The URL can be used to link to this page

Home My WebLink About80-00576 " / ", ~it~:. ~, ~~\./::' \ ~h~ ,,'~." ;,:."f" l~;'i:: 1.';j;""':' fjf\~," ~~,~~::;:;'" ,'. ~-~ '," .... ',,' :"J ',...- " "...;.' ", ~ ..,., , " S " I " .. I1t H gj 8 ~ . >t ,'., E-t ~ I ~ '. ~ ~ . ~ r&'I . CD ~ ~ ::t: l'o, CI.I ~ 11) ~ 0 CI.I " ,.c:> - ,. 0 " .. " ,~ ';', " - ~ .... N :i " . :~ 0 It "-, Z ", L&J 21-80 No. PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY 576 In the Estate of IFssm E. S'1'AMRAIr.H , deceased. To Register of Wills for the County of Cumberland, In the Commonwealth of Pennsylvania. Petllloner(s) Is (001) the execut J:.i..v named In the Last Will and Testament of lEssI" E S'T'AMRAl Ir.H dated l'In" 1 (; 19~ 7 . '- Decedent was a elllzen of the United States and a resident of Boiling Springs, Sou t h fll; J.j IJon \.. I'. Township (8.. _u,;j,), Cumberland County, Commonwealth of Pennsylvania. Decedent died on ~llT"V'f:1Y the ?Mh day of A"g"ot- A.D. 19-5O.-, In the County of 0 rrnhPrl ,mrl , State of ..J?A... at the age of -C1- years. Decedent has (has noll been married and has (has not) had children born to him (her) since the ex- ecullon of the above described Will. Decedent was possessed of personal property to the value of $10,000 00 '1p"'a~li and of real estate to the value of $1 n, non no llp1,,~,.rlS as near as can be ascertained; said real estate situated as follows..a. brick dwelling at R,D ,No.. 1 Boiling Springs, PA & ~~~'1~F~e~ h ~,gp;.r8, ~~fJ,~hi r} Ynl'"k rnunt..y..., Pflnnc:y' ":'In; :1 Therefore, your petltloner(s) respectfully apply(ies) for the probate of the said Last Will and Testa- ment and for Letters Testamentary theron. ,s"pl. .5 ) Dated ',[. I 7R, 1qRO Name and address \J. of Petitioner(s) ." '0 "--.;'/'. \.........f" . ~ ",,"/I~ ~. //,.I.//./) , J . Linda L, Davis R,Ih-1-,-Bex 13G York Springs, PA 17372 COMMONWEALTH OF PENNSYLVANIA l COUNTY OF CUMBERLAND j LIID~L. DAVIS ss named in above application, being duly sworn statements set forth in this petition are true to the best of according to law say(s) that the her knowledge and belief. SWOnL- and subscribed before Z~PJ .3 I me;ar; . -ti - 19 . 80 ---u(1/Mf--J -~.-~. f Register -~~~~/ :{ {]~ \ LI~A L. DAVIS , -------------------------------~'-':c_\?~ '\~, LJ /~ FI'led'. 8 ,/ JANM.!'IILEY, ESQUIRE ~'/I!l. sept. ,1980 ' Attorney' 6-- voJ L" (=>0 Bo L dEi'S / ----n, I/" buy J' Pc.. \ 10 I ~ ' ';:;/-8"0 -~7(p '.i.- - "",,;j ,(-'f:' . !J)",:cp t.~i11"" 1;,. D.f,U.<<. t) =t :{'--t ~l~t #: 0:: fi ~J I >< ~ @i ~ ~ ~ ~ .tl j W t') . ~ ~ ~ ~ ~ ~ ~r- f' Q CIl ~ IJ) ,... . ~~T o ~ . c!S~z . r<I ~ " ~ - LJt fo< z _ ~ r<I IIJ ~ ~ r,~,L H f:lP~ CIl ~ CIl ~ < III ~ t:) !!! r . . . . OATH OF SUBSCRIBING WITNESS COMMONWEALTH OF PENNSYLVANIA } 55: COUNlY OF CUMBERLAND This .........ZiWR....,?:.r..d,.............................................. day of .._'>.4,dat.....Jt:.Ft-:=,:C.l..!?-::..:c............. A. D., 19..~9.., before me ...........~.+.Y...!;;.....~.~l!!;.Ii!........................................................................., 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 ............J.?!)"~k.Wj,J~.Y...!\<..J.C??n..W"...Wg~y......,,.............................................. .......................................... the subscribing witnesses to the foregoing instrument of writing purporting to be the last Will and Testament of ..................J2ssie...E...Stambaugh..................................... .................................... Dated ......June..~(i~..19.6.7........,..... late of .....R.,p_..l.,...Boili.:r1g..Springs.,....!?!?~S:~...~~~.~U:~.!;!?~...~.~......... Cumberland County, Pa., de~eased who being duly .........5.worn.............................. according to law, depose and say, that .............!;h~y...~!:~.................. present, and saw and heard the testa..t;r;i.~........................., .............................................................................................. sign, seal, publish, pronounce and declare the said instrument of writing as and for h..g!............ Testament and Last Will, and at the time of so doing ......~b~...................................................... was of sound and disposing mind, memory and understanding, to the best of ........t:!:le:i,};........................................... knowledge, observation and belief. '~- "J, "p L ~ ~ :~/, 7/7) :" ...........c...~iN~W.;~fLEY ~ 7....................... ............................................................J............................... ..................Slolcl1:b......................... and subscribed before ....0;~..t2.,:..~......... Register. AFFIDAVIT OF DEATH COMMONWEALTH OF PENNSYLVANIA 1 COUNlY OF CUMBERLAND 158: LINDA L. DAVIS . ............................................................................................................................................................................... bclOg duly ..................SWORN..................... says that as nearly as can be ascertained the said decedent ..JESSIE.R.SL\MBAlJGH.. ................................................................................................................................................................................... died on ...................sunda:y..... the .........2~!;h.................... day of ........~)J"'!:'lL.............................................. A. D., 19 80 \C!)l':i ........J at or about ........2.:.00............................... o'c1ock, A. M. .................,.swom............................ and subscribed this ~ Set't. ...................~......~.,Lg(.......... day of ..!.I',:~.~.~....,... 19,~ore .......jL(~,.(!.:..~..... I' /Ja2 ',-- " - .......-t'.... x.... /. . '1....v:~.~~:cL~.:..~;~~. -i..?~~.~l.1............................ Register. 935 . ~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYI.VANIA~ 55: COUN'lY OF CUMBERLAND Beforc me, the Register for thc Probate of Wills and granting of Lcllcrs of Administration in and for thc County of Cumberland, pcrsonally camc ..............kINDA..Lv..DAVIS"...,..........,.................,........,..................................... who, being duly ......,sworn............, do ,es....... dcposc and say that as ....E!<eeutr:iK-.................................................. of the last Will and Testament of .......~.~~.~.~..!';.....g~\.!9.1:t....................................................................... deceased ................~~..................., will well and truly administcr thc goods and chattels, rights and credits of said deceased according to law. And also will diligently comply with the pro\'isions of the law relating to Transfer Inheritances. ................sworn..... and subscribed before me. ................6~J..?fL..$.,;:p:t....3..,. A. D., '.9..~g... R~;i;tf4lj...t2..,.~...................... '/" '-/jn ' .......~l~:(~r.~~~~),... ..l.(!.(,!,(:.o..::,..............,........... ............................................................................................ o 00 I - N, ~ ..,; 0: " ~ ~ iJ .... t: Cl I.L 0 M: 00, ;J:: :IF! -I 1\ -'" \D g co! l' -I .co Ltl ~! - . ., t - - U -1->: 0 ~ ~ Eo< ~ co ~! ril al, I .5 001 ~ til: N >-<' ." M (/), " 0 0 ~I ." ~ (l'I Z 0 '"' v ~ ~ ." " .. ." ell ..!! ~ ~ c .. ii:; lJ.l .. ~ DECREE t&> l' ~ . 8th September Be it rcmembered that on the ....JaIlllC........... day of .......~...................,................., A. D., 19.8Q..., there was probated and recorded the last Will and Testament of ........JESSIE..E;.....5'I'IIMBAl:JGH.........................................., late of ...!3:~.J?:...!.l..,J?~g.~):\g..~P!.~.n.g~.,..~~.~.~~...~~~.~!7.~~JC~~fa~~i&unty, Pcnnsylvania. Dcceased. Letters .................r.!'!.~.~.?~!].~Al.r.Y........................ werc granted to .. ....1J~..1.,..P6Y.~f?.............................................................. Witness my hand and official seal the day and year aforcsaid. ~ Vj . ~ . ................0(LUy........:... .. ...... .......R~~i~;~~:..... ... .-A .. . . . Inventory of the real and personal estate of JESS IE E. STAHIlAUGII deceased REAL PROPERTY: SALE of 69,236 acres situate in Carroll Township, York County, Pennsylvania, to Robert H. Fahrney and Sylvia J, Fahrney, his wife, IT BEING a portion of the same premises which Lawrence A. Fetrow and Alice Fetrow, his wife, by their deed dated August 25, 1944, andrecorded in the Office of the Recorder of Deeds in and for York County, Pennsylvania, in Deed Book 30 Q, at page 572, granted and conveyed unto Glen F. Stambaugh and Jessie E. Stambaugh, his wife, The said Glen F, Stambaugh predeceased his wife, thereby vesting full and complete title in Jessie E, Stambaugh. SALE of Lot No, 21 on the Plan of Lots known as Countryside Acres as recorded in the Office of the Recorder of Deeds for Cumberland County, Pennylsvania, in Plan Book 18, at page 38, to Richard W, Spieth and Brenda K. Speith IT BEING the same premises which Robert G, Yetter and Ona M. Yetter, his wife, by their deed dated October 27, 1978, and recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book C 28, at page 813, granted and conveyed unto Jessie E. Stambaugh, deceased. PERSONAL PROPERTY: 1, Checking Account no, 222 862324 1 Commonwealth National Bank 2. Statement Savings A/C no. 22 0002894 8 Commonwealth National Bank (accrued interest as of date of death) 3, Evergreen Savings A/C no. 22 0010184 4, Commonwealth National Bank (accrued interest to date of death) 4, Savings Account A/C 14 707351 Cumberland VAlley Savings & Loan (accrued interest to date of death) 5, Redemption of 14 E. Series E. Savings Bonds $25.00 denomination 6. Presettlement rent from Mr. & Mrs. Spieth 7, Capital Blue Cross, refund 8, Medicare refund 9, Shillito Farms, rent 10, PA Blue Shield, refund 11. I.N,A., refund 12, Capitol Blue Cross refund 13. Proceeds of public sale 14, United Telephone refund . . . 124,000 00, 58,000.00 . 962, 51 138. 81 48 7208. 32 63, 60 25,000, 00 412. 24 970, 89 100. 00 115, 26 87. 20 1625 00 21 80 78 87 18 35 12954, 35 9, 35 -'!, COMMONWEALTH OF PENNSYLVANIA , . , COUNTY OF CUMBERLAND t. J 5S: LINDA L-----.Qt\VIS ____ _____ n.____ being dulls S\;ORN ___ according 10 law, deposes and says thet s he - Executrix ,______,_ of the Estate of JESSIE E, STMlBAUGll late of -~.R"D, ,1, Boiling Springs, S, ,Hiddleton-TwpCumberland County, Pe., deceued end that the within is en inventory m.de by LINDA L, DAV1S ..___.. , the s.id EXECUTRIX of the entire est.te of said decedent, consisting of .11 the person.1 proporly .nd re.l eslate, except re.1 estate outside Ihe Commonweelth 01 Pennsylv.nia, and that the ligures opposite each item of the Invontory .epresent it's lair value as of the dete of decedent's death. sworn - "-(,,;,. ,/~ -pLI' ~)4& . , ,:/ 61;-( Ai,,} hoc.lor ~i\~ and subscribed beforo me, /1 19 -ll1 -t: LINDA L. DAVIS "V. M. VIETHINGlmJ. ':CIt~ri Pu~; :HG [WROUGH, YORK COU:.d ,i1SSION EXP/RfS DEe, 27, 1532 r'.~nn':.~lo.:3nia t."::':JciatIOrl of NGta:ll2!i Addr." R. D, 1, York Springs, PA 17372 C.te of Ceath 24 DAY 1980 Vu, Augu.s.C- Monfh INSTRUCTIONS I. An inventory must be filed within three months alter appointment of person.1 representative. 2. A supplement inventory must be med within thirty days 01 discovery of addilion.1 a..ets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. ~ o I- Z W > Z >- l;;UJ ~ ~ W 0 II> "" UJ J: 0.. l- LL -' o <( z o 0 VI z ffi <( 0.. ::t: '" ~ ~ <J:l L i g--g e-<;o . c: ~ 0" . '-'0 Qj . 9...... i~~ 1 :~ - ~ o " .D E " () .... ..! it -' LL <( 0 w "" "', ~\ ~I ~I I I ci z " - .. -' ~ \:l .... & <J:l '" ,:,',~~\!k,{ '".'...,;,;.::;l/f~.. PAGE -2- Inventory of the real and personal estate of . .~ ,', I JESSIE E. STAllBl.UGlI deceased 15. Nationwide Insurance, refund 16. Nationwide Insurance, refund 24, 30 17. James Wonders, Insurance refund 18. Tax proration on Boiling Springs Property 92, 00 19. Tax proration on Carroll Twp., York Co. Property 55, 00 347. 79 20, Equitable Life Insurance - benefit due 153. 32 129. 73 TOTAL REAL & PERSONAL PROPERTY 232,569. 17 I ..I I COMMONWEALTH Of PENNSYLVANIA , . " COUNTY Of CUMBERLAND L J 55: LINDA-L-.-DAV.IS----- ----- -,--- being duly SI,QRN____ according to law, deposes and says that S he is the Execut rix ,____ ____ of the Estate of JESSIE F., STAMBAUGH late of -R. D, ..1,,, Boiling Springs ,S. Hiddleton-Twp.--, Cumberland County. Pa., deceased and that the within is an inventory made by _____-1-IND.A_ L, DAVIS , the said Executrix of the entire estate of said decedent, consisting of all the personal proporty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. Sworn and subscribed before me, ~"M..' ;t )()a-t<./~ ---r Executor . Dd\~KmKXX 19 N LINDA L, DAVIS GLENDA M, WETHINGTON, Nol"y P Ie DILLSBURG BOROUGH, YORK COUNTY MY COMMISSION EXPIRES DEO, 27, 1982 Member, Pennsylvania Association of NotarIes R.D. 1, York Springs, PA 17372 Addr.n Date of Death 29th ----Augu"t Month ,QRn Year Day 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. ~Additio~1 she,ets, may be attached as to personalty or realty 4, ':?ee Art<cle IV,:fr~uciaries Act of 1949. L : 1~: 0- N -.- g:~- >- ~~ 0: en c::t: CI~ 0- 2:: ~~ u~ cc- ~c: iO dE; :I: " >- ~ .,; ~ '" : m H I- w ~ ~ ,j ::l ~ '" ?- m 0- w < m <1- I- u '" 0 V> '" .. m '" 0 w w C '" ... :c '" .. ~~. l- I- <1- ....I U. '" ~ <1- Z U. -' < 0 '" .... <1- W 0 < W H 't:l ,;.. > Z 0:: '" 't:l - Z 0 '" 9 c ~ C '" ~ V> Z ..., 0 :z '" <( 0 .... Z w '1 <1- " C - m -.: 0 .. ..0 'tJ .. E - ..!! .. ~ ....I 0 u: --- -" ---.- - - - - -- - -- - -" --- -. - - - --- --- ...-....... -- . )t.REY.1162 EX ~", '. COMMONWEALTH OF PENNSYLVANIA 4 NO K 29529 DEPARTMENT OF REVENUE , . OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX , ~ . 'II !I = " ~ ~ RECEIVED " FROM I ADDRESS - ~~ ...,,------ ~ A ~a -- TAX AT 6% TAX AT 15% Linda L. Davis C 0 Wiley & Benn, 204 M r Lane TAXAT_% Attys . ESTATETAX FILE NUMBER 21-80-576 11,968.94 0 TOTAL TAX CREDIT ~ If LESS DISCOUNT m PLUS % INTEREST (FROM TO_' m TOTAL AMOUNT PAID 11,968.94 Dill.burg, Pa. 17019 '--~f~~T~[~~~~ATiCjir~~-:-24-:-i9B-O---------- COUNTY May 20, 1981 JESSIE E. STAMBAUGH cUIIlberland DATE OF PAYMENT NAME OF DECEDENT --------------------- ------ - -- -- - L POSTMARK DATE r REMARKS: .PAm f' ~ I ON ACCOUNT" SEAL RECEIVED BY / 'i;,,',.! ~"" , "/~;A/-!J ~~GNbi\Uo/ ster of Wills REGISTER OF WILLS REV0449 EX. (3.80) c'OM"QNWEA~ TH OF PENNSY~VANIA OEPARTMENT OF REVENUE . TRANSFER INHERITANCE TAX RESIDENT DECEDENT * AFFIDAVIT OF FIDUCIARY (lnalructlona on Rever.. Side) Estate of JESSIE E, STAMBAUGII Do Ie of Deo lh August 24. 1980 Lost Address ~...R.,P.' J,..B.QUing_:inr..lngs..-;,_;;-;1:" ~1X 'l?t'4rtMf~j(... Ic,7"'?-"" ' /.' ___",_..JA 17007 Sociol Security No. lR7 lfi 'i'iln Bureau File No. (ell YI (STAlE) (liP) dJ/- '>?t"? -57~ County File No, I. Decee/ent e/ied: ( ) Intestate (without 0 will) (XXfCTestote (leaving 0 lost will--copy attached) 2. Is the filing of a Fce/erol Estate Tax Return required for this estate? Yeslili- No 3. ttX ) ExUlOOfXExecutrix ) Administrotorl Administrotrix Nome IIblD^ l 1l^"Il> Address R.-D. 1, Bel' 136 York Springs, PA 17372 C"l ~ r- ",'" C"l1'T1 ~ ~~~ I'T1I'T1 ",,<'> r.-;--;' :x _0 ..");0 ~~p :'=> -<0 ~- =-.:i " '.:'" "-J ':::.~ ~ :') ",' " .. -, ::,-, U .., ~ .....; (CITV) (STATE) IZIP! 4. All correspondence should be moiled to (xx) Allorney ) Fiduciory. 5, If on o"orney is representing the estate, indicote: Nome JAN H. IITLEY , ESQUIRE P.O. BOX 288 Address Dn.T,SRlIRr., PA 17m a (CITY) (STATE) (ZIP) List 011 safe deposit boxes registered in the decedent's individual nome, or jointly with, or os an agent or deputy of onother, or in decedent's individuol nome with right of access by anotner as agent or deputy. Include the nome and address of the bank or other institution where the safe deposit box is located, the nome (s) in which the box is registered and the relationship of the joint holders to the decedent. NAME ANa AODRESS OF BANK OR OTHER INSTITUTION IN WHICH OECEDENT MAINTAINED A SAFE DEPOSIT BOX NAME OR NAMES IN WHICH SAFE DEPOSIT BOX IS REGISTEREO RELA TIONSHIP OF JOINT HO~DERS TO DECEDENT cmmONlfflALTH NATIONAL BANK (I S. lJalti Dillsburg, PA 17019 JESSIE E. STA~BAUGH Under pcnolties of perjur(, I declare that I have examined this return, including accompanying schedules and statements, and ta the best of my knawledge and belief it is true, correct and complete. LINDA L. DAVIS //-//7-1 ~. ~ C ' l'1IAh I I. ',(l"f..d*' , SIGNATURE OF FIDUCIARY ..- rS!/f IF I DATE . . f\EV..t51 EX+ 13.80) COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY '*' (Instructions on Reverse Side) Estate of JESSIE E. STAHBAUGH ITEM NO. DESCRIPTION UNIT VALUE ESTIMATED MARKET VALUE DEPARTMENT VALUATION (OFFICIAL USE ONL Yi 1. Checking Account No. 222 862324 J Commonwealth National Bank 4. Savings Account AIC 14 707351 Cumberland ~all y Savings & Loan (Interest to date of death) 962.51 138.81 .48 7208.32 63.60 25000.00 412.24 (970.89) ,/'1(;. 6> 0 100.00 115.26 87.20 1625.00 21.80 78.87 18.35 12954.35 9.35 24.30 92.00 55.00 347.79 153.32 129.73 2. Statement Savings AIC no. 22 0002894 8 Commonwealth National Bank (accrued interest to date of death) 3. Evergreen Savings AIC no. 22 0010184 4, Common Wealth National Bank (interest to date of death) 5. Redemption of 14 Series E. Savings Bonds $25.0 Denomination 6. Presettlement rent from Hr. & Hrs. Spieth 7. Capital Blue Cross, refund 8. Medicare refund 9. Shillito Farms, rent due 10. PA Blue Shield, refund 11. I. N .A., refund 12. Capitol Blue Cross refund 13. Proceeds of Public Sale 14. United Telephone Refund 15. Nationwide Insurance refund 16. Nationwide Insurance refund 17. James Wonders, insurance refund 18. Tax proration on Boiling Springs Property 19. Tax proration on Carroll Twp., York Co. Ppty 20 Equitable Life Insurance, benefit due TOTAL THIS PAGE (50,569.17) :'-0, .s- t. S~ /? e ...:t:\ff(. 16 West High Slreel. Carlisle, Pennsylvania 17013 249.2525 \~iley & Bonn Attorneys at Law Att: Jan l~. "Illey 204-206 Humper Lane Dil1sburg, Pa. 17019 7 "CUMBtR~ND ~LLEY 5~INc;5 AND L04N ASSOCIf\TION January 21, 1981 R[: Cst"lc of Jessie [. Stamb"uah Date of Death AuqlJst 24, 1980 Dear J.1r. Wiley: Upon checking our records we find only one (1) account in the name of the above captioned estate. This account #14-707351 was opened Hay 29, 1980 and closed on November 14, 1980. The balance of the account was $25,000.00 plus accrued earnings from July 1, 1980 through August 24, 1980 were $412.24 for a total of $25,412.24. If you are in need of any additional information concerning this account please contact this office. Very truly your~, . " p . .L)- 7<C'b~ . ~':-?3 Richard L. Kuntz Accounting Department ymr Corpmonwealrh 1/1 . National Bank l/- (.." ~- . .. , Dillsburg Office January 16, 1981 Jan M. Wiley, Esquire Wiley & Benn 204-06 Mumper Lane Dillsburg, Penna. 17019 Re: Estate of Jessie E. Stambaugh Dear Jan: In regards to your letter of January 14, 1981, our records indicate that Jessie E. Stambaugh had the fol- lowing accounts: 1. Checking Account #222-862324-1 - Single Opened 6/21/67 Balance as of 8/24/80 - $962.51 No accrued interest Name 2. Statement Savings Account #22-0002894-8 - Single Name Opened 8/9/67 Balance as of 8/24/80 - $1)8.81 plus accrued interest of 48 cents ). Evergreen Savings Account #22-0010184-4 - Single Name Opened 10/2/70 Bal. as of 8/24/80 - $7,208.32 plus accrued interest of $63.60 Safe Deposit Box #545 4. Very truly yours, ~~& Vice President SJS/mls The Commonwealth National Bank. 10 South Market Square. Harrisburg, Pa. 17108 (7171564.9500 REV0452 EX'" (3.aO) COMMOHWEALTH OF PEHHSYLYAHIA PEPARTMEHT OF REVEHUE TRAllSFER IHHERITAHCE TAX RESIDEHT DECEDEHTJESSIE E. STAHBAUGIl ESTATE OF SCHEDULE "C" TRANSFERS . INSTRUCTIONS: 1. Answer the questions on reverse side. 2. If the answer to any of the questions on !he reverse side is "Yes," provide a description of the property transferred per Schedules "A," "B," or "E," its estimated market value at date of dealll, 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 USEONLYI TOTAL THIS PAGE -0- 'JI( ~. Did decedent, within two years of death, malle any transfer 01 any material pml of his estate wilhout leceiving valuable and adequate consideration? (Answer "Yes" or "No".) nn ? Did decedent, within two years of death, transfer property from himself! herself to himscll/hcrsell and another party or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) ~ 3. If the answer to one or two aoove is "Yes" and the transfers are claime~ to be nontaxable, plovide the following . inlOlmation: a. Age 01 decedent at time 01 transfer. b. Copy of death certificate. c. Affidavit by the allending physician indicating the state of decedent's health at time of lransfer. d. All other inlormation sUPpOlting nontaxability of transfer. 4. Did decedent, in his/her lifetime, malle any transler of property without receiving a valnable or adequate consideration therefor which was to talle effect in possession or enjoyment at or alter hislher death? (Answer "Yes" or "No".) no a. Was there any possibility that the property transfelred might return to transferol or Ilis/ber estate or be subject to his/her power of diSPosition? (Answer "Yes" or "No".) no b. What was the transferee's age at time of decedent's death? 5. Did decedent in his/her lifetime malle any lransfer without receiving a valuable and adeQnale 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 01 the right to income from the properly transferred? (Answer "Yes" or "No".) llU b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer "Yes" or "No".) no 6. II \he answer to live b. aoove is "Yes," state whether the right was reserved in decedent alone or others. QUESTIONS CONCERNING PROPERTY TRANSFERS ~ 7. Did decedent in his/her lifetime malle a transler, the consideration for which was lransferee's promise to pay income to or for the benefit or care of transferor? (Answer "Yes" or "No".) no 8. Did decedent, at any lime, transfer properly, the bmeficial enjoyment of which was subjeclto change, because of a reserved power to alter, amend, or revolle, or which could revert to decedent under terms of transler or by operation 01 law? (Answer "Yes" or "No".) tin 9. lithe answer to eight above is "Yes," was the power to alter, amend or rP.volle the interest of the beneficiary reserved in the decedent alone or the decedent and others? (Answer "Yes" or "No".) no , . .... . ._.__.~... --.- ,--- ilia ~'il ltlHl iUlb m!'}.thrllU~ltt OF JESSIE E. STAMBAUGH BE IT REMEMBERED, that I, Jessie E. Stambaugh, of R. D. #3, Dillsburg, carroll Township, York county, Pennsylvania, being of saund mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: I give my entire residuary estate to the Harrisburg National Bank and Trust Company, Trustee, until my youngest child attains the age of twenty-one (21) years, at which time my Trustee is directed to pay to all of my surviving children, in equal shares, the remaining' balance of principal and interest in said trust. However, until such time as my youngest child attains the age of twenty-one (21) year, I invest my Trustee with power in its uncontrolled discretion, to anticipate the principal of the trust res for the health, education and maintenance of any of my said children who are of minority age. ITEM 3: I nominate, constitute and appoint Linda L. Davis quardian of the person of any minor children succeeding to an interest in my estate. LASTLY, I nominate, constitute and appoint Linda L. Davis as Executrix of this my Last will and Testament. In the event that Linda L. Davis should predecease me or fail to qualify, cease to act or renounce probate, I then nominate, constitute and appoint William L. Stambaugh to be the Executor of this my Last Will and Testament. Witness: . \ I. f~ 1-.... ) "1. c~J . j (' ,9f .. I " STAMBAUGH) './ ,I (SEAL) '-. I .-j " (JESSIE E. Ii. ') I / .I ,J ......., ,'I. II ",..1 .' .,. ." I' IN WITNESS WHEREOF, I have hereunto set my hand and seal this !L'1:'I-, day of June, 1967. Q, I"'" .':./} 1,; {? "~ /" '. r! f.~, . ".f (SEAL) cJ ,f The preceding instrument, constiting of this and one (1) other typewritten page, was on the day and date thereof signed, sealed, published and declared by JESSIE E. STAMBAUGH, the testator herein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. '\ . , '.. .~~....- -,-....-. (J c:_ , l . - -'~ -.. U of (i . A--. .... ( L (''-' L" () c- I , /' /] ( l:'r' : '1; ; /1 " ,. of /(1 ;' . ; I. / iI .;, --'~;' j/II.J--!.I.-I (/, } .() '-I~. ;. oJ'I I /j I ",f d (2) REV-453'EX+ (3.80) COMMONWEALTH OF PENNSYLVANIA . OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT DECEDENT SCHEDULE "D" BENEFICIARIES ~~, fQ~~ (Instructions on Rcven;o Side) Estate of JESSIE E. STAHBAUGH BENEFICIARIES AND ADDRESSES RELATIONSH1~ SURVIVED DATE OF INTEREST OF BENEFICIARY DECEDENT BIRTH - - nn.... n CTA"nAlIf'U fillC ' non' -1)..8' h l"(u::d ,111""'1 PQt' WILLIAH STAMBAUGH son yes legal 1/Bth residuary est. THlnA mnU nt.UTC . ..~" '_M' , IR'h rp~iduary I pQr JOANNE STAMBAUGH RENARD daughter legal l/Bth residuary , yes est. mAN ..,n" T ""D . ..n~ , nnn' ,/R.h n~. I i PATRICIA STAJolBAUGH daughter yes legal l/Bth residuary estatJ MICHAEL STAHBAUGH d'''o~r ..nc , nOn' l/Bth "edd"~"u es" \ DIANE STAMBAUGH daughter yes legal l/8th residuary est. I I -- j I \ - -, , .---- ---- ------------------..-- I I , i i I I I I NAME DATE OF DEATH I I I i I --I \ The above beneficiaries are living at this time except for the following: I .REV_414 EXt tHOI INHERITANCE TAX SUMMARY SHEET (BUREAU USE ONLY) ,ILl Original o Supplemental o Remainder File Number 21-80-0576 Estate Name J e "silLE.--st.ambaugh Date of Death August 24, 1980 Social Security Number 181-16-5510 REPORT OF INHERITANCE TAX APPRAISER I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of ~bel'~a~d Pennsylvonio, do respectfully roport that I hove appraised the real and personal property os reporte in t e oregoing return at the values S4tt forth opposJtft each item in the last column to the right in Schedule.! "A", HB", "C", and "E" Doted: June 10. 1981 ---Wo/!-'fI'J rlf'htln t/} ) INHERITANCE TAX APPRAISER INVENTORY VALUE AS APPRAISED ADJUSTMENTS (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE CODE Real Property (Schedule A) Personal Properly (Schedule 8) Jolnt.Held Property (Schedule E) Tronsfers (Schedule C) $ la+ oa+ 92+ 21H None 30+ TOT AL GROSS ASSETS :>12,568 88 Leu D.bt. and Deductions (SCH EDULE F) CLEAR VALUE OF ESTATE o Life Estate o Annuity 40- 93. RATE FACTOR PRINCIPLE VALUE CODE FOR USE OF REGISTER ONLY Tax on $ CODE COMPUTATION OF TAX $ $ 5 $ 6% Tax on S 15% Tax on $ Tax on $ Tax on S 5 Exomptlons Total Estate TOTAL TAX INTEREST fROM BALANCE 5 $ 5 lO Less Crodlts DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST 5 + 5 5 = + = BALANCE 5 INTEREST FROM __ TO S BALANCE DUE TAX CREDIT $ REY-457 EX+ C7-801 COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT INIIERITANCE TAX APPRAISEMENT ~ ~~~ '~~i~ ;,'~'-~:~~t; [JORIGINAL o SUPPLEMENTAL Estate of Jessie_..EL ~~aJIl~<l.ll.g!1 File No. ~~-,,1l~~05'lQ....._ Coun ty Cumberland_,_____,____________ Dote of Death August 24. 1980 --- In the event that any luture intcnos! In this estate is transferred In possession or enjoyment 10 collateral heirs of the decedent after tho expiration of any estate ror IHe or lor years, tho Conlrnonwoalth herehy Dxpressly roserves the ril)ht to eppraise end anon transfer Inheritance taxes ot the lawlul collateral roto on on)' such futUlD 1,,'t'rDs'. TOTAL VALUE DEPARTMENT'S APPRAISED VALUE PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH ASSET SUMMARY 1. Total Real Property - 5CH. "A" . . . . . . $ -l82...QQ.Q...Q.L Unreported 5 2. Total Personal Property - 5CH. "B". . . . $ 'i0,'i68.88 Unreported $ 3. Total Jointly Owned Property - 5CH. "E" $ None Unreported S 4. Total Transfers - 5CH. "C". . .'. . . . . $ None Unreported $ o LIFE ESTATE DANNUITY TOT AL GROSS ASSETS DREMAINDER $ $ $ _None $ S 1 R::>, 000.00 50.568.88 None 232,568,88 s I do hereby certify thot the obove appraisement is made in conformity with Pennsylyania law and has been filed this day with the Register of Wills. ~U/JMftl./'1&'"IIIH,J) June 10. 1981 APPRAISER DATE t- o 0' t- .... .c <C 0.. ~ ::l ~ ~ l>:: Cll .0 "' <: a be z ~ ~ t: ~ 0 :>- .., 'M '"' rIl to ~ C. 'tl tIl rIl t: ;:J t<l Cll be .... ...l Q) t: to <: 'M 'M Q) .... ... - "' .... ~ .... u z "' 'M - 0 Q) 0 ~ ..., III t) ~ - 0 !( ~ ~ ci ~ ~ !-< 0 tIl 0 Z 0 tIl Vl :>- !-< 0 - ~ Z !-< ~ !-< ~ Z Z ...l 0 ~ 0 ~ l>:: Z ~ ~ ...l Z Z (:I ;:J U L? ~ - ~ tIl ~ 0 0 <: z ::: - ~ u (:I c.. ...l COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF EXAMINATION OFFICIAL NOTICE OF INHERITANCE TAX ASSESSMENT '* / , ESTATE I, ,/5 -/ ///'/ '..,' /1.- ( ~ ,.)'/iJii/,: /. "- /.' _ . /) _ -jte COUNTY FILE NO: ,') / /( >(/ DATE TO: 'J ... ...,tf /,'1 ///. //,,(/ / . (/c/ ,~ ,f . v _ ff .'1 j' FILE NO, " ;~---7'~. l'_~ ( ':',. I/~ - ;',. ~. ., -" ; I ,I, (" ; , ,I .. ""['" , ',' ..( / j>-,_L {"'I l ,,... " ,/ I,' I>.: COUNTY " /'..' , "/ ' / /-/ , I /i f .'_ "Ur/IIt~' ""'I.Afi(,/)':'.rI'-~ DATE OF DEATH '/ " ',(r,J''i(uL / ';ld j;'/}'() ,7. rr I / .;; Appraised Value of Estate: Real Estate / -,".... . $ 1:".:;/ ,;'/r/ ,'(/ Personal Property + ,:-'.// ,.. > J' ...;.. (/ ..' f.: \ . :~ (' Jointly Held PropertylTransfers + Total Gross Estate :.' 'i.-'/ .,- I. ,- j/ ,., ,- ;,./ /.,/','.;', ,<'., 9.1', '-,;/l ,':../ ~'~. Total Approved Deductions ;.~! "/G - it~ :'-, . ," I. - ...-:". <.~ ,J,'. " '. Clear Value of Estate s ''l ," .' I- ',.r. / ,,/ .. :.__4.,.. , / Less: Approved Charitable Exemptions Clear Value of Estate Subject to Tax ^ ,;'/'1 ";,-,,,. I', ~ / "7......../ .' ..oJ', Amount Taxable @ 6% Rate ,/;/' '/./'" i ~i $ .' / !' w'''I . /...7, / tax due /, ./' r- C/~) $/; /t-r~./..,... Amount Taxeble @ 15% Rate tax due TOTAL PENNSYLVANIA INHERITANCE TAX DUE 1/ c, / r. q -:; $ I~ .If//. #L~ . . .. .. .. .. 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 s// -/6f? '/ . ,; -'-,1 (;7 . ;;-,Ar)-c ( s// kite,;/, + s s ; + ; + ; Interest accrues at the rate of six (6) percent per on the unpaid balance of Inheritance Tax from to date of payment. Interest due if paid by annum _ is See Inlormallon on Reverse Side -f .- /) "C s --"t: \..-~l..,,' ../~./ , ; ! <I'7~' /.;' '.1'1 Ii _;,( ';/>, n _ J Assessed by:---2..- h ,., ~- L C4:i AA./ ~ AgenllonheCotTlm nweal1h / )--:~~ /1//'/ .J-~ :; , /--'-'- vi BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE ItEV.4~~ EX+ tJ.HOI ClOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "F" STATEMENT OF DEBTS AND DEDUCTIONS ~~\ ~. ----- Estate of JESSIE E. STMIBAUGH Date of Dealh~_~}~~lFile Nod/,to -57 t:, WHEN CLAIMING THE FAMILY EXEMPTION. COMPLETE THE FOLLOWING: Claimant Relalionship to Decedent Claimant's Address ITEM DATE NAME OF PAYEE REMARKS AMOUNT NO. 1. 9/3/80 Reeister of Wills, Cumbo Co. Proba te will $ 62.00 2. 9/3/80 Cumberland Law Journal Advertise Estate 18.00 3. 9/3180 Frv Communications. Inc. Advertise Estate I 19.50 4. 9/8/80 Het Ed electric bill 6/..48 5. 9/8/80 Nester's bill 39.55 6. 9/9/80 George Ha tts car inspection 9.54 7. 9/9/80 Gettvsburg Times expense 2.75 8. 9/9/80 S. Hiddleton Twp., B. Williams Taxes 544.00 9. 9/9/80 Robert Grimm Carroll Two. Taxes 318.87 19. 9/17/80 United Telephone Co. bill 36.51 11. 9/17/80 Patriot News thank vou note 80n 12. 9/20/80 York Daily Record thank you note 3.12 p 0/20/80 - .. ,.~ .~"~" l?nn 14. 9/24/80 Cocklin Funeral Home funeral expo 2617.70 15. 9/24/80 Rodnev Lee Decker & Assoc. survev ~~n~nn 16. 9/29/80 Met Ed electric 49.79 17 10/15/80 S. Middleton T',~, M . & M~te" RbR? 18. 10/18/80 The United Telephone Co. telephone bill 46.93 10 ln/l/Rn T.""" c.._"~"' ,~~~ ~~ nn 20. 11/1/80 Het Ed electric bill 27.02 21. 11/1180 Jean Leer sale heln 11n nn 22. 11/1/80 Joanne Renard sale help 90.00 23. 11/8/80 Jack Gaughen appraisal 80.00 TOTAL THIS PAGE I 4960.48 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 deductions far Inheritance Tax purposes. LIND~/~', ,~~YIS j,' l(..,IL<-t,; ..' ,:)/;' / / f! SIGNA;URE OF ATTORNEY/FIDUCIARY DATE OFFICIAL USE ONLY DEBTS AND DEDUCTIONS ARE ALLOWED IN THESUM OF S 33 /J~~' 76 AT ,/ ~ PERCENT. ~-.;{f!-y/ QATE 'Slqap al\16u!Aed JO} Al!\!q!suodsaJ al\l pawnssc SCl\ Ol\M uosJad al\l Aq pau6!s aq lsnw WJOI al\i . L 'paw!c\:l 6u!aq lqap l\:lca 10 lunoWC al\l Jalu3 '9 'paW!C\:llqap l\:lca JOI uwn\o:l s)\JewaJ a41 U! UO!lCUcldxa lapq C ap!^oJd 'S 'aaAcd l\:lca 10 sawcu al\l Jalu3 '17 'p!cd JO/PuC paJJn:lu! SCM lqap l\:lca l\:l!l\M UO alCp al\l Jalu3 'E 'palSlI wall l\:lca 01 SJaqwnu a^!ln:>aSUO:l u61SS"II 'Z; 'uwn\O:llUnOWC al\l U! paw!CI:llUnOWC al\l pue uwnlO:l SltJcwaJ al\l U! ..UO!ldwaxa Ai!wCI.. JalU3 'luapa:>ap al\l 01 d!l\SUO!lClaJ Jal\/S!l\ pUC ssaJppc 'awcu S,WCW!CI:l al\l alC:l!pU! 'paW!CI:l6ulaq S! UO!ldwaxa Ai!WCI al\lll 'l ..:I" 31n03HOS DNI131dWOO lfO:! SNOllOnlflSNI \ \ t"- o 0 Ul t"- ~ '" M 01 < .!'i 0: ~ I>l I>l :r: s.. ~ ;>< ;>< i or . ;z: g' ~ 0 I>l ... !ii .-< c Ul ... B ::> S ~ I>l QJ U < - :a - [il M '0 U ;z: H ... - 0 Ul ;;;: I>< I>< - Ul Cl ~ f:3 . 0 a: Ul ci - '" IJ,. \:.. 0 Ii; 0 Ul Z 0 - I>l Ul ;>< !-- ci Z \( I>l !-- ~ Z z ::3 0 ~ ci '" z :.: I>l ~ Z Z Ii; Q ::> u " z ~ ~ ~ 0 0 < - I>l U Q '" ..J 'sMe1 alclsalU\ C!UC^IAsuuad al\l Aq JO II!M C Aq sscd l\:l!l\M slassc lSUlc6c AIUO a\qcMolIC S! UO!ldwaxa AI!WCI al\i 'luapa:>ap al\l SC p\ol\asnol\ awcs al\110 SJaqwaw aJC Ol\M SlUaJcd JO luaJcd C Aq paw!CI:> aq UC:l UO!ldwaxa al\l 'Pl!l\:> JO asnods l\:>ns OU sl aJal\llUaM al\l ul 'UO!ldwaxa al\l W!CI:l UC:l p\ol\asnol\ aWl!5 al\l }O Jaqwaw C S! Ol\M lUapa:>aP al\l }O Pl!l\:l Auc ual\l 'Sll\6!J Jal\/Sll\ pallapol scl\ asnods al\ll! JO 'asnods ou S! aJal\ll\ 'c!uc^lAsuuad U! pal!:>!WOP pa!p ol\M luapa:>ap C 10 as nods eAq paWlel:l aq Aew OOO'Z;S 10 UO!ldwaxa Al!wCI 'V 'alnpal\:>s S!l\l 01 pal\:>CUC aq p\nol\s paw!e\:> 6u!aq slqap al\l JO} Al!l!qell s,alelsa al\l JO s,luapa:lap au,llJoddns 01 a:>uap!^3 . pal!l Sl uJnlal::l XCl a:>uewal\U\ al\l WOl\M l\l!M sl\!M 10 JalS!6alf al\110 IC^OJddC al\l Oll:la!qns aJC alClsa UC 15u!e6e paw!e\:> 6u!aq slqap 11"11 'JaltJCW a^cJ6 JO aU015qwOl 'lOI\C!Jnq e }O lSO:l al\l 6ulPnl:lu! sasuadxa Icpnq pue \eJaunl 'saal AJe!:lnP!1 'saal AaUJone 'uolleJ1S!U!wpe 10 ISO:> al\16u!pnl:lU! a\qcW!CI:> aJe swal! Jal\lO 'alelsa JO luapa:lap al\l Aq paJJn:>U! slqap 01 UO!l!ppe U\ 'SlBlsa a\qexel Jal\/S!l\ lSUle6c a\q!l:lnpap aJC l\lcap Jal\/sll\ 01 Jopd luapa:>ap al\l Aq paJJn:lU! sall!l!qell palIS!ll!5Un NOll'VWlfO:lNI X'VJ. 30N'V.Lllf3HNI1'Vlf3N3!l , -..- ~ .' , ..f~l }\ IU:V.455 E)(+ (JoHOI cIlMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "F" STATEMENT OF DEBTS AND DEDUCTIONS JESSIE E. STAMBAUGH D f D I Estate of ate 0 eat l-Au~. WHEN CLAIMING THE FAMIL V EXEMPTION, COMPLETE THE FOLLOWING: 24, EFeilP No. Claimant Claimant's Address ITEM DATE NAME OF PAYEE NO. 11/17/8 Recorder of Deeds 11/17/8 Jack Gaughen Realtar 27. 11/10/8 South Middleton Township 28 11/11/8 George Haar 29. 11/17/8 Faye starrbaugh 30. 11/17/8 Met Ed 31. 11/17/8 George Haar 32. 4/81 Register of Wills, Cumbo Co. 33. 4/81 Register af Wills 34. 4/81 Linda L. Davis 35. 4/81 Jan M. Wiley, Esquire 36. 4/81 Register af Wills 37. 4/81 Notary Public Relationship to Decedent REMARKS AMOUNT Transfer st nn Commission on real es final sewer 0 water bill auctioneer e nse land sale sale help electric bill 37. Auctianeer fHin invento filin debts 0 u Executrices fee Attome 's fee filin re1 Nota F r. t 1500.00 TOTAL THIS PAGE 28,126.28 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 estale as deductions for Inheritance Tax purposes, LI~, L. DAVIS] . . _I (I '1"./'" ';;/ I.(Jnwl\. .::>/10 !( SI 'NATURE OF'ATTORNEV;rlOUCI,.,\RV / DATE OFFICIAL USE ONLY DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ '-.;:;~ 1:ft, 1't" AT ~ PERCENT. ~ -d?-f/.-?/ DATE ~ GENERAL INHERITANCE TAX INFORMATION , Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against hislher 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. The family exemption is allowable only against assets which pass by a will or by the Pennsylvania Intestate Laws. r- "" " (') ;>> m ~ !l z > 0 0 " V> Cl (') c::: " ~ z 3: z t"" m 1'1 ;.: Z ;<:l 9 - 9 t"" Z Z m .., m ..., Z 9 9 .., -< '" m - '" z 0 '" 0 .., 9 "'l "'l ::o:l ~ ~ r Ul ;Il 0 '" 0 c... "l - "l Co' . ~. . 1'1 0 - ~.:..' ~ ,~ Ul Z (') t-. 0- .".-. ~ .... Ul - ~i~~ . H > t'l ~~~. 0 ro ~ t"" N ~~;J S- trI c::: co ~~: 1-" V> w:.." >- ::l ..... 0>-- e%; 0" 1-" Ul m ,w a:;Vl :0::: ~17.1 ~ .a i 0 0--- <.>'" 0';5 Z ....w 0::'" ~ ~C,} ~ !< SO u 8 -< -< m m ~ ~ 1-" ::l :r: ;>> > to ;<:l ::o:l .... III ..:] 0 0 -.J INSTRUCTIONS FOR COMPLETING SCHEDULE "F" 1. If the family exemption is being claimed, indicate the claimant's name, address and hislher 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 andlor 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.."U (e"781 COh'MONWEAL TH OF PENNSYLVANIA DEPARTMENT (l~ REVENUE BUREAU OF FIELD OPERATIONS INHERITANCE TAX SECTION OFFICIAL NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX DATE: ESTATE OF: FILE 1'10: COUNTY OF: DATE OF DEATH: 7- 'r-?! ;:r co;- ~,e r S;,.-.'u/""pL. ,..,7/-,'11)- -r"7/-. ,/7,,, ~;J,~A j~ ....,,,/ ::;'-.7.":-%0 TO: ------------------------------------------------------------------------------------------ A. DETERMINATION: 1. Taxable estate based upon: The United States Estate Tax Return (Form 706) The communication from the Federal Government confirming the acceptance of or changes to the Federal Estate Tax Return 2. Amount of crodit lor State death taxos (as veri/ied) 3. Pennsylvania inheritance tax assessed (excluding any discount and/or interest) 4. Normal inheritance tax paid to other States or Territories 01 the United States (excluding any discount and/or interest) 5. Total inheritance tax credits (line item 3 plus line item 4) 6. Total liability lor Pennsylvania estate tax (line item 2 minus line item 5) NOTE: Complete line items 7 and 8 ONLY when determination is based on Federal Closing Letter 7. Amount of Pennsylvania estate tax assessed on determination dated Addition (reduction) to Pennsylyania estate tax (line item 6 minus line item 7) 8. $ I 9'1 ,17 f. $ ,1 _ $ //9t?/.,i/ , ' $ -1'1- It f~~~1 $ $ /)- $ Detennination prepared b'~~t. /) 4f.;", <- Date: 7- 'i'-71 r ------------------------------------------------------------------------------------------ B. ASSESSMENT: 1. Pennsylvania Estate Tax rellected an: line item A (6) line item A (8) 2. Less credits: DATE OF PAYMENT AMOUNT PAID INTEREST ($ ) - ($ ) ($ ) 3. Balance of Pennsylvania estate tax due Interest is due at the rate of six (6) percent per annum from Assessment prepared by: Date: $ CREDIT = = $ to the date of payment. AGENT FOR THE COMMONWEALTH SEE REVERSE SIDE FOR INSTRUCTIONS