. or from the Department's Forms Service Unit 24 hour Forms Ordering telephone hnes in Harrisburg - (7171 787-8094. in Philadelphia - (215) 351-2065. or in PIttsburgh - (412) 565-3601. REPLY TO: QlIestions regarding errors contaIned on thiS notice should be addressed to; PA Department of Revenue. Bureau of Individual Taxes, P.O. Box 8327. Harrisburg, PA 17105-8327. ATTN: Post Assessment Review Unit (717) 787-6505. If any tax due is paid within three (3) calendar months after the decedent's de,;,th, a five percent 15%) discount of the tax paid IS allowed. OISCOUNT: INTEREST: Interest is charged beginning wltn first day of delinQuency. or nine (9) months and one (1) day from the date of death, to the date of payment Taxes which became delinQuent before Januar~' 1, 1962 bear Interest at the rate of SIX (6%) percent per annum calculated at a daily rate of .000164. All taxes which became dehnCluent on and after January 1. 1582 Will bear Interest at a rate which will var~' from calendar year to calendar year with that rate announced b~' the Pennsylvania Department of Revenue. The applicable interest rates for 1982 through 1987 are: !!!!.. Interest Rate Daily Interest Factor ~ Interest Rate Daily Interest Factor 1982 20% .000548 1985 1":10' .000356 -" 1963 16% .000438 1986 10% .000274 1984 11% .000301 19S7 9'. .000247 " --Interest .s calculated as follows: INTEREST . BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice Issued after the tax becomes delinQuent will reflect an Interest calculation to fifteen {151 days beyond the date of the assessment. If payment IS made after the interest computation date shown on the Notice. additional Interest must be calculated. (I) Ul :3 0 :I: (I) U +' ., 'M I-l ., ""' :3 ""' 0 " 0 U II <'l - ~U> (". Ul >..-i .-l +'0 - ~ .-l e.... 'M :3 .-i :;: 0 - '. U .0: ""' "" - 1":," 0 'tl - t. ~ : =-~. 01" e . Cl:l,.' = I-l ltl (I) Ot.;; (I) .-l .-i CJLo..: r-- +' I-l Ul lX!'" lX' Ul (I)'M - 'M .0 .-l Cl E I-l (I) :3 ltl 0: U U ~ "-l Z o - "-l ~ cs ~ ~ '" 0 g::l ~ '" ;;:.In ~:; t) po i-'....z u:~~><~ ~ l;:; O<i 0,", ~ ~.~ ~ ~ ~ "-l 0 Z ..J - c;9 .z ILo '" '" ILo Cl '" ::J O<i oi - .... Z o '" Z :I: o ~ '" o o ..; Z >- o ::;: '" ... " REV. IS&3EX (12-86) eOMY"HWE:~TI'l Of PE"'''S,~,''''lIL INHERITANCE TAY \ASSESSMENl~ OED,l.PTl,IE:H.T ." REV!"l\lE "'^ aU"tA.U 0' 'NCI"'OU'\~ tI.xu. \1 CONTROL . '.0: BCX "" RECORO AO~USTMENT ...:.RR1$8URG, pto 17t06.1327 DATE Oc=.- - ESTATE OF COOK HELElI F FILE NO. 21 80-0480 DATE OF DEATH COUNTY R NOTE: TO INSURE PROPER CREOIT TO YOUR ACCOUNT. SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REOISTER OF WILLS OF THE ABOVE COUNTY. MAKE CHECKS PAYA8LE TO "REGISTER OF WILLS. AGENT." H A JOHllSOll MYERS MYERS FLOWER ETAL ~RD & HARKET STS LEHOYNE 17043 PLEASE RETURN THIS PORTION TO REGISTER OF WILLS IF PAYMENT DUE Amount Remitted to Register of Wills l!l,!1..A!-9~~_1HJ~ .L!N..E.. _. .-::. _ _ .R.E:re-!.N, ~Q~~~ _P_O.!':r~O_N_ ~q~ _Y.9~.!'.I3~c:.q,RP~- -.." - -~- - - - - -' REV. IS&3EX (12-86) ,'INHERITANCE TAX R~CORO AO~USTMENT" ESTATE OF COOK HELEN F FILE NO.21 80-0480 ACN 101 OATE 05-28-87 ADJUSTMENT BASED ON: ADHlllISTRATIVE CORRECTIOll <"l ~ ('"")~ "'~ S:;~ en.., ( II 70,000.00 ;:t~ "~o rn' ",. ;;;::0 ( 2) .00 ::rJ~ ~ _,,=, ;.-;r'Tl ( 3l .00 C.:',; . :~,~? tn ':1:'- ( 4) .00 ~" :~. ., ( 5) 115,607.63 ,", B ( 6l .00 ~ ( 7) .00 .:.,:, ( 8) 185,607.63 VALUE OF 1. 2. 3. 4. 5. 6. 7, 8, ESTATE: Real Esta,e (S:hedule Al Sloe.. and Bond. (Schedule B) Closely Held Stock/PartnershiP Interest (Schedule C) MOrlgages/Notes Receivable (Schedule 0) Cash/Bank DepOSitS/MIsc. Personal Property (Schedule EJ Jointly Owned Property (Schedule Fl Translers (Schedulo GJ Total Assets DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/ Administrative Costs/Miscellaneous Expen.e. (Schedule H) , O. Debts/Mortgage Liabilities/Liens (Schedule I ,1. Total Deductions 12. Net Value of Tax Return '3. Chafltable/Governmental Bequests (Schedule J) 14. Net Value of Estate Subject to Tax ( 9) (10) .00 54,678.58 (,ll (12l (131 (14) 54,678.58 130,929.05 .00 130,929.05 TAX:. , S. Amount of line 14 taxable at 6% rate 16. Amount of line 14 taxable at 15% rate , 7. PrinCipal Tax Due T AX CREDITS: (15) (16) 130,929.05 .00 )(.06= )(,15= 117l 7.855.74 .00 7,855.74 PAYMENT RECEIPT DISCOUN7 1+) DATE p INTEREST H 10-03-80 \ 063386 184.21 05-15-81 \ 029519 27.37- 10-23-81 ' 069780 85.57- 10-23-81 ABATED .00 AMOUNT PAID 3,500.00 958.09 3,220.14 100.43 INTEREST IS CHARGED FROM 10-24-81 TO 06-12-87 AT THE RATES APPLICA8LE AS OUTLINED 011 THE REVERSE SIDE OF THIS FORH.- . IF PAID AFTER DATE INDICATED SEE REVERSE FOR CALCULATION OF AODITIONAL INTEREST (IF BALANCE DUE IS LESS THAN $1 \ I \ TOTAL DUE I 7.77 OR IS REFLECTED AS A "CREOIT" (CRI. NO PAYMENT IS REQUIRED) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST 7 W ALTHU~~ DEPARTMENT OF REVENUE BUREAU Ol=.INDlltIDUAL TAXES.. P. O..BOX~327 - HARRISBURG, PA 17105-B327 . EXPLANATION OF CHANGES DECEDENrs NAME Hel en F. Cook FILE NO. 2180-0480 ACN 101 ITEM . SCHEDULE NO. EXPLANATION OF CHANGES The Notice of Inheritance Tax Appraisement, Allowance or Disallowance of -Deducti ons-;--and-Assessment--of-Tax-i ssued -Oune-1O-;-1981trnrtre-enadjUsted 1 n accordance with the Approval of the Office of Attorney General issued -May-6-;-1987: .------.------ --Interest is -abated.-in the amount of-SlOO:43:----------- -----------------.-.....-. -,--,.,-'-'-'~'-'---_.- ..--------.---.-------.. - ------ --" --..----------.. -------..--.---...---. ----------..--.--- - --_.- .---- ---------------.---- .----.---..-------.-----..-- --".'- .----_.. ..__" .______~_.___.__. _____._.___.___. .._ m..__.______ ----------- ------ - --.--------..--..---.--- __u....___.___. ._____ _ ..__._..___n ----- ---------. ____________.______.___________... ._.._n___._______.___.._.. - ---...---. -.-..------- -' .--.---- _.--- ..- ._-.-~-- _.-.._-- -_.._--_.~. ...--_. .--.-. ----_._-----~-.--.. ... ----.----- ---.------------- ..-----..-. ._.-. .. - . -_.__._---~_.- -~---- L:210 TAX EXAMINER, ........-.... . '" ~ ",'" n~ e_ ","" -~ .,.,n ffi-:- n >= ",,,,, :"'l1C"~ Z ._~Cl ;n-. rr,""-'; .-;.~ I ....":~ ..":.;:.., -~~:. -.... - ,)'1 .-' ., -:-t- ~ -. ~ ,-i; PAGE ___.,_ _ ___ ___ ._n_ _. __ _-" ~- ------ --.-. --- ---- ---." NO. M284011 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX .' o. -. . ---- .. -.:..:....-( .' m ~ m AMOUNT Assessment Control No. RECEIVED FROM: 101 $7.77 I Hyers, Johnson, Duffio & Waidnar I P. O. Box 109 Lamoyne, PA 17043 L ~ ESTATE INFORMATION: FILE NUMBER NAME OF OECEDENT MI DATE OF PAYMENT POSTMARK DATE June 4 1987 COUNTY cumberland ~ DATE OF DEATH iJu1 5 1980 ~ REMARKS G TOTAL AMOUNT PAID $7.77 = SEAL II 110 RECEIVED BY . n a REV.1162 EX 11-851 ,-,L _, I ~;, : :"_ . ,....d! ... - . or_"T'--"'- WL ----.....---- - ... ........,.-- --- ~ __ ___ __ ____ ____~ _ ___. ____ _m~ _ __ -.- --- .------.-