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CQMMONWEAL TN OP PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX OIVISION
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES ONLY
OF RESIDENT DECEDENTS
COUNTY OF Cumberland
This return must he completed In detail and filed In duplicate, with the r-?eqlstHr of Will!; In the County wh':rf' th.! d"C:llrknt re!iIOl..'d within anI!!
year aft~r date of death, unless on extension Is qrcnt~d by the Secretary of r~ev(;'nu,-,.
Will C:;/ -f?()-SSrr
Admn. No. 19_1, T .l"\111'311:'l A O?,phnc;.k;
(Name)
4613 Cb<;!stnut Str'i'et .
of ~nlUjUJ..r. ""en115...Y van1Cl
Addron)
Widow and Executrix
(Exoc., Adm.. Legatee, otc.)
H"mpden.....Il\IP-.
(City, Borough, or Town.hlp)
Auoust 6, 1980
(Date)
consisled ollhe assets lisled below and thai allowable debts and deductions exceeded the lair ma,ket value 01 the assets and
Misc.
being duly sworn according to low, deposes and says that he is the
01 the estate 01 Bernard D. Ozehoski late 01
. deceased, and that the whole 01 the eslole 01 sQld decedent, who died on
n(l pt,.nnsylvania Transfer Inheritance Tax is due.
19~TIIP..Y PU3LIC
LEAH 1. LONG (Signature)
".~ " , Cumberbnd Co., Pa, ,J-ouella A.
"~ " 10 19~
,
, Widow/Executrix
(Tille)
Type of Asset:
Real Estate,Pers.
Praperty,Jalntly
Held Prop. or
Transfers
Departmen.
Valuation
CAUTION
(00 not write
In thl. .paco)
ASSETS
(Attach additional sheets If necessary)
Description of Asset
Estimated
Market
Volue
N
ON
E
TOT ALS
None
N61tiJ
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and far the above County do respectfully report that I hove
appraised the real and personal property as reported in the foregoing schedule at the values set forth opposite each item in
the last column to the right. Y/JJliOh/,l ) "/(/~'Ji,; /#,/./
October 23, 1980 Inherltanco Tax Appraiser
Name of Pay eo
DEBTS AND DEDUCTIONS
Nature of Cloim
Amount
Claimed
Amount Approved
by Register
Fackler Funeral Home
Louella A. Ozehoski
Funeral Bill
Widow - family exemption
$2,034.00
$2,000.00
TOTALS
$4,034.00
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills In and lor the above County, do respectlully report Ihot I hove allowed
deductions in the amounts set forth in the above schedule os claimed, except where I have set forth a greater or lesser amount
in the last column to the right, which greater or lesser amount represents the sum allowed as a deducJion.
Date 01 Approval: 8(;7;;k.J .t<J3 /9 Po q;-1h/U J (l, Y:;.//H:J
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*'
COUNTY FILE NO:
I
--"....". /..
DATE ." .....-t:;;,;/_..-V',.:;"'~: 1//'''''','
... _" .' I (J V
I' ,
ESTATE ,-, ,I :. " i i j ,
....... -l.' I.' /1"-'(.,'1-('/-/'- 1,_","/ ,I -t.." ~::-v
FILE NO: <'''' - -<i'
f -: U -'..../ .:'
TO:
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I .. /-., '~'" ( ..-,
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COUNTY
. ,.'
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::./;..f.///~/'(_....l....-VV;'t..r.:.
DATE OF DEATH
j, . If- /
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,i
-..ApptilSed \lehI8t!>l,E.l~!f: ..
Real Estate (j
"'"
I I I j
( 1/ Il
l,::'tl
s
----
i'ersonal Property
.
--
Jointly Held PropertylTransfers
.
Total Gross Estate
s
--
Total Approved Deductions
Clear Value of Estate
Less: Approved Charitable Exemptions
---
Clear Value of Estate Subject to Tax
s
---
Amount Taxable @ 6% Rate
s
.:' t. ')'l /---,/
tax"dull'/ . .;-I:"/./8t, - .//:-1'
,~I/.r,{.,/,/'(./ v v.. .........."
I
tax due
I .J, /111-.--/
TOTAL PENNSYLVANIA INHERITANCE. TAXOUE Y,,8t: / ?- !!/ y/
f/ / t.::.4'fI'1,--'1 -:-' {/ ..... V
Amount Taxable @ 15% Rale
* * * * * * 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
&
+ &
&
=
&
.
=
.
=
Interest
on the
to date
accrues at the rate of six (6) percent per annum
unpaid balance of Inheritance Tax from
of payment. Interest due if paid by
is
I ' /,"--'"
, I, ,./.) .' I I
"'i $ F ,"" ,.If ." / I: /./
; I ... ....... ~ ~ .., >
BALANCE OF PENNSYLVANIA INHERITANCE TAX oue~,"
" ~ +'
Assessed by: t ; I, ,t. , /. . . .....
Agenlt9"'1t)4tCdmm~ /.l:..-v-
See Information on Reverse SIde , !: { 0 I
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