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cmIMON~l~ALTII 01" I'I-:NNSYI,VANIA
I)f!pnrtment. of' Revenue
"NTIIY INTO SAFE ImpoSIT nox
TO (\EMOVI~ A WII,j, Oil CEMrITlmy IlElm
October 8, 19BD
(Ilnt" 01' I~ntry)
1. Name of deceden t: RlO~""''''' R ~;pp
... Address 01' decedent: 'Qo....nn"l" """'"arc:: 11lnfi Mp,..h~n; t!.Clihn"""q. Pa. 17055
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3. Date of death: Ot"'"....f"\~,.. ? ,c\Rn
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4. Name and address of person who requesterl the opening of the box:
M~"g""Pt- Hnk.. r llBl W. Barefoot Circle, Sebastian, Florida
15. Name and address 01' the financial institution where the sal'e deposit box is
located: n""phin Deposit Bank & TruSt CO.. 5219 Simpson Ferry ROad, Hechanicsburg, Pa.
6. Number of box: 1 d<;
7, Title under which box is registered: Robert B. Sipe or ~~qaret Hoke
B. Was there a will in the box? (Yes or No)
Yes
!l. If yes, state rlate of will, name and arlrlress 01' personal rep,'csentntive, if
named in the will, and name and adrlress 01' attorney, if nny:
october 6 , 1976
UD't"'g::llroi- l.fn'kPr 'F.yp~lltr;~
~lo ~"''''''''''''TU':l.l'' n~mpn
October , HI BO . I hereby
that tile above recor<l is correct and complete
bel ieI'.
Anrl now this Bth day of
certify'under penalty of perjury
to the best of my knowledge and
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S ignirtur.Y"
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Harry D. Reel, Jr., Vice President
Print NAme Anrl Title
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COMMONWEAL TH OF PEN....SYLVA.....IA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
Estate 01
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES
(Instructions on Rcvcrsc Sidc)
COUNTY NO. (1/, ,.", j,., I , ,. ~l../
STATE NO. .511 - f'll- {ll, r,-J'
Robert B. Sipe
( ) Exec. () Adm.
Name lolaI' V,Ul'C t S.
Other Duugh ter
Hoke
Last address 106 Bethany TOl~ers
ISTREETI
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Social Security No.
207 -Q7-9684
1181 vi. Barefoot Circle
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Hechanicsburg, Penna. 17055
(CITY) (STATE) (ZIPI
1ST IH.: t-_TI
Sebastian, Florida 32958
Date 01 Death October 2, 1980
Add,e..
(CITY) (STATL:.I {ZIPI
Under penalties 01 perjury. I declare that I have examined this return and
~ the best of my knowledge and belief it is (rull', correcr and complete.
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Social Security No. 207-07-6174
TYPE OF ASSET
Personalty
ersonalty
ersonalty
ersonalty
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OFFICIAL
USE
ONLY
DATE
10/6/80
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OFFICIAL
USE
ONLY
Slgllatur~ of r:idul;iotry
DESCRIPTION
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ESTIMA TED MARI(E T
VALUE
OEPARTMENT YALUA TION
(0 CIAL USE ONLY)
Checking Acct. No. 79-33-395-8 with
Dauphin Deposit Bank and Trust Co.
Savings Acct. No. 13-6-09629 with
Dauphin Deposit Bank and Trust Co.
$1,000.00 Series E. U. S. Savings Bond
No. M207258761E, issued June 1978 to
Hargaret S. Hoke or Robert B. Sipe
$500.00 Series E. U. S. Savings Bond
No. D10138S296E, issued April 1973 to
Mrs. Kathryn E. Sipe or Robert B. Sipe
527.57
1040.89
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838.40
578.1.\-0
TOTAL $ 2985.26 . 'J.? s: .1.." ,.
I do hereby certify that the above assets were appraised in accordance with Pennsylvania low.
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APPR I ER
December 18, 1980
QATE
NAME OF PAYEE
NATURE OF CLAIM
AMOUNT CLAIMED
Myers Funeral Home, Inc.
37 E. Hain St., Mech-
anicsburg, Pa.
Harrisburg Hospital,
Harrisburg, Pa.
Register or Wills
$
1,920.00
21,987.00
3.00
Funeral Expenses
Hospital Bill
Filing Rev S19-Insolvent
~state T~c Return
TOT AL
$ 23:110.00
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$ ':<3 q /0, tllJ
oecr(,c. TIONS ALLOWED
0;a~ (!, *O'~)
R TER OF WI S
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*'
COUNTY FILE NO:
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ESTATE
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COUNTY I, , (.' I ~ / ~ .1.r_J!
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DATE OF OEATH / .-;,'1/
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FILE NO.
Appraised Value of Estate:
Reel ESlete
&
Personal Property
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+ ./ G.-_, }. oj; !L.
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Jointly Held PropertylTransfers
+
Total Gross Estate
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$ / '_/ /j ;'.'(1'
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Total Approved Oeductions
Cleer Velue of Estete
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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. .;>1'" '~f-..""'..(~
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Amount Taxable @ 15% Rale
tax due
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TOTAL PENNSYLVANIA INHERITANCE TAX DUpi14' (;."...A... //.
'7 .
'* '* '* * '* '* 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 (61 percent per annum
unpaid balance of Inheritance Talt from
of payment. Interest due if paid by is ". . -/ ~ - <:<7 ,?~
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE:) /1.J.,.t;.f/t_lt'-c ./, 'r p;k;L
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Assessed by: . /
See Information on Reverse Side Ag.nt,'o,rt~. ~m~w..lt~
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