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PETITION FOR PROBATE
No. 21.80
OF WILL At<lD
489
LETTERS TESTAMENTARY
in the Estate af
FLORENCE M. CALDWELL
, deceased.
Mary C. Lewis
To ~~li~P,o~f~~ Register of Wills for the County of Cumberland,
in the Commonwealth of Pennsylvania.
IS
PetitionedID efi~he executrix named in the Last Will and
Testament of Florenc" M. Caldw"n dated .T~nll~ rl' 1 ~, 1 q-/.3.
Decedent was a citizen of the United States and a resident of
lCowmM1p{
Borough, Cumberland County, Commonwealth
r::ton"'lp J-flll
of Pennsylvania.
Decedent died on
1<''rit1~)r
the 1 I th
day of
Tnl ~r
A. D. 19 80 , in the County of r;IlIYlberland
, State of
Penn.ylvania at the age of q3 years.
KalS{ ~ her
Decedent has not been married and has not had children born to kimC
since the execution of the above described Will.
Decedent was possessed of personal property to the value of
$100,000 and of real estate to the value of
None
as near as can be ascertained; said real
estate situated as follows
awt9C
Therefore, your petitioner(x) respectfully applies for the probate
of the said Last Will and Testament and for Letters Testamentary thereon.
Dated .Tilly Ii. 1980
Name and address
of Petitioner(;G)
~y~Ji!- r; .{#~
Elizabeth C. Lerner
Apt. 114, 311 April Drive
Camp Hill, Pennsylvania 17011
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY OF CUMBERLAND ~ ss
ELIZABETH C. LEFFLER
named in above application, being duly .worn according to law
say(s) that the statements set forth in this petition are true to the
Sworn
and subscribed before
knowledge and belief. .
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best of he r
Filed:
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me,~ 18 1980
~ 4~~~~
~!b6: IlIIlt~ellJiSIar
Mary C. Lewis, Register ~
1'5:~~
1980 Attorney: Herbert G. Rupp, Jr. ~
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3lia6t JItll aub ffit6tattttut
OF
FLORENCE M. CALDWELL
I, FLORENCE M. CALDWELL, of the Borough of Camp Hill,
,
Cumberland County, Pennsylvania, being of sound and disposing mind and
memory, do hereby make, publish and declare this for and as my Last Will
and Testament, hereby revoking any and all wills by me at any time heretofore
made.
ITEM I _ I direct my Executrix hereinafter named to pay all my
just and lawful debts and funeral expenses out of my personal estate as soon
after my decease as is convenient.
ITEM II _ I give and bequeath to my granddaughter SUSAN E.
LEFFLER the sum of $1,000.00 (one thousand) dollars.
ITEM III _ I give and bequeath to St. Thomas Episcopal Church,
Oakmont, Pennsylvania, the sum of $500.00 (five hundred) dollars.
ITEM IV _ I give and bequeath to my former domestic servant
FLORENCE T. HATCH, Fletcher Way, Pittsburgh, Pennsylvania, the sum of
$200.00 (two hundred) dollars.
ITEM V _ All of the rest, residue and remainder of my estate
real, personal and mixed I give, devise and bequeath to my daughter,
ELIZABETH C. LEFFLER.
ITEM VI _ I nominate, constitute and appoint my daughter,
ELIZABETH C. LEFFLER, to be the Executrix of this, my Last Will and
Testament.
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IN WITNESS WHEREOF, I have hereunto set my hand and seal
l....z.:t;;;
this r J ~ day of January, in the Year of Our Lord, One Thousand Ni,ne
Hundred and Seventy-Three. (A. D. 1973)
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FLORENCE M. CALDWELL
(SEA 1.)
This instrument, consisting of Two (2) typewritten pages, each
bearing the signature or the initials of the above-named Florence M. Caldwell,
was by her, on the date hereof, signed published and declared by her to be her
Last Will and Testament, in our presence, who at her request and in her pres-
ence, and in the presence of each other, we believing her to be of sound and
disposing mind and memory, have hereunto subscribed our names as
witnesses:
I
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residing at U r,.,~~~) f?-..
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OATH OF SUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLVANIA t ss:
COUNTY OF CUMBERLAND ~
. . 18th July 80
ThIs............................................. ........................... day of ................................................................ A.D., 19........,
Mary C. Lewis
before me K~E~el-1!OOi, Register for the Probate of Wills and granting letters of Administration
in and for said County of Cumberland, in the Commonwealth of Pennsylvania, personally came ..............
.......Hl:x.b.l\J:~.Q,...B.\\IlIl,...J.!':'................................................................................................................................
the subscribing witnesses to the foregoing instrument of writing purporting to be the last Will and
Testament of ...n.m:!lf)..c;:.'l'..M,...~.'!-.~g:-.'{!).u...................................................... Dated ..J!HH!~E.Y...~2A...~~.n.....
late of ..............~.'!-.mp..g~l~.................................. ......................................... Cumberland County Pa., deceased
who being duly ...~.':':'.'?~~............................. according to law, depose and say, that .."b.~..~il:I!.......................
present, and saw and heard the testaJ.r.!~........................, ...f.JRE.'l'.m:~..M.,..9.!':~.~~~~L.............................
sign, seal, publish, pronounce and declare the said instrument of writing as and for h~x............ Testament
and Last Will, and at the time of so doing ...............~.~?............................was of sound and disposing mind
memory and understanding, to the best of ...............h~."..........................knowledge, observation and belief.
~~~4~...............
Miry C. ~ewis, RegiP
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.....:/l~..............G<:?...~~.................
...~..\...\.ir.Ji.n..~kl..fMU.~...............
(~erbert G. Rupp, Jr. .
...................................................................................
....SNllorn............................... and subscribed before
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA t ss:
COUNTY OF CUMBERLAND \
...EJ.t'l'.~p.!lt.h.g.....j:,..'l'.fg~.r...... ................................................... ...... .................. ............ ........................being duly
...!!~RE.J;l;................................. says that as nearly as can be ascertained the said decedent ..........................
..ElareD.c.e..M....C.1J.ldNllell...................... ........................ ............... ............. .............................. .... .......... .died on
..f.r.f.':\il:Y................................. the ......).~.~.~.................day of ........!.~.~y...................................... A.D., 19..~.?,
at or about ............1:.0.Q...................... o'clock, ;I2.M.
...~:-.'{!?E.J;l;.....................................and subscribed this
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..:.. ~-.. ~. ~~~:;(. ~.:!: r".;..~.... ....~,. :.: .1:: .r:..!.~ .-;:1..............
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-; Elizabeth C. Leffier
. / .
.......................t~Jh.................. day of ...!..':';~y..............
19, ..~.9..., before
~1f!:Jt~;;r... ~~ww
Mary C. ~~, Reg~!
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA}
COUNTY OF CUMBERLAND SS:
Before me, the Register for the Probate of Will" and granting of Letters of Administration in and for
the County of Cumberland, personally came ....)!;;~!.~.Il..~~~.\;J,..~i:.J~l?ffJ:!!"'.......................................................
who, being duly .....f!.~.'!.'!".~............, do .':.~..... depo~e and say that as....~~.~.S~~.'!".!~..........................................
of the last Will and Testament of ......f..l!?~.".\1S!;..M:...~.!':1.c;l.~.<:.l~........................................................deceased
....~.Il11............... will well and truly administer the goods and chattels, rights and credits of said deceased
according to law. And also will diligently comply with the provisions of the law relating to Transfer
Inheritances. ....9.~.'!.'!".\1............. and subscribed
before me.
...............i1'!:I:~:i...~~......................... A. D., 19 JilL.....
R~~.~~~~....................
Mary C~~iS' Register
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..................................................................................
Elizabeth C. Leffler
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DECREE
Be it remembered that on the ........~~.~.~....... day of ....J.v.1Y...................................., A. D., 19 ..?~.., there
was probated and recorded the last Will and Testament of ....fJ9.1:.".n!<!l..M.....g!!-g~!'\n.............................,
late of .....~.'f.mp..mg...................................................., Cumberland County, Pennsylvania. Deceased. Letters
.......T.M.t.q..mll}),tllh.y...... ................ were granted to ......~~!~.~l?!:~.I:':.~:...~.~.~g~.~...............................................
Witness my hand and official seal the day and year aforesaid.
m~
Mary C. Lewis
.
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Invontory of tho roal ond porsonol o.tolo of
FLORENCE M. CALDvffiLL
REAL ESTATE
None
PERSONAL PROPERTY
CCNB
---- Checking Account No. 126-905-9
Savings Account No. 006-071044-9
principal
Accrued Int.
Mellon Bank, Pittsburgh
Certificates of Deposit:
No.
K66B55
principal
Accrued Int.
No. K43614
principal
Accrued Int.
No. K36156
principal
Accrued Int.
No. K56194
principal
Accrued Int.
Dollar Savings Bank, pittsburgh
Nos. 50230B623
principal
Accrued Int.
5020172B2
princ ipa1
Accrued Int.
National City Travelers Checks
united States series "H" Bonds
M 16330044H July, 1975
M 16330041H July, 1975
M 16330040H July, 1975
M 16330039H July, 1975
M 16330042H July, 1975
M 16330043H July, 1975
united States Series "E" Bonds
C 9249566E May, 1942
C 9249565E May, 1942
Q 333597975E Dec, 1943
Q 1605461279E Dec, 1957
Q B762543E Feb, 1942
Q 8762542E Feb, 1942
Q 1B027755E May, 1942
Q B762541E Feb, 1942
L 7B517B4E May, 1942
docoa.od.
$13,927.B6
2J..16
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~~':'tJ~tr?60-'''''.
45.00
$ 3,000.00
26.00
$ 3,000.00
24.77
$10,000.00
2B.62
$ 2,000.00
67.79
$ 2,000.00
.41
1) t..ltr'.4J '-
B67 97
13,949
\02
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4,045 00
3,026 00
3,024.77
10,02B 62
2,067 79
2,000 41
100 00
1,000 00
1,000 00
1,000 00'
1,000 00
1,000 00
1,000 00
329 04
329 11
79 7
53 4
B1 4
B1 4
B2 6
B1 4
164 .2
.
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COMMONWEALTH OF PENNSYLVANIA I,
COUNTY OF CUMBERLAND J
ss:
ELIZABETH C. LEFFLER EXECUTRIX
._______~_._. _____________ _..__._ __ _r.___.___
being duly SWOI;.O___ according to law, doposes and says that Ehe _ is the
Executrix of tho Estato of FLORENCE M. CALDWELL
late of Camp Hill , Cumberland County, Pa., deceased and that the
within is an inventory mado by ~~IZABETH C. LEFFLEB._., the said Executrix
of the entire estete of said decedent, consisting of all the personal prop.rty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figuros opposite each item 01 the Inventory represont it's fair value
as 01 the date of decodent's death.
Sw,")"< '"
and subscribed before me,
Jl~, ~.zt g ~<<-~
~ E...utor. ~ lit
o ,,-io.be..- ~ ~
~I>>. t1"~1
CLEMENT A. LiO. NOTNlY I'UIlUC
M, .. ............,.
~--YlIJ,... r 1 0 or .
311 April Drive. Apt. #4
Camp Hill, Pennsv1vania 17011
Addr."
Date of' Death
11th
Ooy
July
Month
1980
Y..r
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personat representative.
2. A supplement inventory must be filed within thirty days 01 discovery of additional assots.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act 011949.
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LIST
ESTATE OF FLORENCE M. CALDWELL, DECEASED
HOUSEHOLD GOODS AND FURNITUnE
LIVING ROOM
Sofa Bed
Secretary Desk
Occasional Table
2 Lamps at $1.00 ea.
Chair-l broken arm
Table
Brass Table Lamp
Chair (40 yrs. old)
Gr. Velvet Chair
Rocker
~Iirror
Table Lamp (broken)
Occasional Table
Tea Tray Table
KITCHEN
Pots, pans, dishes,
glasses, etc.
Electric coffee maker (brkn)
BEDROOM
Dr~ssGr with mirror
Old Se\ling Machine
Chair
Bed Tray
Tea Wagon
Mirror
2 Table Lamps at $ .75
2 Dresser Lamps at $ .50
Humidifier
2 Sets of Lamps at $1.00
DWING ItOOM
Mirror
2 cases at $ .50
rlISCELLANEOUS
$35.00
$25.00
$ 3.00
$ 2.00
$ 5.00
$ 7.00
$ 2.00
$ 5.00
$ 7.00
$18.00
$ 5.00
$ 1. 00
$ 1. 00
$ .50
TOTAL:
$116.50
$ 5.00
$ 1. 00
TOTAL:
$ 6.00
$ 5.00
$ 4.00
$ 5.00
$ 1.00
$ .50
$ .50
$ 1.50
$ 1. 00
$ 1. 00
$ 2.00 TOTAL: $ 21. 50
$ 4.00
$ 1. 00
TOTAL:
$ 5.00
$ 35.00
BAT.ANCE HOUSEHOLD GOODS
l'.ND FURNITURE:
$184.00
(included on page 3)
,.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
*'
6< ( . ,f~' . '1'Y I
RESIDENT DECEDENT
"80 OCT -9 P3 :53
COUNTY OF Cumberland
IMPORT ANT,
~ -- --.---- -- . - -
This return must he completcd in dctllillllld filed in dupliclIte. with nil attnched, with the Register of Wills of the
County where decedent rcshlclli Return is tlue within nine Il\flOlhs urlcr date of death. unless un extension hi grunted
by the Secretary of Rc\lcnuc. (Sc~lion 703 lif Ihe Inhcrilllllcc nml Estate Tox Act of 1961.)
-._-
1.oto of
Cumberland
} AFFIIlAVIT Ill'
EXECUTOR
X~XOR
County
IN TilE MATTER OF TilE ESTATE OF
FLORENCE M. CALDWELL
!STATE FULL NAME OF DECEDENTl
Counly of
Pennsvlvania
Cumberland
'} n,
Executor
State of
ELIZABETH C. LEFFLER
~IDl~K'~
of the estate of tho above.nomad decedent being duly Iworn, depose 5
ond say S
tMONTHI
Namo Clnd oddr... of ottorney or }
oth.r authorized representotlve to ....hom
011 correspondence .hould be moiled.
{DAyl
1 19~{IC'lote leaving 0 lo.t will, copy of which I. hereto ottached. }
{YF.ARI ~
Decedent dicd
July 11
Herbert G. Rupp, Jr., Esquire
1110 Fernwood Ave., Camp Hill, Pa.
17011
That as such Executrix deponent is familiar with the llffairs of said estate and the property constituting
I EXECUTO".<<*~*X'lWfl{M
the assets thereof and their fair market value.
That at the time of death there was no safe depnsit box registered in decedent's individual name, or jointly with, or
as agent or deputy of another, or in deccdent's individu<llnamc, with right of access by another as agent or deputy, with the
exception nf the following: - NONE
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A S.tFE DEPOSIT BOX
THIS SAFE OEPOSIT BOX RENTED
IN N^ME OR NAMES OF
REL.ATIONSHIP OF JOINT
HOL.DERS TO DECEOENT
That the conlents of said safe deposit box or boxes are ilemized under Schedules
wi th the exception. of the following, for the reasons hereinafter set forth:
of this return,
That Schedule A attached hereto amI made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which deccdent died having an interest therein. It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at
death, name of mortgagee, datc, rate of interest, and book and page of record thereof. lllllso sets forth in the
columns provided therefore lhe assessed valuation of each of said parcels, the estimated market value thereof
as of dote of death of decedent.
That Schedule B attached hereto nnd mnde pnrt hereof sets forth fully and in detail all personal property
wheresovcr situated owned by the decedent nt the time of death: all moneys left by the decedent at the time of
death, whether in decedent's immediute possession, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued interest therenn, if any, down to the last interest day prior to decedent's
death in the case of savings banks, and 10 the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they arc designafed as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign counuy, "Y~~~_h,~~~.~~nA~time of death;
all wearing apparel, jewelry, silverware, pictures, books. works of art, h_OI.~~.~ltSl.~~/~~I\WM~~.s, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever. kind 9~. na~~,\ lc.(l;)>y decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedenl and of all
claims due and owing decedent at the lime of death, and all promissory noles or other'instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair.market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon Ihe death of the decedent: all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of decedent's
death and other investment securities owned by the decedent at the time of death, with the.market value there-
of at such time.
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possihl" snhstnntlnt.,,1 (0)' I'Innndnl stnt"n",nts lOt' Ih" ""rp"r"ll"ns, sh".I"~ ,h" nSS.'ts ",,,lllnhIIILlos
Ih"reol' us ,,\, Ih,' ,Int" o\' ,I..nth. Th.' s",...oI"lo nlS" s,,1S \""'\1. Ii'"~ h,t",','SI ,,\, .1"c".lent. nt \1... tlm" ,,\,
dcntl\ in nn)' cO_I",rtn"rshlp tIC InlSlnosS. ",,,I In snl'l",rt. ,,\, 11". vnl"" ,,\, "",h IntNost t.hcre Is nnncxcol 10
snhl scln..I"I,', rtnnnclnl stnt"m,'nls sho..ln~ \1.., n",'ts n".1 11,,1>1 I II I"s "I' snl,1 co_p"rln"rship or '"lsln"ss.
.,\ COl')' or Ih,' c"_pnrln,,,shlp lI~r",'m,'"t. (I\' orlll, II stntcm"nt sou.ln~ t'"r'h tho olllnr" ot' Ihc "~roc,,cnt)
I"~"th,,r wilh II stntem"nt s"ltllI~ \'"r.h th" "',"rnet."r "I' "... IlIlsI""", Its I"l'ntl"n, ",,,I such olh"r \'lIels
portnin"'~ to tho hnsln"sS liS mil)' I'" 1,,'r'ln.'nl I" n I'nlr n,,,1 .I"sl nppr"lsnl ,,\, U.., oI"ccdent's inlcrcst
th,.,,'ln mllSt hosnhmIW',I. It sh""I,11I1So sct I'"rlh In 1101017....1 \'"rm. ,,,~""h,'r with Ihe 1'"lr mllrket v"I,"'
Ihercol'. IIn)' uUI'" pr.'pert)' "wlI,.,1 "r 1""I""lIlh.,,1 h)' \1... ,\o'c",\o'nl n' Ih.' ,Imc "I' oICII\1I.
Thc Sc"dule C n'tnchc.1 h"r"I" nnol .""1,, pllrt hore'''' S"IS \'orlh n IrnC IInSW'" '0 "nch In'lniry
conlalned tl",reln 1111I1 In ,hc ,'IIS0 101' trnnsl'ors nl'prop"r')', CI.nl or I",rsonlll, within ,wo yenrs 101' decedent's
dealh, in eontomplntl"n or ,1"0,'01""" s ,h,alh, "r In"""lool to I"k" 01'1'0", In possessIon or en.lnyment lit or
arter ,iellth, snl.1 sch,'oI"io selS I'"rlh U". nll,nro .",,1 VIII".. "I' s"cl, propert.y, t.n whom I.rlUls\'crrool, the
relntlonshlp or 'he trnnsl'creos t.o th" .Iec","'n'. tI,o propnrtlonnte Shill''' r"celveol (0)' each trllnsl'eree and
all other I'lIclS or II perl.lllont. IIl1tur" r,,~"r,1I111< 5"i.1 t.rIlIlSI'crs. III \.110 cnso 01' t.rllnsl'ers intended to
tnke "I'fect In posSl.sslOII or cn.lo),"cnt. "t. tIC "I'l"r .IOllth, t.h"ro 15 "Iso 1It.t.ach...1 t... t.he schedlllo II copy
of t.he oleed, trust. lI~reemcnt or ot.her lnst.rumellt. er""I.lnl; \.I'" trust.. TI,er" Is also 5el. I'orl,h In said
schedule II list. 01' aI' pr"port.)., ro,,1 IInd 1,0r","\I.l. wlt.h it.s vlllue, whleh pa"ses lit. d"eed,,"t'S denl.h (0)'
virtue 01' th" exercise hy ,Ieccd,,,,t, ."t.hor 1,,,lIvl,l,,ull)', or.lolnl.ly wlt.h IIl1o\.lwr, or nn)' power or appoint-
ment vested Indecedellt, ellher IIIIlIvloIually or .10Intl)', by the wIll, d"ool, or ot.her IlIst.rument. or nnother,
with a copy 01' I.he InstrUmont crelll.ln~ such p"wor nt\.llch",1 to tho scl""llIle.
That Scl>edule D nl.tached hel'eto nnd mado part I,oreol' s..ts fort.h I.ho nIlmeS 11",1 noldresses or an
persons beael'lcl"lly Inl.ercstool In thIs "st."te at the Ume or .Ieco.lent' s ,Icath, t.h" nnture 01' their res-
pective Intorest.s, t.helr relationshIp, if lillY, to tlte d..ec,lellt, I.o",ot.her wll,h the al;es lit the I.lmo 01'
decedent's denth or nil mInors, nnnultllllt.S alld h"nel'lclaries I'or life ulI.ler Mce,lent.'s WIll. It alsu
contaillS a statemellt showing whIch of the heneflclarlos IInmcd In t.ho ,lecoolent'S will, il' IIny, died prior
to decedellt, t.h.' ,lnl.eS or their death, their Iss,,"'. '"III t.he relntlOllshlp 01' such Issue to t.he benel'lclnry.
Thnt. S.f>edule E n!.lnched heret.o nnol n"..lo n pnrt hereof sots I'nrth nil property, real .m,i per-
sonnl, owned b)' thO decedent .Ioinl.ly with nnol.her or ol.hors, Indulling Int.nn~lblo, stn",\In~ in the nnme
of the decedont nn'\ ot.hers, pi,," the ,Int.o nnd placo 01' rocord of inst.rHlnonl.S ofl'oclin~ the ,estlture 01'
relll ostnte nn,i t.he d"to or nC'lulsl tlon or personnJl.Y, plus tho nllme, lI.hlre" .uIII relatlollshlp, il' allY,
of' co-owners to thn decedent.
Th"t Scf>edule F ntl.llched heret.o nnd ma,le a pnrt her""l' sets 1'0 r \.I I I'II11y and In det"ll nIl debts
and deduc tions cl" imed I'or nn.1 on hoha1\' 0(' th i s ,Ioeeolen t' s es ta I.'" I nc1 u.\In~ fUller,,1 expenses pnid;
fnmily exemption, where nl'pllenbl"l cost.s or n,lmlnlst.ratlon nf tills e5tat.o; cOllnsol I'ees IInd I'udlcinry's
commissions pnld or I." bo pal,l: cost oxpondool I'or l1ur 1,,1 trusts, tomh5t.OncS or grnvemnrkers, "nd reli-
gioUS servIces, in consOlluenc" or Iho dca,.h or tM deco,I<",tl debt.s all,1 cllllms owlllg .m'\ anpnld nt time or
deatb; tnxeS IIccrue,l chnr~enhle 1'01' perinol prior 1..0 dec",lent'S ,\oat.h (except those nllowed under Section
651 or t.hc Inheritnnee an.1 Est.nt., Tnx Mt.): to~ethcr with II stat.em"nt. 01' coUnt.er,,1 1'le,lged I'or oblign-
tlons. II' nny. It- Is lI~reed t.lInt t.he l'iduclary will pres"ntpr.",r 01' salol dalmcd obllgntlons upon re-
'1uest, that II' thO nmoUIlt. nctuoU)' paid In setll"m"nt of IIn)' foe, eommlsslon or debt Is 1"55 tllnn the
estlmllt.ed IImount cllllmln~ nn'\ nllo.."I, tI\I.t the snme will I... rcporteol to t.he 1l,.~15I.er nr WillS, anll tMt
th" "m,,"nt "I' t."x aSSes",,,1 cnn "" rc"",,"",.,1 In "eeo..oIan.." 1I,,'r,'wlth.
TMt th.. lot.,<15 or tho nl'l'rol'rlal," "nlllmlls In Seh..dlll"s ".\", "II", "CO, "E", ,,11I1 "F" as oIlrectell ther"ln,
have been c"rrle,1 fnrworol nnll Ilrol,er1)' re~lst.oro'l In t.h" slI,un"ry.
Subscribed and sworn to before me this ".5s'~.~..,..,...
~..~~"OQ
QBtoIINT A. LEO. NOTARY pUBUC
My _...,lIIIln _It.. A;lril 9. 19B3
~,.,., 1\Np. Pa. CumI>lJllnd County
{.' e~'
. . .. ~ (/ y'/.."/"
[l~~/v1i:~io'{~0,.;L0=!...-,,------
311..l\p;d.l,.,.Pd.v.e."...J,Pt,........._i1A""._-,_.
(SlTeet Number)
Camp H~.l"l,.)?l'.'JI!:I.f!YJy'<,!,I}Jg,,,,:L7.QJ.:t..,,.,
(City or Town and State)
........~......M.......-..........
....................................,
~OTEt 1I01'"rc sl~lIlng nfnolllvlt m"ko sllre ..11 !.lallk spa,"" In II'" al'l'I,lnvlt. anol s"he,llIles anllexcol are
I'lllcd' In with .1"ta\1s or th" wllr,1 "~one", a 11I1 III caS" II'" "ss,'IS ladll,l" ,'ar" and IInUst.e.1 seellrilles,
seollrltles "r "'''so or l'amllY eorl,oraUons or "n ,,,t.,,..,,st In all)' "o_pa..w"rshll' or hllslneSS, that the
,I" tn .1lI11 sl." lementS re'I"1 r..,1 ",,,\,'r t.hc IOlra~,'al'h a"ov,' rd a 'I ng 10 set,..,IIII', "II" ar" nl.tneheol. ,\1 so mllke
cert"in th"t c"ll1mll 41 I" Ih" "~II'~IIIrl'" h"S III"'" pr"l'"r1)' ""ml'le'o,\ as al""e-.llr.'ct",I.
", RCC-3'4 (..."')3)
(;OMMON'WEAL TH OF PENNSYLVANIA
O,EPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
*
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant in common with another or ather, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported an Schedule "E.")
The r.al property located In the Commonwealth of Pennsylvania .hould bo
described by lot and block number, atreet and .treet number, together with
a g.n.rol description of the property, with a reference to the record of the
conveyance by which the decedent toolc tlllo; If 0 farm atote number of a.
crel; ol.a Itatement of mortgage encumbrances upon each parcel at death
of d.ced.nt. Taxe., a.....m.nt., accrued Inter..t on mortgage., etc.,or.
to be lI.t.d on Schedule IIF" and mu.t not b. deducted from thl. Ichedulo.
(1)
(2)
ASSESSEO VALUE
FOR YEAR OF
OECEDENT'S
OEATH
131
DEPARTMENT
VA LUA TlON
CAUTION
(00 not writ.
In thla .puc.)
ESTIMA TED
MARKET YALUE
NONE
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column an the last page of this return.
tWntv -!,i9fV
i
;
I
i
I
RC:":~5
.
- COlNOS\\lULTIl 01' PESSSYI.\".\S 1.\
Tlll'iSrnn ISIlF.nlT.\SCr-: TA\:
Rr.SlOEST OEClmEST
RCIIEIll!l.E "Il"
I'EIlSIlS ,\ (, 1'II0l'EII'I'Y
~~~~
..-.'
.I< --. \
TJ "'~ti' .
".I~"
Issnn'CTIO~S: Thl!4 Sdlf'lhll~ must dlsclns~ 1\11 t"n~lhlt! IUllllnl"'u~lhll' 1"!rSnnlll IlrnJll!rty OWllt'd IrlClh.tfhJlt.11V
b~' tilt' df'Cl',h'nt. nt till' t.lml~ 01' his Illo,.th. Prul1torl)' ()Wlll~tI hy tlu' c11'1~'!lh'nt Jointly wi tll nnnthl'r nr uthers
must \)e listed IHllh'r ~cllt?c1ulc "I':". Int.llll~thle IwrsulIII. J1rnll'~rt~., tll.llHI In the "nlnt! uf Um 111~cl'llf'nt, but
l'R)'uhlo at deKth to Rnot.lu~r or otlll!r~t IlIclUlll"~ 11lll nnt llnalll',1 I.u P.O.O. U. S. S"vlll~~ IInluls IUlII ll1nta-
l1\'c trust Ilcenunts, mllst be Ilstt!.I, tlf'splle LIlt! l'nl~t thllL UII'Y IIrl' nut of L1m lulmlnlstHrl!lt ~stlltH.
Tnn~lblll I"~rsoll"l I,rnl"-rty shnulll Ill! 11slf1c1 l'lrst (f1.~. Jmwnlry, wCllrlnJ.; RI'llnrl.'l, household
gOOll5, nnel 1\lrnlshll1J;s, hooks, [lUllllll1~~, uut.nnlllhll.ls, honts, l~lc.)
IntnllJ;thlt~ 11Orsonlll [lrnlH'rl)', such liS hnluts, trllll!iUr)' cf1rt.lflcl1tn!l, cllsh nn lIunet 1U1Il In bnnk.
Slocks, mortg"~es, no lOS, lOAotlu!r with lu~crtlt'll lllll'rl'st, or ftlvhhmlls, sll1l1rlf~5 or wn~Hs, Insurflnee [lIlY-
"ble to the estnto or flftuelnr)' In snlll t~"l'uclt)., JI"rt.nl.'rshlp tntl~rcsts, tntorl!st In IlnYlHlfllstrihllt~rl
eSlftto of or IIlCOml! .'rom nil)" l'roJlI~rt.~' Imlll In trust. lUulur the will or ngrccmullt of I1rlothl!r. even though
Illl!llted outslllo of the Stllte, Ilt tho tlml! of dl.!nth, shuultl hn 11stl~11 In this sclU:!flult!.
Item
NO.
1T1;J1
List nnd descrIbe 1\111)'
PERSO~AL PROPERTY
cc~n
- Checking Account No. 126-905-9
Savings Account No. 006-071044-9
Principal
l\ccrucd Int.
$13,927.86/
2l..16/
:.tallon Dank, Pittsburah
Certificates of Daposit:
No. K66855
Principal
Accrued Int.
$ 4,000.00
45.00
No. K43614
Principal
Accrued Int.
$ 3,000.00
26.00
No. K36156
Principal
Accrued Int.
$ 3,000.00
24.77
No. K56194
Principal
AccJ:;'ued Int.
$10,000.00
28.62
Dollar Savinqs Bank, Pittsburah
Nos. 502308623
Principal
Accrued Int.
$ 2,000.00
67.79
502017202
Principal
Accrued Int.
$ 2,000.00
.41
Nation",1 City Travclars Checks
United States Series "II" nonds
H 1633004411 JUly, 1975
H 1633004111 Jul~', 1975
H 1633004011 July, 1975
H 1633003911 July, 1975
/I 1633004211 July, 1975
H 1633004311 July, 1975
United States Series liE" nond~
c 9249566E . Hay, 1942
C 9249565E Ho.1)".. 1942
0 333597975E Doc,. 1943
0 lG05461279E Doc, 1957
0 8762543E Feb, 1942
0 8762542E Fob, 1942
0 18027755E HolY, 1942
0 8762541E Fob, 1942
L 7051784E Hay, 1942
'Insert thIs total oJlJ1osite "Pcrsonnl Property., Scherlult! IIU" III X X
the liAs Reported" COlUnul on the last page or this return.
UNIT
VAI.UI~
ESTIl~ITI(()
llAIlKlIT V AWE
867 '97
I
,
'021/
,
"
,,13,949
II
Ii
I'
Ii
"
I'
'I
4,045 00
I
,
I
3,026 '00
I
,
I
3,024 :77
I
I
,10,028 162
:1 i
I, ,
112,067179
II I
II I
, I
2,000141
I
,100 00
I
. I
1,000 pO
1,000 eo
1,000 pO
1,000 ;00
U~~ r~
329l'l
329 ~1
79 67
53 ~4
81 114
8l ~4
82 46
8l 84
164 02
I
IlfJ',UITlI;;~'T VALU,ITION
(Do not wrIte In
this spRee)
~ .' ... '.
- .'- .,',,;
'. ~ ..,~.... ."~ .
~C~-:!50
.
j:Oll\IOSl\'E.\LTR OF PESSSYL\'.\S IA
TIUXSFER ISRERITASCE T.\X
P,'CE il';O
RESlnEST OEeEnEST
SCIlEOl:W '8"
PEIlSOS,\L PIlOI'EIlTY
~~
:l'&S1::.X.'\
~~
ISSTRl'CTIOSS: This Schedul~ must disclose all tangible nnd intanJ;iblo por!ionlll property ownr.ct Imt1vtdullllv
b~' the decett~nt. At Ih... tlnu' of his death. PrOl1erty owned by the dt"ccdont Jointly with another or others
must be listed under Schl'duld "E". lntnn/liible IJCrSionftl property, titled In tho nlUllo of the decedent, but
parable Ilt dCtlth to l\l1other or othl!rSi, lncludlnJ; but not limited to p.D.n. U. S. SAvln~s Dands Bnd tenta-
th'e tru~t accOlmh, must bl' listell, despite t1m fact that they are not of tho Rllmlnlstered estntP.'.
TllnRlblu pcrsonal prol,urty shoulrt he llstocl first (e.g. Jewp.lry, woaring AppArel, household
goods, "nd furnhhlngs, books, paintings, Qutomobllcs, hoats, etc.)
Intnns;lblc Ilcrsol1nl proJ1'~rty, such as honds, treasury certificntos, cash on hand nnd In banle,
stocks, mortgu~l'~, notes, to,.;ethcr with accrued lntorcst or rlivldcnds, sf\lnrlos or WR.I;CS, Insurllnc~ pay-
able to the estate or ridllcinry in said cnpnclty, pnrtnerRhlp lnf.crests, lnterest in anyundistrlhuted
estate 0.' or lncome from Rn)' prop~rt). held In trust under tho wl11 or ngrl!ement of another, eYen thDugh
located outslcle of tho State, at the timo of denth, should bo listeel in this schedule.
Item
'No.
!TEll
Llst Nul ,tt"scribe rully
EST.i\TI: OF' FLORENCE ::. C.\LDHELL, DECCi\SED
IUVENTORY CONTt:-:UEO FROH P,'CE ONE
Sterling Silver Flat\,'arc
UNIT
VALUE
(soc .1ttJ.ched ..1ppr.lisal)
:lis.:~II.J.n~ous Sterling Silver
(see att.lchcd apprais.11)
~
Allegheny Ludlum
ATS,T
Reserve Oil
Universal Cyclops
Cerro-Harr:\on
Oranqe and Rockland
Union Oil of Ca1.
General Hotors
Duquesne Light
Hutual Funds:
126 at $27.75
293 at $52.75
20 oid. at $25.26
172' at $20.63
14 cum. A pfd. at $20.63
200 at $H.07
110 at $5~.75
63 at $49.75
10 pfd. at $1~.76
h"ellington Fund
~'je1lington Fund -
Dividend
MaGS. Investors
':rust
Dividend
325 at $10.0B
STOCl( DIVIOE:IOS
Oranoe and ~ockland
union Oil of ColI.
Cerro-Narmon
Allegheny Ludlu~
AT&T
Duquesne Light
Universal Cyclops
A:.~UUITIES
State Mutual Assurance
Contract #3130
Ne'... York Life -
Cert. I 500593
Teachers Ins., Etc.
Company
Proceed!>
Proceeds
$62.97
$5~. O~
Ii~TE:U:ST
u.s. Treasury - IOWI Bonds
N~llon Dilnk
Dauphin Deposit
cc:m
$3,496.50
$15,455.75
$505.20
$3,548.36
$2BB.B2
$2,814.00
$6,022.50
$3,134.25
$147.60
$3,276.00
$ 69.41
~4,555.33
$ 50.00
Insert this total opposite "Personal Prollcrty", Schcllulc "U" in X X
the "As Rcvortcll" column on the ln~t page or this retnrn.
.
I-.:"':":~::;-~~'''''''':'':':'''_;' ,,:'
.' . ,. ,.,,~.
ESTIlLITED
lI.1IU(Er VALUE
DI:l'.lIlTlIE~'T V,U-CATION
(Do not write 1n
this space)
$G51.~BV
$ ~7.ool
$80.00
$H.OO
$ 7.SB
$H.I0
$366.25
$ 5.00
$37.8~
$15B. H
$1~6. 32
$117.01
$162.50
$525.2~
$l02.~0
$12~.~B
..-. .
............ ...... .... ...........--...-...
,....~~ ':r. t'~~~'~:.f.~.~t~tJ~:i',~:~~.:..:~..
..\....._-t,-.,t.'J1._ .,'. _ ,_ .__..-
. , -,' ",..; 11'....... .,.' .~.. R. "'. __ _. :.......
" ......~."~;.~..,...~. . "--.--.::--.
.)-
, '-. .,-
~~-::~~"~~:':~::?;;~':~~::'~::;:'-~Y22~~S~~~~ .
"'"..
~1Il:;'~Z~=-i:~"".::::c'~:~:_:~~~::;~_;,::::'-:~;:~~JZ
I
/---
'.
American Gem Society
Registered Jewelers
$ 25.50
108.48
24.00-
102.00
108.00
72.00
108.00
72.00
11.50
20.00
4.00
)
."" ~ r
i
737-8024
737-4719
2' 29 Market Street, Camp Hill, Pa. 1701 I
INC.
August 22,1980
;
,
.,
Mrs. Elizabeth Leffler
311 April Drive
Camp Hill, Penna. 17011
Concerning the silver pieces of the Estate of Florence
Moore Caldwell, the fOllowing items have beeneexamined and
appraised.
Sterling silver flatware:
Silver plated tray, 15" round, with engraved design
in center, heavy grape and leaf design in applied
border. 6.00
Silver plated well and tree platter, 21" long,
Rogers 857, with two compartments. 5.00
Thse pieces have been examined and appraised. This is a fair
market value at 'which the property would change hands between
a willing buyer and willing seller if both ha~ reasonable
knowledge of relevant facts and neither was/under tompulsion
to b,y or ..". ~" .~
.A ( (~iJp-t'(i, \
R.W.6andis, Registered Jeweler
American Gem Society
6 luncheon knives, Alvin "Hamilton"
6 luncheon forks, Alvin "Hamilton"
6 luncheon knives, Reed & Barton "St. George"
6 luncheon forks, Reed & Barton "St. George"
12 teaspoons, Reed & Barton "St. George"
6 salad forks, Reed & Barton "St. George"
6 f.h. butter spreaders, R & B "St.George"
6 dessert spoons, Reed & Barton "St. George"
1 SUgar spoon, Reed & Barton "St. George"
1 small gravy ladle, unidentified
1 small sauce ladle, 1881 Rogers, plated
Sterling silver compote, weighted, sf" diameter
at top, 5-3/4" high, pierced design at edge.
RWL/es
32.00
6 yf.JjS
~.~,-:,...,,~:;...:..i;~~';., . . ,"~'.' . . ....::':..".~\;g;..jii;~:.i-i;,~.;".;~
i _~~, ~I" -.,... - -............ _-' ._.~ ._. . . .,-~ -.." ~"#~- -, ..." ~.
~... I-.:-or,; .. ... .- .-- ~ _....... -
;~~;:~f..~~:-~':-~:~"'::: ..:.:.~: .-. ',::::::,;.::,: . .: .,..:...;:':~-"'--' --"""":;~'...:':' <;>..:::--:,:"':::~::"".~-::~:.,..-::';::':'::':;."
.'.- C, h'-__', . --. . -.' t' ," .,.. .. p" ,'. . ....~.-.__.. '''--.'.....i-.......-_.-...:........;;:.;~ . ',.' '.
, .". .~...:" .--;.;;;~~~'W~~-w~~~:"'.~~" .' .~ ~.
~ ' '. . . . _ ,_.' ~i:-....;-*.. '~p ......... d. '_ ... ,-' 0'
r ~h:~ioO!tith~~.I,...-..fta;.:r'~jPt'~'?1.;~:~7~..a.;.".~.,==r~-':;4...-.;~-.:.., t;C.w.:!:',:7~~-' rr." .
. .~~~:~~-::.'.::,::::-c::_::':~:~~_:::"~~--::~~,:':.C::::~;~:~
. (-.
-.
-
G
~ ~i.l "'''''r'.:~ r r.:-;:)
~ _~.~ MAIN OFFICE 331 BRIDGE STI1EET NEW CUMBERLAND. PENNSYLVANIA 17070 17171774.7000
CCND UAN'<<', N.A.
Date July 30, 1980
TO: Rupp and Meikle
1110 Fernwood Avenue
Camp Hill, PA 17011
ATTENTION: Herbert G. Rupp, Jr.
HE: Estate of Florence M. Caldwell
Name of Decedent
The foll~wing is a complete record of the above decedent's accounts
as of
July 11, 1980
Date of Death
Account 110.
Type of Account
Balance on Date of Death'
Principal Accrued Int.
Names on Account
(All Owners)
Date of Creatior.
of Joint
Ownership
126-905-9 Checking $ 864:97 !lone Florence Moore Caldw 11
006':'071044-9 Savings $13,927.86 $ 21.16 Florence ~Ioore Caldw 11
Cert. of Deposit $ 5,000.00 None Florence Moore Caldw 11
Elizabeth C. Leffler 7/10/78
19132 Cert. of Deposit $ 8,000.00 " 1~.~~1 Florence Moore Cnldw 11
.:1
Elizabeth C. Leffler 8/12/78
Cert. of Deposit $11,000.00 $122.83 Florence Moore Caldw 11
Elizabeth C. Leffler 5/5/79
20568 Cert. of Deposit $ 5,000.00 $ 30.91 Florence Moore Caldw 11
. Elizabeth C. Leffler 1/19/80
20573k Cert. of Deposit $ 5,000.00 $ 46.21 Florence Moore Caldw 11
Elizabeth C. Leffler 2/9/80
. '.
.
~ C". {e-" IJ::L
R. S. Step~enc ~.d~
.. ~~'<M Sir.nature
.,.
._----.~N~. .~
w.,,:._.J --.~"",,~"""''''J_'''!'' .;,-".....~_:'..':2:~"tq:..rir:.:-....:--:.->: .:- -~.
\'....:".'.l.r..l.
C'..:;
.
-
(-.~,
Dauphin Deposit Banl<
and Trust Company
MAIN OFrICE: 213 MARKET STREE.T, HARRISBURG. PENNSYLVANIA 17105
717 I ~55" 2121
D
Mlfmtler FftdertJI Depos.lllIsuMnce CorporatIOn
August 21, 1980
Rupp and NeDde
1110 Fernwood Ave
Camp Hill, Pa. 17011
Re: Florence H, Caldwell
0.0.0. July 11, 1900
Attn: Herbert G. Rupp Jr.
Dear Mr. Rupp Jr.:
In regards to the above mentioned, >Ie sub!:lit thc follO\;ing infor-
!:latior. as of the date of death:
certificate of deposit # 14 34 002497 opened 2/22/80 balance 5,000.00
interest 216.66
certificate of deposit # 14 32 017741 opened 4/30/1\0 balanc13 10,000.00
interest 39.64
th~ above accounts joir.t Florence H Caldwell or Eli:.:.,beth C. Lefflcr
If we c:m be of any further assistance, pleane do not hesitate to
contact us.
JCS/ ci::I&
Very tr~ly yours,
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.) JoAlm C. Stover
Account Service Officer
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Mellon Bank N.A.
East LIberty Ollleo
Penn MlIlI and Penn Clrclo South
Pittsburgh, Pennsylvania 15206
August 28, 1980
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Ilr. Herbert G. Ru?p, Jr.
1110 Fernwood Avenue
Camp Hill, Pennsylvania 17011
RE: Estate of Florence ~l. Caldwell, Dee 'D.
Dear Mr. Rupp:
Below is the principal & Interest accrued to date of death on the
following certificates:
K66855 - Principal $4,000.00
Interest $ 45.00
TOTAL $4,045.00
K43614 - Principal
Interest
TOTAL
$3,0')0.00
$ 26.00
$3,026.00
K36156 - Principal $3,000.00
Interest $ 24.77
TOTAL $3,02b.77
K56194 - Principal $10,000.00
Interest $ 28.62
TOTAL $10,028.62
Sincerely,
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C,.~t~ ,YoN ..",:...rr::-t.....
Elbert L. Kater,
Safe Deposit Department
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DOLLAR SAVINGS BAN K
4'" II SMITHFIELD. PITTSBURGH. PENNSYLVANIA lS230 . TEL. (412) 261-4900
'-, -.
August 28, 1980
Rupp and Meikle
Consumer Life Office Center
1110 Fernwood Avenue
Camp Hill, PA. 17011
Dear Mr. Rupp, Jr.
The principal and interest accrued to date of death, July 11,
1980 is as follows.
Certificate of Deposit #502308623 -
Certificate of Deposit #502017282
Certificate of Deposit #502013999 -
for the amount of $1,000.21.
$2,067.79
$2,000.41
closed April
10, 1980
If you have any further questions please donUt hesitate
to write or call 521-7031.
Sincerely,
'r?6'/Jt- -&!~J
Mary Broadus
New Accounts Administrator
Squirrel Hill Office
Rec-3D
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COMMOSWEALTiI OF I'ESSRYLVAXI,\
TRAXSFRH rXIlElIlTAXm TAX
Sl'IlFIH~IY "('''
'I'll \~"'FI':II~
RES lIlEXT I1ECEIlEXT
(1) Oitt deccllcnt, wlthlll two p'lIrs lI!'ctl'llth, mIlk" IIII~' ll'/lllSt'''I' 01' un;.' 1lI1t1"rlll) IllIrl, 01' his "!illllf>, without
recel\'lng Il \'lllunble und lull'lltllltf! ctllls~III'r/J1 Illll 111"I'''l'or'/ (,\lIs....'.r ~'(>S (1(" nn) no
(2) Old dccC''''''l, wi thin twn l','..rs nr ,,,...th, lr"nsr"r prnp"rt.y r"n", hllll,,'II' to h!",s..II' ..n" ..nolhor or
others Uncllllllng n sllulIsn) In .101111, CI\'ill;~I'Slllp? (,\IlSI'I'I'I' Y"S or nil) no
(3) I f' the nnswer to (1) n r (:!) IlhO\,I~ I s III lIlt~ It 1'1'1 rlllll tI \'I~ S tit te:
(n) '\~e of' Ilecl'chml, Ill.. tlml' nf U'/lIlsf'l!r
(b) StIlle or decedent.'s Iltwllh ilL tlnll~ ot' lIllLklng t.hn I.rllllsf'I!I'. (Not.'~ 1).
(e) ClIIISI~ 0 I' (h~I:"fhmll s .1('111.11. (Sut.e 1).
(4) Old decedent, In his I1fel..lml~, 1II1lh' /lilY lrllllsf'l'r of' JlI'UPI'I't.\' without rncl!lvln~ Il vnllluhlp. or lulc'lllnle
consideration therf!for which WllS to Llllw ef'l'eel III llosSI~SSlflll Ill' pnJnymellL It!. or nfter his death?
(Answer )'es or nn) no
(n) WIIS there nn~' posslhl 1 tt~' !.hllt. t.lw prnlll!rty trunsf'erreil might. retllrn to transferer or his
estnte or he suhJect to his JllIw...r 01' lllsflllsltlon? (Answer ~'es fir no)
(b) Whnt WIIS the t.rltnsl'er(H~.s lIgl! Ill. Llmf~ III' .11~(:l'dfml.ls dent.h?
(5) Did decerlent In his IJI'etlme mnke 11Il~' trHllsl'er wlt-hullt r(!eelvlll~ It Vltlllllhleftnclllcle'luntc consideration
thc("ct'o(" unrh!r '..lIlell trnnsferor eXfll'essly or Impl Il'ln~' reSI!rves for hfs t ffl! or llny period which does
not in fuct end het'ore his llent.h:
(n) The Ilossessinn or cn.lo~'mellt. uf' or tile rl/.;ht to Income from tilt' property trllnsl'crred?
(Answer ;yes or 110) no
(h) The ri:;ht. to .Ielitgnnte the IJl~I'Sf)I\S who slll1ll Ilossess or enJoy the property transferred or
income t.her(~fr()m'l (Answer yes or no) no
(0) If the answer to (5) (h) uhovf! is In th(> Ilfl'lrmlltlve, stut.e whether the rIght wus reserved In decedent
alone or others
(7) Did decedent In his lifetime mnke II trllosl'er, t.he consideration for which WIl.S transferee's promise to
pay income to or I'or the henefJ t of cltrn of lrllllsferor? (Answer yes or no) no
(8) Did decedent, nL Iln)' time, t,rnnsf'er propert.y, thl! hennflctul on.lO)'lIIcnt or which was subJect to change,
because of n reservetl power to alt.er, Ilmentl, or revoke, or which could revert t.o ftecollent under terms
of transfer or by operntloll of' law? (Answer yes or no) no
(9) If the answer to (8) llbove is ,In till! u''firl1llltl\'c, WIIS the }Jnwer t.o niter, ntTlp.n1t, or revoke the inter-
est of' the benefIciary reservell in t.he dl~ccdent. Hlone or till! llt~cellcnl nncl others?
(Answer yes or no)
NOTE1: The answers to t.hese questions shuuld he sUPl'ot'ted hj' Ilffl.Jnvl thy the Ilttcnlling IJhyslclan as
well a!o a copy of the death ccrtl flcnte.
NOTE 2: If llnswer to llny of' the nhove questions Is yes, set fnrth helow n description of the property
transt'erred, it' 5 fair market vHlue at. rllltf! of' cleI1t.h, l:ut,es of' t.ransfers nnd t.o whom transferred, with
relationship of trnnsferees to decedent, If' (toy. Subntll. cOJl~.' (If Illl~' trust dcell or instrument, ii' trans-
fers are claimerl to be non-tllxltble, also suhmit detlll1r>d stntcmcnt 01' fnets on which suld claim 15 based.
NOTE 3: List applicable property below In n1unner in which prnvillerl in SChcllules A, n, or E.
ITEM
lLllUffiT V,U,UE
(Estimated)
DFl'T. V,U.UATION
(Dept. Only)
IlESCIIII'TIO~
NONE
Insert this total opposite "Trllnsf'ers", Schedllle "C" in the
-As Reported" column on the last. p/l~e or thls ret.urn.
N",~
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IN WIT'\ESS WHEREOF. 1 have Ill'rpunlo tiet my hand and s..at
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:.' day of Janu.lrY, in the Year of Ollr Lord, Onl' Thousand Nine
Huncred and Seventy-Thr"e. (A.n.1973)
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FLORENCE M. CALDWELL
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This instrument, consisting of Two (2) typ.owritten pages, each
was by her, on the date hereof, signed published and declared by her to be her
Last \,{ill and Testam.ont, in our presence. who at her request alld in her pres-
enc.o, and in the presence of each other, we believing her to be of sound alld
disposing mind and memory, have hereunto subscribed our names as
l \\'1.tne~s~s:
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SUMMARY
Real Property ................................... . ..................(Sch. "A")
Personal Property......'................ ............................ ...(Sch. "B")
Transfers ................................................... ..(Sch. "C")
(1 )
(As Reported)
(2)
(As Dct,'rmineu)
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Cross Taxable Estate ..
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COMMONWEALTN OF PENNSYLVANIA
DEPARTME NT OF1l~E"UE~.
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BANK NO.
60-83
DATE FILED
NOTICE OF DECEDENT ACCOUNT STATUS
? 16 eo
STATUS OF ACCOUNT NO: (JOINT, TRUST, OR INVESTMENT
,. 29 eo
RETURN COMPL ETED
FORMS TO LOCAL COUNTY
INHERITANCE TAX OFFICE
NAMES ON AC:COUNT
SOCIAL SECURITY NUMBER(S)
[lorence Hoor Cp1dwel1 Dr
Elizabeth C. Lefflar
NAME
SURVIVING DEPOSITOR (Bo,oflel...,) INFORMATION
RELATIONSHIP
TO DECEDENT.
E1lzeb&th C..Leff1e De hter
DECEDENT INFORMATION
NAME
DATE OF DEATH
ADDRESS
Florence MaDra Caldwell
ADDRESS
711BD
UKNOlIIII
311 April Drive Apt #3
Dauphin Depoalt Bank end Trust CD.
AUnl DASD
213 Market Strest
Harrisburg, Pennsvlvanie
CIT't;mp Hill, c~.~erlend
ZIP CODE
1 11
BALANCE OF ACCOUNT AT 000 S
INTEREST ACCRUED AND COLLECTIBLE AT 000 $ ~3g_fila
TOTAL $
BANK AUTHORIZA TION
I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN 15 A
CORRECT REPRESENTATION OF INFORMATION IN OUR FILES IN ACCORD
WITH SECTION 742 P Il!o E TJlX ACT OF 1961.
BANK/INSTITUTION ADDRESS
SIGNATURE OF FINANCIAl. INV~STIGATOR
.-::/ ......:..;,::
DATE
7 16 BD
"
t'CC-JI .
COMMONWEALTIl OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
Page 2
SCIIEllULE "E"
JOINTLY OWNED PROPERTY
'*
RESIDEI'\T DECEDENT
INSTRUCTIONS: Thl~ sclll~i1ule mUMt dtNclO!lC nil proJlorty, r4!nl nlllt IH!rSollul, owrwd hy lhe (Ip.CI~df!nt jotntly
with another ur others, tncludlnJ; tntnnglbll!s, Ktundtn,; III the 118ml! 01' the Ih~c,!dlH1t. /llld othors. List
renl estote flr~t. liS ol1tiretios, or Joint tenants, ~tvlllg hriof (luserlStllon, 115 lndlcutJ~11 IDHter Schedule
-A", )llus tho Itnt.A unci Itlnco of rocord of lnstr,unollt nfl'ocUIIR Yf!sltlllrf!, hut, fto not lru:ludo ontirotlofi
or out of st:lte rOlll estntc YIlluo In eNtllle Yllluntinn culumn. PI!rSUnlll properly shuuld ho llsterl ns in
Schedule "U", plus dlite of llC1lulsilion, IIMI tho nnMf!, nd(lress IItHI rf!Jlll.1onshill (J f any) of co-owners to
the de(':~,tont.
Description of Property, Dnte of Acquisition, Sumo
Address anrl Relationship of Co-Owners, 1\1'111 PI Reo
of Rcmcord of Instrument, where Real Estate.
:xx> >000<:>0<
~ ~<XX
UI\I t
Vnlue
pf!rCl'ntu~e Estut.o
Short! Valuation
D~~ARTIlF.NT VALUATION
CAUTION-Do not WrIto
In This SnRee.
:xx XKl>
Value of
EnUre
Property
Value of
Decedent's
lnt.erest
United States Series "Hit Bonds -
Elizabeth c. Leffler "or"
No. V40075015H; 1-72
Principal $5,000
No. M2183293H; 5-61
Principal $1,000
no. 142183296H; 5-61
Principal- $1,000
No. M2183297H; 5-61
Principal $1,000
No. M2183295H; 5-61
Principal $1,000
No. 142183292; 5-61
Principal $1,000
INTEREST
ON ABOVE:
$189.50
$10,189.00
50%
5,094.:0
TOTAL TWO PAGES:
3 ,377.91
Insert this total opposite "Jointly Ownod Property., Schedule "E.
In the "As Reported" column on the last page or this return.
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SCHEDULE "E"
JOINTLY OI~~ED PROPERTY
EXPLANATION
Certificates of Deposit - CCNB -
Elizabeth C. Leffler, JTWROS
No. 19578 - Originally put into Joint Names
in prior Certificate of Deposit dated 5-3-77
No. 20573 - Originally put into Joint Names
in Certificate of Deposit, dated 2-4-78
No. 19132 - Originally put into Joint Names
in Certificate of Deposit, dated 8-9-76
Certificates of Deposit - Dauphin Deposit Bank -
Elizabeth C. Leffler, JT~mOS
No. 14 34 002497 - Originally put into
Joint Names in Certificate of Deposit
dated 2-12-76
"EYa4U EX+ '1-101
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
[E] Original
o Supplemental
o Remainder
File Number
21-80-0489
Florence M. Caldwell
Estate Name
Date of Death
7-11-80
Social Securi ty Number
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Approlsor In and for tho County 01 --C.llmh"...lann
Pennsylvania, do respectfully report that I have appraised tho real and porsonal proporty os rep-..r.d In tho lorogolng
retvm at the valuo. .ot forth OffO.lto oach Item In tho last column to tho right in Schodulos "A", "B", "C", and "E"
Dated: M~..."h n, loRl Al;~~"'/J I-R//,,fd~'/)
INHERITANCE TAX APPRAISER
ADJUSTMENTS REMAINDER APPRAISEMENT CODE
INVENTORY VALUE AS APPRAISED CODE (HARRISBURG USE ONLY)
Rool Proporty (Schodulo A) S no e 00+ B2+
P.rsonol Property (Schedul. B) 93 656 84 10+
Jolnt.Hold Proporty (Schodulo E) 2lH
Transf.r. (Schedule C) o e 30+
TOTAL GROSS ASSETS 131.034 J2.
Leu Debts and DeductIons 40- 93-
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Lllo Estoto RATE FACTOR PRINCIPLE VALUE CODE
o Annuity
FOR USE OF REGISTER ONLY
Tax on S
CODE
COMPUTATION OF TAX
$
S
S
$
6%
Tax on S
15%
Tax on S
Tax on S
Tax on S
$
Exemptions
Total Estate
$
$
$
TOTAL TAX
INTEREST FROM
BALANCE
TO
Leu Credits
DATE OF PAYMENT
AMOUNT PAl D
TAX CREDIT
S
$
INTEREST FROM
BALANCE DUE
REV..4H (l.801
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITAII!CE TAX
RESIDENT DECEDENT
INHERITANCE TAX
APPRAISEMENT
'*
Estate of
Florence M. Caldwell
File No. 21-80-0489
County
Cumberland
Date of Death 7 - 1 1 -80
In the 'Vlnt that .ny futur.lntertlt In thl'lstat,l. transferred In pOIMllion or onJoyment to collaUral heirs of the deced.nt aftttr the expiration at any
estet. for IIf. or for vea", the Commonwealth hereby ,)Cpressly reservos the right to appraise and ossess transf.r Inherltanco taKes.t th,lawful collettral rate
on any such futur,lntlrll1.
PROPERTY REPORTED BY THE ESTATE
DEPARTMENT'S
APPRAISED VALUE
1. TOTAL REAL PROPERTY - SCHEDULE "A" . .
2. TOTAL PERSONAL PROPERTY - SCHEDUL E "B"
3. TOTAL TRANSFERS - SCHEDULE "C" . . . .
4. TOTAL JOINTLY OWNED PROPERTY - SCHEDULE "E"
none
93,656.84
none
37 377.91
TOTAL REPORTED PROPERTY
PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH
131,034.75
TOTAL UNREPORTED PROPERTY
none
TOTAL GROSS ASSETS
131,034.75
LIFE ESTATE OR ANNUITY CALCULATION
I do hereby certify that the above appraisement is made in conformity with Pennsylvania law and has been filed this day
with the Register of Wills.
,liJ!ev i" I Ii)/~ /7,1 .. J )
APPRAISER
3-13-81
DATE
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COMMONWEAL TH OF PENNSYLVAtllA
OEPARTMEHT OF ReVENUE
BUREAU OF COUNTY COLLECTIONS
APPLICATION FOR CHARITABLE EXEMPTION
FROM PENNSYLVANIA TRANSFER INHERITANCE TAX
(Act of Moy 28, 1956. P.L. 17S7. ond Act of Juno 15, 1961,
P.L. 373, as amended)
Application is horeby filod lor tho approval
of on exemption from Penn sylvania Trans fer
Inheritance Tax on the transfer of the property
described below,
1. Buroau File q
,,-{ /-i't,_ 'fK'1
2. Doto 01 Dooth -'l.ulYJJ.,_1.9_8.0
3. Doto 01 Approval ;JJd./~ /fn
4. Nomo 01 Docoden t
Florpnce M. Caldwell
5. The Cammonwoelth's approisod voluo 01 the proporty lor which on ..omption is c1oimod is S 500.00
(Note: Where the property is other than a specified amount of cash, the exemption cannot be approved until the value of
the property has been established by appraisal by the Commonwealth, except in those cases where the amount of the gift
or bequest represents a stated fractional or percentage portion of the entire estate or the entire residue. In those cases
enter such fractional or percentage amount above).
6. Check the manner in which the transfer was effected and submit a copy of the document authorizing the transfer, unless
such material has been previously filed.
WILLP;
DEED 0;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTH ER 0;
(II other, e.ploin)
7. Correct Business Name and Address of Charitable Organization receiving property:
NAME St. Thomas Episcopal Church
ADDRESS Oakmont-pittsburqh, PA
o See listing on reverse side lor additional charitable organizations covered.
8.. I certify that the information contained herein is, to the best of my knowledge ond belief, true and Correct..
Signature 01 Applicant fl~~L-k--t {!. ~.f'!~
U ELIZABETH cMEFFLER
Add,o.. 01 Applicont 311 April Drive, Camp Hill, PA 17011
Of/iciol Title
Executrix
Doto
Septemher 2Q. lQRO
This farm must be camplcted in Iriplicate and all thrue copies delivered to the Register of Wills for the Caunty in which the decedent
resided, or in which lettors were issued for a non-resident decedent's estate. U the decedent was a non~resident of Ponnsylvnnlo and
lotters were not issuod by 0 Pcnnsylvanla Rcgistar of Wills, deliver all ~hree copies to thc Director, Bureau of County Collections,
Pen no. Deportmenl of Revenuo, 26 S. 4th Sheet, Harrisburg, Pa.
Oo."ot write below this line.. For Official Use Onl
REFERRED to Buroou Hoodquartors
Approved 0
For Secretary of Revenue
Denied' 0
(Initials 01 Rogistor 01 Wills)
(Authorized Signoture)
L-
~ (County)
(31 /,1, /fYd
. / '
(Dote of Approval)
(County)
(Title)
(Dote 01 Rele"ol)
(Date 01 Action)
. See revorse side for reasons
MUST BE FILED IN TRIPLICATE
.~ "0 '. .to o___"'~".,
" '..
"..-........./.;-......
This section will be com I eted b Bureau Head uartors ani when the a lication for ox om tion has beon denied.
Dot.:
The application for exemption contained on the faco of this form has been deniod because
Hale: Any party in inle,e.I, including Iha Commonwealth, agg,ieved by Ihi. aclian may wilhin sixly (60) day. alt.,
the date of this notice exercise their rights of Protest, Hotice, or Appe\J1 in accordanco with the provisions of applicable
Pennsylvania Inheritance and Estate Tax Acts.
-,.;.~~~.:......-...- ...-.
OAT! MO. OP N...."'1i: 0" PAVEE REMARK. AMOUNT
VOUCHC" ,
7-29 80 1 Max Blatt, Inc. apartment rent 260 00
7-31 2 Ann Keller, tax collector personal tax 14 70
loans, co ts
8-5 3 Elizabeth C. Leffler reimbursement for adv. et.... 326 49
8-5 4 H. Samson, Inc. copies of death certs. 5 00
8-13 5 Myers-Hall Funeral' Home funeral costs 1,785 00
8-13 6 Restelli Monument Works inscribing tombstone 45 00
8-13 7 Dale C. Stahle, M.D. medical expo last illness 110 00
8-13 8 Bell of Pa. telephone 8 49
8-15 9 Herbert G. Rupp, \.1r. leqal costs. on account 100 00
8-28 11 Dennis Wentling hauling, etc. 20 00
8-28 12 Elizabeth C. Leffler reimbursement ~Bettl Ho1-~~ d) 15 00
or c ean~n
8-28 13 Elizabeth C. Leffler reimbursement for ~'~il ton-
\~i tness fee 10 00
. ".'~ :T~','~'~~~ - .; ~, ~" nn
8-28 14 P P & L electricity for apartmeth. 9 11
9-6 15 Jane Campbell Services cleaning and shamp. caroet 55 00
9-6 16 P P & L bill for a /24 to a/2a :1 ,4Q
9-9 1 q pa Denartment of Revenue Estim. ;_~~~O r"'.... lie; Inn
income t x 1nn Inn
9-9 20 Internal Revenue Service Quarterlv installment '''}'
9-30 21 Elizabeth C. Leffler Comoutation of Stock value 28 00
-
ESTIMATED EXPENSES:
Reqister of Wills filing inventory. etc. 13 00
Elizabeth C. Leffler notary fees. postaoe. etc. 12 00
Reaister of Wills filino First and Final Acct 51 00
(CaNT NUED ON PAGE TlVO)
OEDUCTIONS ALLOWED IN
Fntm RCC.IQ
J I-,j {' 'IS' '/
STATEMENT OF DEBTS
AND DEDUCTIONS
THE SUM OF ............, 9,jtfJ?2Y
DATE APpnDVED ......!JJf~Lc26}111
&.
'_ O'FIC~ 0" THE
. "IOlln" 0" WILLI
DP Cumberland
COUNTY
AND AOINT 0" THIl COMWONWIlALTH
{"".}... ''"'C'{.'
. .-:::-., ,:...t
ESTATE OF FLORENCE M. CALDI;ELL LAU DP Camp nill. Cumbo Countv. Pa.
DATE 0" FILING A,,.RAIIIMINT
..1- /? - :1'1
.ill1y 11
, qRn
. OAT' 0" DEATH
COhlMONWF.A~TH OF PENNSYLVANI"
}..:
HEREBY CERTlf'Y. THAT. TO THE BEaT 0"
COUNTY OF
I.
MV KNOWLEDGE AND .ELIEr. THE FOREGOING III A JU&T AND TRU E .TATEMENT OF DEBTe. ,UNERAL EXPENSES AND UPENSD OP'
ADMINISTRATION SUBMITTED TO nUt ESTATE 0" DIEClAIID, AI DEDUCTIONS ,.DR
INHERITANCE TAX PURPOaEl.
(L. S.l
IWORN AND 'U..CAI.ID IIE,.OAE MI. THII
DAY Of"
-'.-
PAGE 1
AFFIDAVIT ON NEXT PAGE
DEDUCTIONS ALLOWED IN
Form RCC.10
THt SUM OF ............, 9fff,;(.,;JY
OATt APPROYEO ...... .~~.:?s; I rit
~~;f., q.~II!:.~
FLORENCE H. C1\LDI'lELI. LAn o. Camp Hill , Cumb. Countv, Pol.
- OFFICIO" THE
STATEMENT OF DEBTS
AND DEDUCTIONS
.... REGleTER 0" WILL.
. OF
Cumberland
COUNTY
AND AGINT or THI COMMONWIALTH
ESTATE OF
DATi: 0(11" FILl NO APP"A1S1MINT
J-I? -,?/
. DATI 0' DEATH
July 11, 19BO
DATI!:
NO. 01"
VOUCH'"
NANE Olll' PAYEE
REMARK.
AMOUNT
Elizabeth C. Leffler
Herbert G. Rupp, Jr.
Executrix's commission
Attorney's fees
00
r
6,552
TOTAL:
9 B02
2B
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF Cumberland ..,
I. ELIZABETH C. LEFFLER, EXECUTRIX
NY KNOWLI!!:DGIt AND BELIE', THE rOREGOING 18 A JUST AND TRU I!: .rATEMI!:NT OP DEBTS,
ADMIN,8T"AT10N SUBMITTED TO THE ESTo\TIi: 0' FLORENCE r-t. CALDl"lELL
,
INHP.RITANCE TAX PURPOIIIEB.
HEREBY CERTIP'Y, THAT. TO THE BUT 0'
'UNERAL EXPENSES AND EXPEN.a 0"
DIlCU8ID. loa DEDUCTIONll rOR
eWORN AND 8Ulli!lCAIBII:D III:I"ORE MIlE Hla
Oc r
~/1f
BO
e. ...)-:...L'fl(-,<-- CL. s.)
C. Leffl.l3r, Executr~x
nAY Of"
,.
.'. ~\ .".) CLEMENT ~ I.!O. NOTARY PUBUC
My COITlftlIsIlon ellPltW AjlfIIIl. 1883
> ,.--
..:. .~Alln1\op."'c..,,..~.d_.,
PAGE 2
-
~
CO\
0-
cr
S
.~
----------------------------
._-___ __ ~ __""'-"" ~ __ ..,. __........ "'.A --.
_.'REV.t182EX .
~.;'>.. .. . . . COMMONWEALTH OF PENNSYLVANIA
4 'NOU000202 DEPARTMENT OF REVENUE
, 1\ OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
Id
""
.
If
It
=
~
~I RECEIVED
'J FROM
-
TAX AT 6%
TAX AT 15%
ADDRESS
Blizabeth C. Leffler
C 0 He G. RUpp,
1110 ernwood Ave
E8q.
TAXAT_%
ESTATE TAX
Camp Hill, Pa.
17011
TOTAL TAX CREDIT
7,157.89
FILE NUMBER
COUNTY
PLORUCB M. CALDWELL
Cumberland
m
m
LESS DISCOUNT
PLUS % INTEREST
(FROM TO_J
357.89
DATE OF PAYMENT
oc~ober 9 1980
NAME OF DECEDENT
TOTAL AMOUNT PAID
6,800.00
POSTMARK DATE
REMARKS: "PAnl ON ACCOUNT"
SEAL
RECEIVED BY
. / 'I I .. / /; ,,-;' ,. /
/~ ",' ,-. C ../ ir,t-LC~
M r lY.' SIfW~~E /
ReqrS~.r of Wills
I
REGISTER OF WILLS
________ ___ - __ __ - - ___ ___ - ____ __ __0
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
*'
// / tJ
/!/v'7' --:4.fL
, I
( ~'
';... .,:>#(.
/i
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A A'Ir'- ~/! /..( C __
ESTATE
,,' //j I "/' /;" - /11'/
/ I ' ',I /// ~ .' -' -x ) I
, ' ?
;, ")/j I' /;?t
>,f ~-l/-)<' F~'" .,,~ ' .L1_~'
COUNTY FILE NO: ",;/ /-:((J - -'/71
,
',I I / _ r :j ..
AJ>,I.{/(AA"" fl. /-;-r/'-'"
, i 1
, ~~ .' :/
/' ), . ' ,
,/'/.; ,f' /.-,Fr.-t r .
DATE
TO:
FILE NO,
'// ';- -I (/'9
A - v l... ,'.1
/--.'.
COUNTY
(. , ,~. I~ "P
. .of, (/,r '/ /t /. 1I,4"-:.~~
,~
, ""
. , .
//ti//
DATE OF DEATH '/,1
Ii
/1
<;;)
...
Appraised Value of Estate:
Real Estate
-
s
+
/!f It ~-((.' :: ,I
,
Personal Property
+
:;/3'l'l1/
Jointly Held PropertylTransfers
1/.'
$ / /? i
- /
-
) 3/}/;,
Total Gross Estate
Total Approved Oeductions
! '/,..., 'i'/
, ('0'" 01-
,
I
I
,
,
,
I
i
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I
1\
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S / -;, ,/ '" ., -I' ("
"I J~.2A,
Clear Value of Estate
Less: Approved Charitable Exemptions
..) /;-fj. u"/}
s /)0 7~;,/'!7
Clear Value of Estate Subject 10 Tax
Amount Taxable @ '5% Rate
/,
~ ~1) ..,-,....)
tax due
s //:Jj J'f
/.
:;" t,-ZJ
, 0,
s ~;;'t/. .:;"i
Amount Taxable @ 6% Rate
s hi) 1;3/'/7
I
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX OUE
'* '* '. .. .. '* A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
OATE OF PAYMENT
AMOUNT PAID
OISCOUNT
INTEREST
TAX CREOIT
/o-1.?r)
.
,/ t/.,:... ,'-
S ,J' /. ',1}, ".1
I
+ S :;'~-7 ?J- $
= s 1/1.;-; ?'7
I
+
=
+
=
Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
is
BALANCE OF PENNSYLVANIA INHERITANCE TAX OUE
s
"'4' -
I II 1/ -?
See Information on Reverse Sido
,". ,'l::-,;..:"
..,'_1___
'*,
APPLICATION TO
TRANSFER SECURITIES
FILE NUMBER:
COUNTY ,;f' /-,iQ- ..y'.ft
,
REV.517 EX+ (2.80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
REVENUE
NOTE: THIS APPLICATION MUST BE FILED IN TRIPLICATE WITH THE REGISTER OFWILLS FOR THE
COUNTY IN WHICH THE DECEDENT RESIDED AT THE TIME OF DEATH.
"
Name of Decedent: '-!-,j-;.'"
v'
" ~. ~f' jl
-h:_~""
,
/:"/:,irLl'-LI!--'DATE~ 1.1, 19f'A.
/ [:-ll ;) .J
(, , "/ Ii,;' f/
C-t_"__;IL.-_../j, ...Lrf-":A-,J>- . __
(CuUI'JTVl
Date of Death: 7 - I (
/
Address of
De..,dent: ',1/1
/!"
(CITY, 80
I
>1.
, J "
//7"\: (__("''-{'
d
I 1'/
(5TATI.::)
DESCRIPTION OF SECURITIES:
1. Stocks a,
/0
(N\JMBER OF SHARES)
b, i ~AS~~:)
c71~ ;~A~~SSU~Y) C!O .
e, J -1/- f ~
d.
11-17-S-~
(DATE OF ISSUANCE)
{DATE: OF DeATH
TOTAL MARKE.T VALUEI-7'
I~ J 60
2. Bonds a.
b,
c.
(FACE AMOUNT)
(INTEREST RATE)
(MATURITY DATE)
d,
e,
f.
(NAME OF ISSUING COMPANY) (DATE OF ISSUANCE) (DATE OF DEATH
TOTAL MARKETVALUEI
The securities are registered as follows: "I g.~ 7~ CJ ~
(NAME OR NAMES IN WI-IICH CERTIFICATES ARE REGISTERED)
Name of Applicant:
Address of
Applicant:
~. - ) /"1 / ~ /
..... J_-/' ;/ 'A __ ~~t'~..I~ J L--
\ /
;7:/
{C" i ;' ;, \
__.__I.w-[... I ,./(.-"J'-7'_~'------'"
(STATE) (COUNTY)
~{!,~~
V"-h -eo -/
CONSENT TO TRANSFER SECURITIES
I hereby consent to the transfer of the above securities and waive the filing of a certificate certifying to the
payment of the transfer Inheritance Tax.
'*~";;,.?:
/ 1'f,;(
,
~a~ .
't.<d , G.-V-~
EGISTER OF LSI
:"
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c
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~\
APPLICATION TO
TRANSFER SECURITIES
FILE NUMBER: d. -ft .-f!f'd
COUNTY '/- - 'd-,
REV.517 EX. (2.801
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
REVENUE
NOTE: THIS APPLICATION MUST BE FILED IN TRIPLICATE WITH THE REGISTER OF WILLS FOR THE
COUNTY IN WHICH THE DECEDENT RESIDED AT THE TIME OF DEATH,
Name of Decedent: . J 2r.',-~~<, ~ -1 L--r ,- -7)~1-"'---(!.--i. L
(// ".
. _' 4' .irl. ,/ <.L .l:(,
DATE/;1 / ~ I rf2
Date of Death:
Addre.. of
Decedent:
~
" (
.-' //,i..;7 Y
/) / t' , /1' //
(__~_rlt./tl-<'_4'(_..t:~-/'-....~
ICOUNTY) ( t:j,.tl; . )
~~~~.
?
e, 7- 1/- J 0 I'
(DATE OF DEATH 3 . J 9 / S'!:o
TOTAL MARKET VALUE) -") 7 O.
- /1
r;'
.Y r'j
DESCRIPTION OF SECURITIES:
1, Stocks a,
/ :;, 6 b, ~'j'l1. '
(NUMBER OF SHARES) {CLAS~ OF STOClq
k di:c.b.,L
d. p.m.)F IS5UAN("t.':.1
2, Bonds a,
b,
c,
(FACE AMOUNT)
(INTEREST RATE)
(MATURITY DATEI
~.
e,
I.
(NAME OF IS5UlNG COMPANY)
(DATE OF ISSUANCE)
(DATE OF DEATH
TOTAL MARKET VAL.UE)
The securities are registered as follows:
(NAME OR NAMES IN WHICH CERTIFICATES ARE REGISTERED)
~~
Addre.. of
Applicant:
{
(CITY,
(
(COUNTY)
U),. ../~,d t
(:'.:...,.; .", ,';
,/\-< -{$I';'/;_.;
{SI~T El
.-/
CONSENT TO TRANSFER SECURITIES
I hereby consent to the transfer of the above securities and waive the filing of a certificate certifying to the
payment of the transfer Inheritance Tax,
f!;;'l,j,.?,; .H/ .:(
~ a.~
. ~EGISTER 0 )LLSI
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