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No. 21-80 f;S6
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
In the Estate of
'IllEJ1.1A H. FISHER
, deceased,
To Register of Wills for the County of Cumberland, In the Commonwealth of Pennsylvania.
Petltloner(s) I~ the execulnr
named In the Last Will and Testament of
Name and address
of Petitloner(s)
r7-':> f. 14 '{
l'-
JAMES E. TIlavIPSON
.a..,
.
TIlELMA H. FISHER dated October 10, 1979
Decedent was a citizen of the United States and a resident of New Cumberland Boro
Township (Borough), Cumberland County, Commonwealth of Pennsylvania.
Thursday
Decedent died on
the
25th day of September
80 I
A.D, 19_, n the
County of Cumberland , State of PA at the age of E- years.
Decedent has (has not) been married and has (has not) had children born to him (her) since the ex-
ecution of the above described Will.
Decedent was possessed of personal property to the value of $12,000.00
and of real estate to the value of
as near as can be ascertained; said real estate situated as follows
Therefore, your pelltloner(s) respectfUlly apply(les) for the probate of the said Last Will and Testa.
ment and for Letters Testamentary theron.
Dated
October 9, 1980
4609 Chestnut St.
Carno Hill. PA 17011
COMMONWEALTH OF PENNSYLVANIA l
COUNTY OF CUMBERLAND j
ss
'1'?
Tn~<; R 'l'HnMP<;()N
n'1!!,ed in above application, being duly sworn
st?tements set forth in this petition are true to the best of
,....i
according to law say(s) that the
his knowledge and belief.
~=- and subscribed before
"'-'
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1/1 ~1 . ,
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~ Register
1/-/3'/-d
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, ~S~~avIPSON
*~ o.J~
J . WI ,-'ESQUIRE
Attorney
C:iZrO
1,/'/0
Flied: October 15, 1980
. .
.
lliast lIill anu Q[eslamrttt
OF
THELMA H. FISHER
BE IT REMEMBERED, that I, THELMA H. FISHER, of 1012 Allen street,
New Cumberland BOrough, Cumberland County, Pennsylvania, being of sound
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: All the rest, residue and remainder of my estate, of whatso
ever nature and wheresoever situate, whether it be real, personal
or mixed, including property over which I have a power of appointment,
I give, devise and bequeath unto my son, James E. Thompson.
ITEM 3: Should my son, James E. Thompson, predecease me, fail to
survive me for a period of thirty (30) days, or should we die simulta-
neously, I then give, devise and bequeath my entire residuary estate
unto his children, in equal shares per capita.
ITEM 4: I direct that my hereinafter named Executor pay all inheri-
tance, estate, succession and legacy taxes of whatsoever nature and
kind, to which my Estate or the transfer of any property passing hereund
er or otherwise passing by reason of my demise, and may be subject and
to charge such taxes against my residuary estate, it being my intention
that none of the aforesaid taxes, either federal or state, or any
property required to be included in my gross estate, under the pro-
visions of any state or federal law now in force or hereafter enacted,
shall be prorated among the persons interested in my Estate to whom
such property is or may be transferred or to whom any benefit accrues.
''WITNESS:
c;1r-2' ,,"
y:1r II t/;'
'J fd L,>~(.. 17. :JI<"J U.L~ ( SEAL)
XI 'I'HELMl\, H. FISHER
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OATH OF PERSONAL REPRf,SENTATIVE
COMMONWEALTH OF PENNSYLVANIA ss:
COUNTY OF CUMBERLAND
Before me, the Regisl~r for the Probate of Wills and granting of Letters of Administration in and for the County of
Cumberland, personally came
JAMES E. THOMPSON
who, being duly sworn
Executor
, do es depose and say that as
of the last Will and Testament of
THElMA H. FISHER
deceased
HE 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 Inheritanees,Sworn and subscribed before me.
October 9
:< Ck-~ E. ~~~
tI c?l~S~:~. ~d
i Register
1\.0" 19~
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DECREE
Be it remembered that on the 15 th day of October
,A,D.,19~, there was probated and
recorded the last Will and Testament of THElMA H. FISHER
late of
New Cumber land Bora
,Cumberland County, Pennsylvania,
Deceased. Letters Testamentary were granted to
Witness my hand and official seal the day and year aforesaid,
JAMES E. THOMPSON
0o/~~e.~
;,[
, REV-450 EX+ (3-eo)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
*
(Instructions on Reverse Side)
ESTATE OF 'lHEI.MA H. FIS~__
ITEM ESTlMA TED DEPARTMENT
NO. - DESCRIPTION MARKET VALUATION
VALUE (OFFICIAL USE
ONLY)
I
I
I
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I
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!
I
I
,
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TOTAL THIS PAGE -0- - (j - ..
AIJ
, '
REV-45t EX+ (3.80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*'
(Instructions on Reverse Side)
Estate of
lliElMA H. FISHER
ITEM
NO.
DESCRIPTION
UNIT
VALUE
ESTIMATED
MARKET
VALUE
DEPARTMENT
VALUATION
(OFFICIAL USE ONL Yi
L
Savings Ale Dauphin Deposit eo, no. 157 05374
$11,895.8
TOTAL THIS PAGE
$11,895.8 I~ ffrf":<f.z.
.A't5
':;
REV:4~2 EX'" ,(3.80)
COMMONWEALTH OF PENNSY LV ANIA
DePARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEOE'ffIEu.1A H FISHER
ESTATE OF .
SCHEDULE "C"
TRANSFERS
*
INSTRUCTIONS:
1. Answer the questions on reverse side.
2. If the answer to any of the questions on the reverse side is "Yes," provide a description of the properly transferred per
Schedules "A," "B," or "E," its estimated market value at date of death, dales of transfer, to whom transferred and
relationship of transferees l~ ~ecedenl. Mach a copy of any trust deed or insliu1l1cnt relating to the transferred property.
ITEM
NO.
DESCRIPTION
ESTIMATED DEPT. VALUATION
MARKET V Al.UE (OFFICIAL USE ONL Y/
TOTAL THIS PAGE
-0-
-1)-
.A[')
QUESTIONS CONeERNING PROPERTY TRANSFERS
1. Did decedent, within lwo ye~rs of de~th, mnke ~ny transfer of ",IY lII~teri~1 pmt of his est~te without receiving
valuable and adequate consider~tion? (Answer "Yes" or "No".) no
2. Did decedent, within two years of dealh, transfer property frolll hilllsel II horsel f to himsell/hersell and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) --D2..-
3, If the answer to one or two above is "Yes" and the tr~nsfe;s ~re claimed to be nont~xable, provide the following
information:
a, Age of decedent at time of transfer.
b, Copy of death certificate.
c, Affidavit by the attending physician indicating the stale of decedent's he~lth nttime of transfer.
d. All other information supporting nontnxnbility of transfer.
4. Did decedant, in his/her lifetime, m~ke any transfer of property without receivinp, ~ v~lu~hle or adequate consideration
therefor which was to take effect in possession or enjoyment at 01 ~fter his/her de~lh? (Answer "Yes" or "No".)no
a. Was there any possibility that the property translerred might return to lransferor or his/her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No".) no
b. What was the transferee's age at lime of decedent's de~th7
5, Did decedent in his/her lifetime make any tr~nsfer without receiving a v~lu~ble ~nd ~dequnle consideration therefor
under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end belore his/her
death:
a, The possession or enjoyment of or the right to income frolllthe property transferred? (Answer "Yes" or "No".) nn
b, The right to designate the persons who shaft 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 right was reserved in decedent alone or others.
7. Did decedent in his/her lifetime make a transfer, the consideration for which was transleree's promise 10 pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No".) no
8. Did decedent, at any time, transfer properly, the bmeficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operalion of
law? (Answer "Yes" or "No".) nn
9. If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Yes" or "No".) no
REV.4\,3 EX+ (3.801
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
*'
{/nst'uctlons on Revers. Side!
Estate of THE1J.1A H, FISHER
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY
DECF.DENT BIRTH
Jarres E. Thompson son yes lel!al entire residua"" est.
-
The above beneficiaries are living at this time except for the following:
DATE OF DEATH
NAME
REV<454 (l.ao)
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
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(lnstrucrions on Reverse Side)
WEOO H. FISHER
Estate of
P
TOTAL E VALUE OF DEPARTMENT
ITEM A
DESCRI PTlON MARKET c DECEDENT'S VALUATION
NO. VALUE E INTEREST (Official Us"OnIV)
N
T
-
1- eertificatl' of Deposit, Dauphin Deposit Bank
No. 3895, dated January 18, 1974, in the 2,000,00 1/2
name of ThelIm H. Fisher or James E. Thompson 1,000.00
2. Series E. Bonds as listed below:
No. L21oo967156 E - $50.00 - Mrs. Thelma
Fisher or Albert T. Thompson, Feb. '78
9-$100.00 bonds in narre of Mrs. Thelma
'Fisher or Albert T, Thompson, Feb.'78
No. C2052200103 E; e2052200102 E; C2052200104 E;
e 2052200105 E; e2052200106 E; e2052200107 E;
e2052200108 E; C2052200109 E; C2052200110 E;
$50.00 Series E. in name of Thelma Fisher or
James E. Thompson dated Feb. '78 no. L 210096 7159 E
5-$100.00 Series E, Bonds in name of ThellM
Fisher of Jarres E. Thompson dated Feb. '78
No. e 2052200098 E; e 2052200099 E; e 205220C lOO E;
e 2052200101 E; e 2052200119 E
3-$100.00 Series E, Bonds in name of
Thelma Fisher or Megan Verrecchio dated
Fe1;J.'78.
e 2050003487 E; e 2050003488 E; e 2050003483 .
3 - $100.00 Series E. Bonds in name of
Thelma Fisher or Jonathon Verrecchio dated
Feb. '78
e 2050003484 E; e 2050003485 E; e 2050003490E
3- Series E Bonds in narre of ThelIm Fisher
or Andrew Thompson, dated Feb, '78 - $100.00
e 2050003490 E; e 2050003491 E; e 2050 00348 E'
,
3-$100.00 Series E. Bonds in name of ThellM
Fisher of Lisa Thompson dated Feb. '78
e 2050003493 E; e 2050003494 E; e 2050003489 ,
3-$100.00 Series E. Bonds in name of ThellM
Fisher or Johna Thompson dated Feb. ' 78
e 2050003495 E; e 2050003496 E; e 2050003492
SEE PAGE 2 TOTAL THIS PAGE $4044.16 /fC If-It
,4/6
Page -2-
JOINTLY a.JNED PROPER1Y
FSl'ATE OF TIiEIJ'.1A H. FISHER
3-$100.00 Series E. Bonds in the name of
Thelma Fisher or Jama T. Thompson dated 2 '78
C 2052200091 E; e 2052200092 E; e 2052200111 E
3 $100.00 Series E. Bonds in name of Thelma
Fisher or eindy TIlompson dated 2 '78
C 2050003499 E; e 2050003500 Ej e 2050003498 E
TOTAL VALUE OF BONDS:
2 ea, $50.00 as of date of death 9/25
35 ea. $100.00 as of date of death 9/25
TOTAL VALUE OF JOINrLY OONED PROPERTY
$84.56
2959.60
$4044.16
REV-484 EX" (3.801
INHERITANCE TAX SUM!.'ARY SHEET
(BUREAU USE ONLY)
File Number
Estate Nom" ___J.1JEU1~di,__EJSJ:l~IL__._----
Date of Death __September 25, 1980
Social Secur; ty Number --
188_12 3417 ---- .
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and far the County of
Pennsylvania, do respectfully report that I have appraised the roal and personal property as reported in the foregoing
return at the \'olues set forth opposite each item in the lost column to the right in Schedules "AIt, liB", "e", ond liEU
Dated:
INVENTORY
INHERITANCE TAX APPRAISER
--
ADJUSTMENTS
VALUE AS APPRAISED CODE (HARRISBU RG USE ONLY)
S 00+
11,895. 82 10+
4 044. 16 21l+
30+
15,939. 98
9,445. 93 40-
REMAINDER APPRAISEMENT CODE
92+
Real Property (Schedule A)
Personal Property (Schedule B)
Jolnt.Held Property (Schedule E)
Transfer. (Schodule C)
TOTAL GROSS ASSETS
Less D.bts and Deductions
(SCH EDULE F)
CLEAR VALUE OF ESTATE
93-
Voluatlon of life estates or
annultl... . . . . . . . . . . . . .
RATE
FACTOR
PRINCIPLE
VALUE
'CODE
FOR USE OF REGISTER ONLY
Tax on $
CODE
COMPUTATION OF TAX
S
S
S
S
I
6"
"
Tax on S
lS~;'
Tox on $
Tax on S
Tax on S
Exemptions
Total Estate
TOTAL TAX
INTEREST FROM
BALANCE
TO
s
s
s
Less Crodits
OATE OF PAYMENT
AMOUNT PAID
TAX CREDIT
S
s
INTEREST FROM
BALANCE DUE
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE uF"
STATEMENT OF DEBTS
AND DEDUCTIONS
-*,
Estate of '!HElMA H. FISHER Date of Dealh~L80
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
File rjJo. d. ) - .PII - C'5{..
. Claimant
Relationship to Decedent
Claimant's .L\ddress
ITEM DATE NAME OF PAYEE REMARKS AMOUNT
NO.
lo 10/6/8 Register of Wills probate will 2~,no
2. 10/6/8 Patriot News ..l. 'i~~ ..... <0 n.,
3. 10/6/8 Cumberland Law ,Tnllm"l "..1. 1R IV)
4. 10/80 Gilbert W. Parthemore Fun. Horn Funeral Exa. ? "". Rn
5. 10/80 " " " death certificates 1 ~,(')(')
6. 11/80 Thomas R. Pheasant M.D. last illness 12~ IV)
7. 11/80 Oscar D. Fisher debtowed decedent 4,700.l.R
8. 4/81 Wilev & Benn fee Uti F,-n' p"r"rp ROlL ,no
9. 7/81 James Thomason '0 "no <OJ. .,,,
1('), 7/Pol .T"" M. 1.1il~" k'o~.l~~ '" Fo<> ,aI, 7a
llo 7/81 Re~ister nF T.T<,,_ F1Hnn R. & j)p,-jl1rri" h" 1n nn
12. 7/81 Re,dster of Will" FiTi"" D~lMM ?, IV)
11. 7/Po, p"hH~ F'"",,, ':?n IV)
TOTAL THIS PAGE I 9 M.~.a~
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 for Inheritance Tax purposes.
JAMES E. THa-lP N ,,~ /
~ {, g fI
NFY/FIDUCIARV I DATE
FICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S r Jj '-/5: r:;q
AT
t,
PERCENT.
a;J
9-;?d-J'/
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her 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.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the family exemption is being claimed, indicate the c1aimant'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 and lor 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.
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1 "REY.t162 EX
'~.'..' . . COMMONWEALTH OF PENNSYLVANIA
4 NO K' 29654 . ;)EPARTMENT OF REVENUE
. OFFICIAL RECEIPT' PENNSYLVANIA INHERITANCE AND ESTATE TAX
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M ~~g~VED Wile & Benn. A tt 8.
f' ADORESS 204 206 urn er Street
~,-
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TOTAL TAX CREDIT $]Q7 64
, _ ~;;'_u~...:;~~~..!:...~ -- .
PLUS
(FROM
LESS DISCOUNT
~o INTEREST
TO_J
TAX AT 6%
TAX AT 15%
TAXAT_%
ESTATETAX
Dillsburg, PA 17019
ESTATEmFoRMAT~N7-------------- ------
DATE OF DEATH Se tember 25 1980
FILE NUMBER
21'"'80=656
Jul 16 1981
TOTAL AMOUNT PAID
S397.64
/ j. / I (' ~ ./ :.. <. (, _'~,. ._ .~/
. / -/ SIGNATURE /
/,
"
---------- - - - - - - - --- ------- -- - ----.
DATE OF PAYMENT
NAME OF DECEDENT
Thelma R. Fisher
m
m
COUNTY
Cumber land
POSTMARK DATE
REMARKS
~
"PAID ON ACCOUNT"
SEAL
RECEIVED BY
REGISTEr'. Of WILLS
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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ss:
JAMES E. 'fHCtolPSON
being duly sworn____ according to law, depe.e. and says that he is the
Ex~utor __._.__ ____ 01 the E.tate 01 ,",p 1"", I.J Fi ehpl"
late 011-012-Allen St., New Cumberland , _,.___,__, Cumberland County, Po., deceased and that the
within is an inventory made by ___.' JAMES_~-,-THa.1PSON .. .____. , the said Executor
01 the entire estate 01 said decedent, consisting 01 all the personal property and real estate, except real e.tate outside
the Commonwealth 01 Pennsylvania, and that the ligur.. eppo.ite each item 01 the Inventory represent it'. fair value
as of the date 01 decedent's d.ath.
and sub.cribed bel ore m.,
~'E~ ~~~~
Executor
/,r
Notary Public
. GlENO^ M. WETHINGTON, Net"y PuLlic
D1llSBURG aCROUGH, YG,K COUIITY
MY COMMISSION EXPiilES DEC, 27, 1982
Member, Peniisyl~ania A~socjation 01 Nat,i1ies
Date of Death
4609 Chestnut St., Camp Hill, PA 17011
Address
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I. An inventory mu.t be filed within three months after appointment of personal representativ.r::~
2. A supplement inventory must be filed within thirty day. 01 discovery 01 additional assets. ~;.;
3. Additional sheets may be attached as to personalty or realty :<,,',
4. See Article IV, Fiduciaries Act 011949. ..
SeptembeL25..--198.0
DIY
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COMMONWEAL TI1 Or- PENNSYLVMJlA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
INHERITANCE TAX
APPRAISEMENT
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I!JORIGINAL
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File No. ___'_~l-80-D.g59__,
Estate 01 ----Thelma-H. _Eisher,_____
Caun ty
C,wnberland-,-,-,----,---- Dote 01 Death _Sj:lp~b5lr:.25_f-19.8.0
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In the event that any futuro In'f1rost in this entatc is hansferred in possession or unjoymen' to collateral heirs of the decedent after tho
expiration of uny eslate for Ilfo Dr far y~a"l the Commonwealth hereby upreuly reserves the rlg!.t to appral.." and on05S hansfor
Inheritance taxes at the fawful collafarut rale ~m any such fu'uro Intllre~ _
PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH
ASSET SUMMARY
DEPARTMENT'S
APPRAISED VALUE
1. Total Real Property - SCH. "A". . .... ~
2. Total Personal Property - SCH. "B". . . . $
3. Total Jointly Owned Property - SCH. "E" $
4. Total Transfers - SCH. "C". . ,'. . . . . $
--.None.
11.A95 R?
4 ,0!llL.J.6
None
Unreported S
Unreported $
Unreported S
Unreported $
$ tJnn~
$ ---1.1., A95 A?
$ 4,044 11>
$ None
$ 15,939.98
o LIFE ESTATE
DANNUITY
TOT AL GROSS ASSETS
OREMAINDER
------- -------.---- --- ----
TOTAL VALUE
$
I do hereby certily that the above appraisement is made in conlar y with Pennsylvania low and has been liled this
day with the Register of Wills.
~-
Septemh~r lA. 1981
DATE
APP lSEA:
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REV-4U EX+ (HOI
INHERITANCE TAX' SUMMARY SHEET
(BUREAU USE ONLY)
o Original
o Supplemental
o Remainder
File Number
21-80-0656
Thelma H. Fishel'
Estate Name
Date of Death
SeDtembel' 25~-1980
Social Securi ty Number --18Bd2.,,3.!t.11
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and far the County of -Cumh"~J ~ n
Pennsylvania, do respectfully report that I hove appraised the real and personal property as reported in the 'foregoing
return at the values let forth oppollte each item In the last column to :he rl ht In Sch;;-Ies "Aft, "8", "C", and "E"
Dated, SeDtembel' 18. 1981 ~
lNHER TANCE TAX APPRA ER
v
ADJUSTMENTS REMAINDER APPRAISEMP.NT CODE
INVENTORY YALUE AS APPRAISED CODE (HARRISBURG USE ONLY)
Real Property (Schedule A) S 00+ 92+
Personal Property (Schedule B) 10+
Jolnt.Held Proporty (Schedulo E) 211+
Transfers (Schedule C) o e 30+
TOT AL GROSS ASSETS 15,939_,98___
leu D.bl. and Deducllons 40- 93-
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Estate RATE FACTOR PRINCIPLE VALUE CODE
o Annuity
FOR USE OF REGISTER ONLY
Tax on $
CODE
COMPUTATION OF TAX
$
S
$
S
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6"
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Tax on $
15~g
Tax on S
Tax on $
Tax on S
$
Exemptions
T alai Eslato
TOTAL TAX
INTEREST FROM
BALANCE
TO
s
S
$
--
Less Credits
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREOIT
S
+ S
S
=
s
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=
INTEREST FROM
BALANCE
TO
S
S
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
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COUNTY FILE NO:
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DATE OF DEATH
Appraised Valuo of Esrate:
Real Estate
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Personal Property
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Joinlly Held PropertylTransfers
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Total Gross EstBte
Total Approved Oeductions
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Clear Value of ESlate
$
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Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
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Amount Taxable @ 6% Rale
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tax due
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Amount Taxable @ '5% Rare
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
$
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* * * * * . A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credils:
DATE OF PAYMENT
AMDUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
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Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to tjate of payment. Interest due if paid bV_
is
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BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
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DATE OF OEATH
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Appraised Value of Estate:
Real Estate
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Personal Property
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Jointly Held Property /Transfers
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Total Gross Estate
Total Approved Deductions
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Clear Valul3 of Estate
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Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
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tax due
$
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Amount Taxable @ 6% Rate
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tax due
Amounl Taxable @ '5% Rate
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$ ;':';i 9'/ (,.,1-
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TOTAL PENNSYLVANIA INHERITANCE TAX DUE
* .. .. .. .. .. A five
will be granted if the Inheritance
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pe'rcent discount totaling
Tax is paid by
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$
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Less Credits:
DATE OF PAYMENT
AMOUNT PAID
OISCOUNT
INTEREST
TAX CREDIT
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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. Interest due if paid by
is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
$
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Assessed by: ~ . /' / /. / .'
Agent lor tM Commonw..lth.-
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