HomeMy WebLinkAbout80-00532
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21-80 532
No.
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
In the Estate of 'I:) ~J.A :. 0 CiJ S4L? . deceased.
To Register of Wills for the County of Cumberland, In the Commonwealth of Pennsylvania.
named In the Last Will and Testament of
dated ~- j1/!Q..-v>-& It.! / or G 7
Decedent was a citizen of the ted States and a resident of '/~L"n:"A{~'^<;'1
Township (Borough), Cumberl nd County, Commonwealth of Pennsylvania, U
Decedentdled~n ~- the r<:?4\.caYoh A,D.19~lnthe
County of C ' U\~ . State of \ ,.Q;\ov'Y~ at the age of ..:z..tL years.
Decedent has (has not) been married and has (has not) had children born to him (her) since the ex.
ecutlon of the above described Will, JJ
Decedent was possessed of personal property to the value of ,;:l7 1(0 7. 0 ()
/
and of real estate to the value of ^ J r,", .p
, ....
as near as can be ascertained; said real estate situated as follows
/VI) + tD 0 yO) I~' a-b)p
/I
Therefore, your petltioner(s) respectfully apply(ies) for the probate of the said Last Will and Testa.
ment and for Letters Testamentary theron.
Dated ~'M.,i- 12.. /'9 ~O
Name and address
of Petitioner(s)
~~ .~I
a--a.c/<.. :. .. U ~/7
q (/ (i LA :s;:tt,(?-I
IY/(}~'~U'.J) ti~ /7.c:>6-s,-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
named in above appil ation, being duly )Lc~
statements set forth in this petition are true to the best of
.q.t.<rt'f'Vv\..... and subscribed before
me, August 12 19 80
qJ~f-~' ?6,~,~J
t' f ~ter
1-1"~ 12
ac~ording to law say(s) that the
~ knowledge and belief.
~~
l,;oc1e
Filed:
August 15, :1980
Attorney
I~ II '1)<9___.....__. ~
I /- I iJ -; - /
OATil m' SUBSCRIBING WITNESS
This '- day of "-.0.,19 ,
before me, Register for the Probate of Wills and granting lellers of Adminislralion in and for said County of Cumberland, in
'- /
the Commonwealth of Pennsylvania~ personally came /
/
"-
the subscribing witnesses to the foregoing ins~nt of writing pUl'porling to be the last Will and Teslament of
'.
"'-Daled
,
late of
Gumberland County Pa" deceased who being duly
"
/
according to law, depose 7.that
/'
instrumenl of writing as ang.for h Testament and Last Will, and at the lime of so doing
was of soun~:,~~~p6si'~g mind memory and understa~ding, to the best of "
knowledge, ~.ation and belief.
. ~t, and saw and heard the test.
sign, seal, publish, pronounce and declare the said
'--. ,
and subscribed before
,
'-
'--.
/"
,//
/
Regisler
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA t ss:
COUNTY OF CUMBERLAND ~
~ tl~ t2 ~ ',/7
-<2AA. ~
says that as nearly as can be ascertaineclthe said decedent
being duly
Pa~J L__" A~ sl:::::p
died on
'~j,Jr
at or about
the
(::)R"-~ d~~
o'clock, .
A.D,,19..2)
s-
~........------ and subscribed this
/ 2.... day of () f~-?,;I-
19,.Ji7L. before /)
~.'l 'J '--'" . )
//I /''1/ ~ . (7fi-/h~----
.Y 7 Register
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r l ",.;
11',~
$km;v
OATH OF PERSONAl, REPRESENTATIVE
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, personally came U ^ r ,\). - -) .(~ -o-'~ J /J _
who, being duly (J'" --&1,0, do<2.,~ depose and say that as .~-^--
o //' (\ C"-r--
of the last Will and Testament of ' !~ 11./ JA A ^" ,D r~:l/l1--r-; deceased
-.a 12 .. 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. .<<~ subscribed before me.
'"
August 12
80
A,D., 19_
,1\
Register
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DECREE
Be it remembered that on the
15th day of
August
,A.D.,19~. there was probated and
recorded the last Will and Testament of
Pauline D. Stroup
late of
Mechanicsburg
, Cumberland County, Pennsylvania,
Deceased. Letters Testamentary were granted to
Witness my hand and official seal the day and year aforesaid.
Jack Stroup
. . . ..
...."..... 1
.. ~(':' i:_:
a . J
, -/)2("2.<-1. 6! 'Jt!C(~
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'.
. R!V."4D (1-'80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
AFFIDAVIT OF
FIDUCIARY
(Instructions. on Revorso Sldo)
I-/{, -fJ
*
.
Estate of f> A 1J /...>11\) e: J) S T~ Oll" P
Dote 01 Death 7-.;J..'ir-?"o
Social Security No. I 'if 4 - d-D - (;, 90S-
Bureau File No. :-X I ~1J - 5,:<:;:1."
Last Address Cl /0 (I ffAR.,-IOS S I
M~~ ko.".H h<J~, p,,- I 7c.J..)-~-
tCITYl ISTAIEI (ZIP)
County File No.
I. Decedent died:
( ) Intestate (without 0 will)
(X) Testate (leaving 0 lost will--capy attached)
2. Is the filing of 0 Federal Estate Tax Return required lor this estate? Yes_ No "J(
3. ()O Executar/~~.: ( ) Administrator! Administratrix
Nome <TA<!..k tI ":'.,Ro"tJ P
Address 9/0 (!.i-IARLEc:. 'S r
..Mfi.~/fANI<!.s8u~r~ PA. I '70S-6-
(eln') ISTATEI IZIP)
()C) Fiduciary.
4. All correspondence should be moiled 10 ( ) Attorney
S. If on aftamey is representing the estate, indicate:
Nome
Address
ICITY)
("TATE)
(ZIPI
List 011 safe deposit boxes registered in the decedent's individual nome, or jointly with, ar os on ogent or deputy
of another, or in decedent's individual nome with right of access by another os agent or deputy. Include the name
and address of the bank or ather institution where the safe deposit box is located, the name (5) in which the box
is registered and the relationship of the joint holders to the decedent.
NAME AND ADDRESS OF BANK OR OTIIER INSTITUTION
IN WHICH DECEDENT MAINTAINED A SAFE DEPOSIT BOX
NAME OR NAMES IN ~HicH
SAFE DEPOSIT BOX IS REGISTERED
RELATIONSIIIP or- JOINT
HOLDERS TO DECEDENT
Under penalties of perjury, I declare that I hove examined this return, including accompanying schedules and
statementsr and to the best of my knowledge and belief it is true, correct and complete.
/6 ~'J 19(1 :
DATE
........J
R,EV-4i50 EX. (3-S0)
COMMONWEAL TH OF PENNSYLVANiA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
(Instructions an Revarse Side)
ESTATE OF t'ALJkIIJL"J2...-"5:I.Ro..Y..!?
ITEM
NO.
DESCRIPTION
NotvF
ESTIMA TED
MARK ET
VALUE
TOTAL THIS PAGE CJ
*'
DEPARTMENT
VALUATION
(OFFICIAL USE
ONLY
REV~51 EX+ '3-S0)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEDENT
Estate of
ITEM
NO.
I,
d-,
3,
SCHEDULE "8"
PERSONAL PROPERTY
{Instructions on Reverse Side!
fJArJt../IJE.. :D 5 (1(0 U~
,
DESCRIPTION
tue.o.~l:J tlffO{ f'~1 i /11 ~1"l'It '(,{i'((.,./J
vo.,/()e. - d oVlaJ.e '..f-o bGloJ,.C..Ill/
o..~ needy -td-w,', Iy beJoI'f"
Q kv-: S'f WIltS.
-J
us (r<!4...fury?Jute 10000
J)Cl--I-e.J IS" Fd / 1~() f-)tJ-N
S"rz;,a! No 100 qf, ($c;'-/a.~e"(;~r.
US"frcQ..i'ury iVok /1160"0
:J)J.ed I~ Feb fi fa ' ?-If'--J'~
5e;(d N. /00 q7 (!liN'Ial!.uv4/Z",,1)
ESTIMATED
UNIT MARKET
VALUE VALUE
No It.-e
/0000 $/040Y
/ IJOao 'JI /6 l.(Cj <f
'*
DEPARTMENT
VALUATION
(OFFICIAL USE ONL Y!
TOTAL THIS PAGE [) CJo9 &' f
!
.,
QUESTIONS CONCERNING PROPERTY TRANSFERS
. ..
1. Did decedent, within two years of death, make any transfer of any material part of ilis estate wililoutreceiving
valuable and adequate consideration? (Answer "Yes" or "No".) fVc:J
2. Did decedent, within two years of death, transfer property from ilimself/ herself to illmself/herself and another party
or parties (inctuding a spouse) in joint ownersilip? (Answer "Yes" or "No".) 7JcJ
3. If tile answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide tile following
information:
a. Age of decedent at time of transfer.
b. Copy of death certi Ii cate.
c. Affidavit by the attending physician indicating the state of decedent's health at lime of transfer.
d. All other information supporting nontaxability of tr<lnsfer.
4. Did decedent, in hiS/her lifetime, make any tmnsfer of property witilout receiving a valu<lble or adequate consideration
therefor which was to take effect in possession or enjoyment at or aller his/her death? (Answer "Yes" or "No".) 'JJA
a. Was there any possibility that the properly Iransferred might return to lmnslerol 01 his/her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No".)
b. What was the transferee's a!(e at time of decedent's death?
5. Did decedent in hiS/her lifetime make any transfer without receivin!( a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves for hiS/her life or <lny peried which does in fact end before his/her
death:
a. The possession or enjoyment of or the ri!(ilt to income from the property tmnsferred? (Answer "Yes" or "No".) x.lD
b. Tile right to designate tile persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".) No
6. If the answer to five b, above is "Yes," state whether the ri!(ht was reserved in decedent alone or otilers.
7. Did decedent in his/her lifetime make a transfer, the consideration for whicil was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No".) lVn
8. Did decedent, at any time, transfer property, the b61eficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or whicil could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No" ,) ,NO
9. If tile answer to eight above is "Yes," was tile power to alter, amend or revoke the i<lterest of the beneficiary reserved
in the decedent alone or tile decedent and others? (Answer "Yes" or "No".)
PEV-45J EX+ (J.80.
COMMONWEALTH OF PENNSVLVANIA
. DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
Estate of PAtJt...ltJlf. /) "'5"'TRo cd"
SCHEDULE "D"
BENEFICIARIES
(lnsln/crions on Reverse Side)
*'
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY
DECEDENT BIRTH
.:T .All\;- 1-1 ~-TRou P ~AN 'YES V., ~ s-lc.cr-Q..
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1M;:"'''"'''''''''''''>?'' Pa-
I
SOJU\ T SPRAtd DA u"'-H ,ER \/2- p,fa-+-e: I
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The above beneficiaries are living at this time except for the following:
NAME
DATE OF DEATH
3.
.RCV.....4 1I.~OI
COMMONWEALTH OF PENNSVLVANIA
O~PARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECED~NT
SCHEDULE "E"
JOINTL Y OWNEO PROPERTY
flnstruct;wIS OIl Roverse Sido)
~CfJ8 ee..^,:f,c.....{.-? cr ~r'S'1 1-
#,OI?J'4::<1 .:To'.",'/- (JJ,f-",
.::J"i!)A,IJ 5fJ/?ow (Ji<t..u~/"'fer)
.:33" '?' S-+()/,Jl!. R /1)6-c R))
'-}Ofl../{, pPj. C.lJ9 ~(.r.'",,1 'J:i1k>y(',f) tJ~7co9,Jf.so f,;lJOs!
JJ4:k OU."'~Y!f/.('p Es-lo.t,r;J/"~/ 19.J(}/J 19?5-
e.~N 8 S 'b/l "'~ S A-.1 Cl<iUo1. ~
N~ C!)lo-0'77/~S-9 .:r;,;1\If UJi77-j
JAc.l( SI'1!.c>up (SON)
'110 (! /l1I1? U: s 5T'
MIZt!IMAJdHI/CNUr (.10.- (1P3'/lN.<l.r<."J 2:;...+)
:D"'-fe O"....tevs,,:p ~fr:,. b ,;"J""c/ I Ma..y /y7~-
t!..a /.II) (/4eo k, ~T1 AQ.cou"f
/Vo. IS" OO(,~3 0 :;01N/ wmf
-:t M..I( S"tf{oup (SoiJ)
<110 Q."o<~(<?s S+-
M~<>.k.."", <!.s bU,f:-\ Po.-
1Jo..\-e O'-"M'Vft..:, fO ~'s'-Ir...bl;~4..J ,1.8"& j In
Estate of Jg l)LINF ]) ':'1/1(0 (, f
ITEM
NO.
DESCRIPTION
Iv
;2.
L.{, ';j)/Zl=r-1V5/e. A-,l.:t'V'"rIl=:; (]Rrn>ITVlVtotJ
AfLt1.Qu!Jr .l:/=. /'{'-ILl! .J""OI~T WI r-/-I-
.:J1>,(!,k 13 "t-RouP (SOIJ)
~ I 0 <!..ito..v((;:,5 5f-
F Me(l/.tO<.K~acb'-'.r~ P,"- (l$/&-g AQCf-{.JJlJ
:D","~ O",-,\efS!"p Tz:s-tL'j;(,54 -eJ Ga..! ('1"rtt
~ UAV-11 '1 S'
TOTAL
MARKET
VALUE
I ng. '?
IJtf~ S.)) oS.:>
')'J/P1.0S"
1/(a,3S 7J ,nJ
P
E VALUE OF
\ DECEOENT'S
N INTEREST
T
i'92.. ?)
t, 7~
c2.7.1'7~-:S 1b/.'. .\
f!.o> 3L/) so I.!. 0 3(.7)
TOTAL THIS PAGE 'A'17 9
.~~~
~
DEPARTMENT
VALUATION
IOfficiD' Usa On/vI
cZs1;'I: Co '/
'11M.'!
II FS.,),j
1'f.i'7'1. ?I
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INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
.
.
Schedule "E" must include all property. real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship, Both tangible and intangible property are to be
included. List real estate first.
1. Describe all real property as indicated in the instructions for Schedule "A". Describe all personal property
as indicated in the instructions for Schedule "B", Include the name, address and relationship to the
decedent of the co-owner (s) and the date the joint ownership was established,
2. Indicate the total market value of the jointly owned property.
3. Indicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest.
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INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
21-80-0532
m Original
o Supplemental
o RemDinder
File Number
Estate Name
Pauline 0, stroup
Dated:
Date Df Death
July 28, 1980
Social Securi ty Number
184-20-6905
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance To. Appralur In and for the County 01 Cumberland
Pennsylvania, do respectfully report that I have opproised the real and personal property as reported In the foregoing
retum at the values set forth opposite each item in the 10" column to the right In Schedules "A", "B", "C", and "E"
(~Ji" fi" ))
.....l"'f '/' ~ "I / - 11I/1},,,
INHERITANCE TAX APPRAISER
April 20, 1981
ADJUSTMENTS REMAINaER APPRAISEMENT CODE
INVENTORY VALUE AS APPRAISED CODE (HARRISBURG USE ONLY)
Real Proporly (Schedulo A) S None 00+ 92+
Per.onol Property (Schedule 8) 20,988 00 10+
Jolnt.Hold Prope"y (Schedule E) 19,532 87 211+
Transfer. (Schedule C) None 30+
TOTAL GROSS ASSETS 40,520 87
L... Oebt. ond Oeductlons 40- 93-
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Estate Rill FACTOR PRINCI PLE VALUE CODE
o Annuity
FOR USE OF REGISTER ONLY
Tl]lc on $
Tax on $
CODE
COMPUTATION OF TAX
S
S
S
S
S
6%
15%
Tax on $
Tax on $
Tax on $
Exemptions
Total Estat.
TOTAL TAX
INTEREST FROM
BALANCE
TO
s
s
S
Leu Cr.dlts
DA TE OF PAYMENT
AMOUNT PAID
TAX CREDIT
S
s
INTEREST FROM
BALANCE DUE
REV.~18 FO (Hal
~."..
Ir;:~~
COMMONWEALTH OF PENNSVLVANIA
OEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
NOTICE OF FILING OF APPRAISEMENT
Mr. Jack H. Stroup
910 Charles Street
Mechanicsburg, PA 17055
RE: Estate of
County of
File No.
Pauline D. Stroup
Cumberland
21-80-0532
Dear Mr. Stroup:
You ore hereby notified that the original
appraisement in the estate of Pauline D. Stroup
has been filed in the office of the Register of Wills of Cumberland
County on April 20 ,19 ill... Said appraisement reflects the following valuations:
Real Estate
Personal Property
Ja in tl y Owned
Transfers
Total
None
$20.988.00
5:19,532.87
None
$40,"='0 R7
As to such tax that is paid within three months from dote 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 rate of six (6%) percent
per annum is chorged.
Any party in interest who is aggrieved by this notice may object thereto within sixty days
after receipt of said notice as provided by Section 1001 of the Inheritance and Estate Tax Act of
1961,72 P.S. 2485-1001, P.L. 373.
Dote
April 20, 1981
Signed
- ,cAlM /n /--jfff lid .J )
Chief Appraiser
Title
NOTE: This is not 0 bill.
;.
I
REV-457 (l.ao)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
INHERITANCE TAX
APPRAISEMENT
..
Estate of
Pauline D. Stroup
File No,
21-80-0532
County
Cumberland
Date of Death
July 28, 1980
In the eVlnt that any uturelnter.1t In thl, eltal.l, transferred In poSSMslon or enjovm.nt to collateral heln 0 t e deel Int a tlr I I .xp rllt on 0 anv
estate for m. or far VNn, thl Commonwealth hereby Ixpresslv reserves the right to appraise and assess transfer Inherltlnce taxIS lit thllllwful colllterel rltt
on any lOch futurlllnterest.
TOTAL REPORTED PROPERTY
DEPARTMENT'S
APPRAISED VALUE
None
$20,988.00
None
$19,532.87
$40,520.87
PROPERTY REPORTED BY THE ESTATE
1. TOTAL REAL PROPERTY - SCHEDULE "A" . .
2. TOTAL PERSONAL PROPERTY - SCHEDULE "B"
3. TOTAL TRANSFERS - SCHEDULE "C" . . . .
4. TOTAL JOINTLY OWNED PROPERTY - SCHEDULE "E"
PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH
TOTAL UNREPORTED PROPERTY
None
TOTAL GROSS ASSETS
$40,520.87
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.
fl' ? , }
'/1 -I( i /1 ,,-oll 'ft' it Ii' \( I
APPRAISER
April 20, 1981
DATE
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
.
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
COUNTY FILE NO:
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TO:
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ESTATE
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FILE NO,
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DATE OF DEATH
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Appraised Value of Estale:
Real Estate
s
Personal Property
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+ ~.'(,
51ft. ,1..()
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Joint Iv Held Property/Transfers
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+ " 7
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Toral Gross Estate
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TOlal Approved Deductions
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$, :~fr /?-/ ./,/
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Clea, Value of Estate
less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$J'~ It.; ,)'1
,
Amount Taxeble @ 6% Rate
;./
$ ,-'l/~
tax due
$ ,_.~~/ /'/, () '1
,
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Amount Taxable @ 15% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
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$. ...-
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... ... ... ... ... ... A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
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$ ~. {.'t.. (! I'll
=
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$ ,;:;: /t:^'C f''rJ
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+
$
$
+
=
+
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Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interesl due if paid by
is
$
////.,1
BALANCE OF PENNSYLVANIA INHERITANCE TA.X OUE
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Assessed by: . ,.-t.. ,;.. "'l II' /.J /C4/
See Information on Reverso Sldo Agent forthe Cornman eallh -/
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REV.." EX' (J'HO)
COMMONWEALTH OF PENNSYLVANIA
.OEPARTMENT OF REVENUE
T~ANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE of''
STATEMENT OF DEBTS
AND DEDUCTIONS
Estate of D AUl-lIJu ." 5TRo v f' Date of Oeath ,::tl? ,il Y l'1fO File No,
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant , r A Q.!-< H Relationship to Decedent
>)
'a..
Claimant's Address
.5n iJ
J 70 -
REMARKS
d. Fa ~ H
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 estate as deduct~'tance Tax purposes~
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fATURE OF ATTORNEY IOUCIARY I OifrE
OFFIClp:L USE ONLY
DEBTS AND DEDUCTlDNS ARE ALLOWED IN THE SUM OF S .(133 (,. /J-t)
AT
t;
PERCENT,
$1 (I#Arl:.J
REGISTER ILLS
a-/3-1/
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxable estat~,
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 52,000 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. The family exemption is
allowable only against assets which pass by a will or by the Pennsylvania Intestate Laws,
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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.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
*'
COUNTY FILE NO:
d.1-(;'()-j?'>~.
DATE
TO:
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Appraised Value of Estate:
Real Estate
ESTATE
()005
FILENO, ~ ;(r;,;,..::5~
COUNTY (~J}/),(L.;/"I_l
DATE OF DEATH \JqDy ~ A/ I 9 go
$
Personal Propeny
+
Jointly Held PropertylTransfers
+
Total Gross Estate
$
Total Approved Deductions
Clear Value of Estate
$
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$
Amount Taxable @ 6% Rate
$
tax due
$
Amount Taxable @ 15% Rale
tax due
/7/.~;~
~I 7(,57
* * * * * *
....; T~TAL PENNSYLVANIA INHERITAN~E TAX DUE ) $
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(.00.;13'7\
A five percent discount totaling --$
Inheritance Tax is paid by
c
will be granted if the
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT INTEREST TAX CREDIT
+ $ $ J!,Lt; = $ J? / ~/
I
+ =
+ =
rJ;J, "7, 1 '71 5J'
5-15_~l
$ J'7I'()7
Interest accrues at the rata of six (6) percent per
on the unpaid balance of Inheritance Tax from
to dale of payment. Interest due if paid by
annum
is
$ (tria ~)"'1'q jIJ
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BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
Assessed by: '." ////.1 , I (~.'
See Inlorm.Hon on .~.ve"e $;de A.en, f~~~ ~m;,,;/e~ L.-
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