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REV.45~ (1.BO)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE STATEMENT OF DEBTS
TRANSFER INHERITANCE TAX i,' \,e AND D,EO, UCT,ION, S, ' ' ,-
RESIDENT DECEDE~____~f;.jl&::t.._,'c_\Q;.[,p{.LjAI:)i/_L/ A2j!J~{)
Estate of III"" MlIT'''RY nRlIghprty Dale of Death .TRn ::>1 I 19R()
WHEN CLAIMING THE FAMIL V EXEMPTION. COMPLETE THE FOLLOWING:
SCHEDULE "F"
*,
File No....} /. f?t, .-59' Ii
Claimant
_ Relationship to Decedent
Claimant's Address
ITEM DATE NAME OF PAYEE REMARKS AMOUNT
NO.
1 1/23/8C Nancy D. uortner J!ixpenses incurred 1'0r guests 100.00
at; 1 unera!
2 2/8/80 Washington star J!lewspaper Obituary Notice 42.84
~ ~ ,~~ 'nr n___ "'"np...,,' U~m" "'.. 1 ? ,U.'7'J ()n
4 , /?4/P.() - " r1 n, )("" n3~, ,..~,.. ~, do nl' ^ , , '7c:. ()()
5 r /6/80 J .L. Mathias, Inc. Tombstone lettering 50.00
TOTAL THIS PAGE I ~2.?44.84
I hereby certify that to the best of my knowledge and belief Ih foregoing is a just and true statement of debts, funeral
expenses and expenses of administration submitted to the est e ~ ducti s fa Inheritance Tax purposes,
,~ 8-/'/..f 150
TTORNL FIDUCIARY . DATE
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S .:/ 111. t'lV
J
AT
(LJ
PERCENT,
:/}?l (' ~-
it-'. f. ) L~
f ~GISTER 0 WILLS
//_/&-(u
DATE
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NOI.l,\;/Wl:lO:lNI XV.L 3:JNV.LIl:l3HNll\H:l3N3El
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
.
COUNTY FILE NO: ;:{ ,I . P (\ ')1 0
To:J?rl\J~ [(l t\~rk d;
I"~ tl\ d -'\^~ .","," !"J .-i, . ^
f\. H"........ ~.......'l~
( i^, ^,L c;,", ..J.JI~,L p(~ ,.) d( V\ ?'
DATE '':'~1\ C," -:;;5, ,I 9 r~)
ESTATE"f\r... \"J"',,, L JI",^ 1-'4-'
. ~.., .. 'l'v. '''- ""'I''''r~\..'1\...
FILE NO. ~ , -- ~>n ;:~O 1\
I...... .- I --
COUNTY ( ~ ,---~- f) ~ 1 ~ , I
~'f\'-" ~.'" )Lv. , -v,
1\ ......
DATE OF DEATH....! (:"fY1 ;;. / I () (f'()
U '
Appraised Value of Estate:
Real Estate
s
+
Personal Property
+
Jointlv Held PropenylTransfers
s
Total Gross Estate
Total Approved Deductions
s
Clear Value of Estate
Less: Approved Charitable Exemptions
Clear Value of Estate Subject 10 Tax
s
Amount Taxable @ 6% Rate
s
tax due
$
Amount Taxable @ 15% Rate
tax due
._.*..
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
l Q,-,,)" Yd" I n "-.I' 'f'; /.. II '-I /6)
A f. d' (, vO 1)\ S
Ive percent Iscount totaling
Inheritance Tax is paid by
s d, '7 :l./. 'F./
,iP I
I;; (0 ..:,
- -.
:;f '1lf(J L!J.
will be granted if the
Less Credits:
DATE OF PAYMENT
AMOUNT PAlO
DISCOUNT
INTEREST
TAX CREDIT
/1- ~t; YO
Sa" .:If_
, .
':'9
+
$
S /" I j,
=
S d. '7 II () . II ;X
+
=
+
=
Interest
on the
to date
accrues at the rate of six (61 percent per annum
unpaid balance of Inheritance Tax from
of payment. Interest due if paid by
is
$ i.11l ,,),,'). v,}lJ
\
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
As.e..edby:
See Information on Reverse Sido Ag.nllor th. CDmmonW"~lh
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*
TO:
/~'-/'-->'Y'! .J- .: /) / ,:;',.,--1/,'/
I -I
, t'"/J"
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i, /1/I/_/1.-1~'_n.:.'A./( '/'J . -' ./
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.;.....
ESTATE
//, "I;~")/I) )'1'Yc.l
", ,. / +-
,',iiI' -"I:J """J_ ;';:~A~~
';'/- <j,_0;'Cj,t}! (/
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COUNTY FILE NO:
..-/ I " )
-;w' / -. ,~f -"
, - I (I
DATE
FILE NO,
COUNTY
/,;/././....r;;: &...~ 1;'/7/_~
,.
DATE OF DEATH ;. J,:,< ,
(;/ "/ Ul
,,::l/ /</ftJ
.. . / ~
Appraised Value of Estate:
Real Estate
s
Personal Property
+
Jointly Held PropenylTransfers
I;" '/
+ '1'/ ...' /
~. <';/
./
v,
Clear Value of Estate
s .// /1/ -,; ?
I
~ /"14. /'7
"
I
S .';. " "-I i ~ ,:.-. /,-1
,
.--.---
Total Gross Estate
Total Approved Oeductions
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$ //1.- L/ '-//L I,~/'
,
Amount Taxable @ 6% Rate
S .-j1i- /il".../(~~) ,..-J.!-
,
tax due
s ) 7);; /9
/
Amount Taxable @ 15% Rale
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
s )1;2,11'19
/
'* '* * .. '* . A five percent discount totaling
will be granted if the Inheritance Tax is paid by
s
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
OISCOUNT
INTEREST
TAX CREOIT
s
+ S
s
. S
+
.
+
.
Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance TaK from
to date of payment. Interest due if paid by
is
.... -r.' ..... I
;,-::;~'.<,'y/jl7i/4lt
s ;..;:7./(1' 1 'l
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
Assessed by: ".//",// ,/" (:~'. ',I" ../,If...;J
AQtlnttorthoCOmi'JIIOnwelhh .....j
See Information on Reverse Side \ ~/ ~ Ij". ,C.
I;_L!<_~' C/
::1",,'; 1/
-~~,e~~~_~~~~~"~~~t~'r
~
1-0.. -1'0
. REV.449 EX.. (3.80)
COMMONWEAL TH OF PENNSYLVANIA.
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
AFFIDAVIT OF
FIDUCIARY
(Instructions on Reverse Side)
*~.
, .
, - .
-.
Estate 01 Nan Murra;}': Daup;herty
Last AddressHOII!.~wood Retirement uenter
Date of Death JaDuar.y 2:t.-.l_96.D____.
Social Security No. 179,04924 .____
uarlis1.EL....._.;Fa.
(CITn
(STATE)
17013
("ZIPI
Bureau File No.
County File No.
~ j-glJ-5ejc;
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDEN r MAINTAINED A SAFE DEPOSIT BOX
NAME OR NAMES IN WHICH
SAFE DEPOSIT BOX IS REGISTERED
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
1. Decedent died:
( ) Inlestote (without 0 will)
( X) Testate (leaving a lost wi II--copy attached)
2. Is the filing of 0 Federal Eslate Tax Return required for this estote?
Yes_ No X
3.
Executo r/Executrix
( :JO Administrator/ Administrotrix
Nome Robert M. Daugherty
Address 6802 Murray Lane
Annanda1e
ICln)
Va.
(STATE)
2200'3
tZIP)
4. All correspondence should be moi led to (
Attorney
( X) Fiduci ary.
5. If on attorney is representing the estate, indicate:
Nome
Address
(CITV)
(STATEI
(ZIP)
List all sofe deposit boxes registered in the decedent's individual nomel or jointly with, or as an agent or deputy
of another, or in decedent's individual name will, right of access by another as agent or deputy, Include the name
and address of the bank or other institution where the sofe deposit box is locoted, the name (s) in which the box
is registered and the relationship of the joint holders to the decedent.
Under penalties of perjury, I declore that I hove examined this return, including accompanying schedules and --'
statements, and to the best of my knowledge and ~ef it is true, correct and complete, .~
/ /-/,2/-d.... @~a:L~~' ~. 'VJ/'6-0 f.)
~ SIGHAU: ~CIARY I
REV-4S0 EX. (3.80)
COMMONWEAL TH OF PENNSYLYANIA
DEPARTMENT OF REYENUE
TRANSFER INHERIT ANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
.
(Instructions on Reverse Side)
ESTATE OF Nan Murray Daugherty
ITEM
NO.
i~ one
DESCRIPTION
ESTIMA TED
MARKET
VALUE
DEPARTMENT
V ALUA TION
(OFFICIAL USE
ONLY
TOTAL THIS PAGE
N011.X.../
~I\'.
R~V"'51 EX. (3.80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*'
(Instructions on Rovorso Sidol
l~an Murray Daugherty
ITEM
NO.
DESCRIPTION
UNIT
VALUE
ESTIMATED
MARKET
VALUE
DEPARTMENT
VALUATION
(OFFICIAL USE ONL Y)
~one
TOTAL THIS PAGE
Nmu
~
REV"'U EX+ 13.80)
COMMONWeALTH O~ PENNIYLYANIA
D~PARTMENT D~ REYENUE
TRAN5~ER INHERITANCE TAX
RUIDENT DECEDENTNan M
~5TATE OF urray
SCHEDULE "C"
TRANSFERS
*'
Daup;hert:v .
INSTRUCTIONS:
1. Answer the questions on reverse si de.
2. If the answer to any of the questions on the reverse side is "Yes," provide a description of the property transferred per
Schedules "A," "B," or "E," its estimated market value at date of death, dates of transfer, to whom transferred and
relationship of transferees to decedent. Attach a copy of any lrust deed 01 instrument relating to the transferred property.
ITEM
t{o.
DESCRIPTION
ESTIMATED DEPT. VALUATION
MARKET VALUE (OFFICIAL USE ONLY)
"
1'1
TOTAL THIS PAGE
N ll-1'lU
49fl
QUESTIONS CONCERNING PROPERTY TRANSFERS
.'
1. Did decedent, within two years 01 death, make any transfer of any material part of Ids eSIJte wilhoul receiving
valuable and adequate consideration? (Answer "Yes" or "No" ,) _:',Ro-- ' ,)
2. Did decedent, within two yealsof dealh, ltansfer property from himselfl hersellto himself/herself and another parly
or parties (including a spouse) in joint ownerShip? (AnsVlCl "Yes" or "No".) ~
3. If the answer to one or two <lbove is "Yes" and the tr:lIlsfcr:, ;He claimed 10 be nontaxable, provide lhe lollowing
informalion:
a, Age of decedent at time of transfer.
b. Copy of death cerlificate.
c, Affidavil by the allending physician indicating the sl<lle of decedent's health ~t lir!le olllansfer,
d, All other information suppOlting nonlaxabilily of tr<lnsfer,
4, Did decedent, in his/her lifetime, make any transfer of properly withoullllccivi!H~ a v;ilu"hle or adequate consideration
therefor which was (0 lake ef(cc! in possession or enjoyrllr;!)1 al or <liter his/her death'} (Answer "Yes" or "No",) --
a. Was there any possibility lIwllhe property lranslerred mighlreturn tn transferol or his/her eslale or be subject
to his/her power of disposition? (Answer "Yes" 01 "No".)
b. What Vias Ihe transleree's age at lime of decedent's death?
5. Did decedent in his/her lifetimenwke any transfer wilhout receiving a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves lor his/her life or any pCliod which does in f<lcl end before his/her
death:
a. The possession or enjoyment of 01 the right to income from the properly transferred? (Answer "Yes" or "No".) No
b, The right to designate the persons who shall possess or enjoy the property lr<lnslerred or income lherefrom?
(Answer "Yes" or "No".) 'No
6, If the answer to five b, ahove is "Yes," stale whether the right was reserved in decedent alone or others.
7. Did decedent in his/her lifetime make a transfer, the consideration for which was transferee's promise 10 pay income
to or for lhe benefit or care of transferor? (Answer "Yes" or "No".j NO
8. Did decedent, at any time, transfer property, the beneficial enjoyment 01 which was subject to change, because of
a reserved power to aller, amend, or revoke, or which could revert to decedent under terms of ltansfer or by operntion of
law? (Answer "Yes" or "No",) No
9. If the answer to eight above is "Yes," was lhe power to aller, emend or revoke the interest of the beneficiary reserved
in tlle decedent alone or the decedeut and olhers? (Answer "Yes" or "No",) No
~lUlt Will m ~t.lifa:.m.tn1 nf
NAN MURRAY DAUGHERTY
I, NAN MURRAY DAUGHERTY, of Springettsbury Township, County of
York and State of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this as and for my Last Will and
Testament, hereby revoking and making void all Wills by me at any time heretofore
made.
1. I direct my hereinafter named Executor to pay all of my just debts
and funeral expenses as soon after my decease as may be found convenient to do so.
2. The balance of my estate, real and personal, and wheresoever the same
may be situate at the time of my death, I give, devise and bequeath my estate, in
equal shares unto my children, to wit: Mrs. Jean L. Carr, Mrs. Ruth Elizabeth
Robillard, Nancy D.IBaggeW: and Robert M. Daugherty.
3. I appoint my said Son, ROBERT M. DAUGHERTY, Executor of this
Will. I direct that he shall not be required to post bond in this jurisdiction or any
other jurisdictton in which he may act.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
day of ~~ ,1968.
tI,
10
Witness:
hi
( I
r) )71 IJ
Nan Murray Daugherty
Ie /)7? 19
(SEAL)
Signed, sealed, published and declared by the above named NAN MURRAY
DAUGHERTY, Testatrix, as and for her Last Will and Testament, in the presence
of us, who have hereunto subscribed our names at her request as witnesses thereto
in the presence of the said Testatrix and of each other.
h? [;) Y~')
/-'L) 1 /1
i
I. .
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\I,of"'~""'~f.,""';r'~l""",'" ~''''..~l..:'''.''', ~\',I.~' ,\,~.;: .'.1
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' ,- '.....'~.' '" ';, t.;' ~ ,...';':=",':';'~<~ "~.' '~~,;::),,:~{~',"~ '.1\ r.~d~'~)'~,
':":-.: '~':'I:~'. -, ... :,.,. ".co' '-, '" .,...... ..'~.,':....'1' ...~~ .ii'i'~~.t)~
\.<. '.. ,', , ,'. "~'~'/ ......-. :,' ,.' ~j...l\..(~ '.' i-;~').'~~:'~"':~~~i
( .... .t.... :',,' ~-..:'::' I ~l"~.,~"...,~.'t"lt'~"'~""'!.""':\'H.,:~r;~
:..\: '. .t..... '::\'\,..,;;......:.'r' >.,,~. \\~.~'.~....:':-'....,1~/.7.,f\,.',\-~':!~~',
" ~ .~. ' ,~,. _.~~....\. ,- "!;'r~'A')'(.lJ..~'..;;..rJ,~":~'~~"~\.
~"', ...:........_.-';<':..,'..~;~. ,,~ "r:' \"~:4'j.n'JJ(I~l;~'':t.~''''''':;;~'(~\(;;:-
/~. .
" ,
FARMERS TRUST COMPANY
CARLISLE, PENNSYLVANIA
Date .Octobp.r .7. ]980
Gloria J. .Richard. Chief Appraiser
Dauphin Co. Inheritance Tax Office
1846 BrookvoDd St.
Harrisburg. Pa. 17104
Re: Estate of Nan Murray Daugbp.rty
Date of Death
Il(IlIH .T"'",R7 :>1, 19RCL-
Dear Ms _ Hi cham
In answer to your request concerning accounts owned, either separately or jointly, by
the above referenced decedent and the balance in each account .as of the date of
death, we have checked our records and are submitting the following information in
duplicate, We suggest that you file one of these letters attached to the Pennsylvania Inven-
tory forms (RCC) to substantiate the balance you repDrt.
Note that we haye shown the correct registration for each account. Also, interest accrued to
the date of death, if any, is listed as a separate figure.
0ery, truly yours, /1
'-;(\,^ -' , l~
" , l,(.V>' """-'
Dianne Cornmsn
Special Services
cD# 14445 Dated August 19. 1917 .
in the nSllles of Nan Murray Daugherty or
Robert M. Daugherty
Purchased for $16,000.00
Value as of date of death $16,006.67
Csshed January 23, 1980 for $16,013.33
Interest rate wss 7~
.1 :
I
.. ...--...J
:~EV.45411.aO)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEOENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
*
,. :~.,.(~
" ~~~
(Instructions DO Reverse Side)
Eststeof Nan Murray Daugherty
P
TOTAL E VALUE OF DEPARTMENT
ITEM R
NO. DESCRIPTION MARKET C DECEDENT'S VALUATION
VALUE E INTEREST (Official Use Onlv)
N
T
1 Certificate of Deposit 18,08,.09 100% 18,08,.0 ~
Uumberland valley S&L Assn.
2 Certificate of Deposit 22,104.C ~
Uumberland valley S&L Assn. 22,104.95 100%
, ~t~ 66,01'.' ~
3 Certificate of Deposit Jj /1 /77 ~6,01'." FtJO 3,51'
Farmers Trust Bank 'J ~6. 61
TOTAL THIS PAGE~ ,
56,201.'7 Iff; J 'II, .,J f
~
~
File Number
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
21-80-0590
Rt::V-464 EX+ 13.801
Estate Nome
DAUGHERTY , Nan HurrJ!Y_
Dole of Dealh
01/21/80
Social Security Number
179-30-4924
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and lor the County of Cumberland
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the laregoing
return at the values set forth opposite each item in the last column to the right in Schedules "Au, "Bit, "C", and uEII
Dated:
November 6, 1980
--f/l", " ,', I tPF(lR/..I)
INHERITANCE TAX APPRAISER
INVENTORY
YALUE AS APPRAISED
CODE
ADJUSTMENTS
(HARRISBURG USE ONLY)
REMAINDER APPRAISEMENT
CODE
Real Property (Schedule A)
Personal Property (Schedule B)
Jolnt.Held Property (Schedule E)
Tran.f.r. (Schedule C)
$
None
00+
92+
None 10+
TOTAL GROSS ASSETS
48 191 38 20+
None 30+
___~~,191 ~
Leu D.bt. and Deductions
(SCHEDULE F)
CLEAR YALUE OF ESTATE
40-
93-
Valuation of IIf. estates or
annultl.s. . . . . . . . . . . . . .
RUE
FACTOR
PRINCIPLE
YALUE
CODE
FOR USE OF REGISTER ONLY
T 0)( on S
CODE
CDMPUTATlON OF TAX
$
S
$
$
$
TOTAL TAX
INTEREST FROM
BALANCE
TO
$
$
$
6%
Tax on $
15%
Tax on $
Tax on S
Tax on $
EKemptlons
Total Estate
Less Credits
DATE DF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
S
+ S
S
=
$
+
=
INTEREST FRDM
BALANCE DUE
BALANCE
TO
s
s
s
"REV.S18 Fe (7.80)
~~
I~~...
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
NOTICE OF FILING OF APPRAISEMENT
November 6, 1980
Robert M. Daugherty
6802 Murray Lane
Annandale, VA 22003
RE: Estate of
County of
File No.
Nan Murray Daugherty
Cumberland
21-80-0590
Dear Mr. Daugherty:
You ore hereby notified that the orieinal
approisement in the estote of Nan Murray Daugherty
has been filed in the office of the Register of Wills of Cumberland
County on November 6 , 19 80. Said appraisement reflects the following valuations:
Real Estate
Personal Property
Jointly Owned
Transfers
Total
None
None
48,191.38
None
$48,191.38
As to such tax that is paid within three months from date of death, a five (5%) percent
discount is ollowable. As to any tax that remains unpaid ofter 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 date of death, interest ot the rate of six (6%) percent
per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within sixty doys
after receipt of said notice os provided by Section 1001 of the Inheritance and Estate Tax Act of
1961,72 P,S. 2485-1001, P.L. 373.
Dote
November 6, 1980
Signed
rh' . . . i'i'....;; 1/
,/-'l'tflN/O / (II .tJ~+,
Title Chief Appraiser
NOTE: This is not a bill.
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