HomeMy WebLinkAbout80-00678
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No. 21.80 G78
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of
Lottie 1.1, Felty
, deceased.
MARY C. LEWIS
To RieRara a. ^.R88HI91il, Register of Wills for the County of Cumberland,
in the Commonwealth ot Pennsylvania.
llI5
Petitianer(s) are the execut ot'S named in the Last Will and
Testament of LottieH. Felty dated Sept. 7, 1967
Decedent was a citizen of the United States and a resident of
;qlOWl'lm~
Borough, Cumberland County, Commonwealth
Mechanicsbut'1O':
of Pennsylvania.
Decedent died on Thursday
A. D. 19 80 , in the County of
Pennsylvania
the
31st day of
July
Cumberland
State of
at the age of 89
xklu millS: he r
Decedent has not been married and has not had children born to kam<
since the execution of the above described Will.
Decedent was possessed of personal property to the volue of
$15,000.00 and of real estate to the value of
years.
None
as near as can be ascertained; said real
estate situated as follows
None
apply
Therefore, your petitioner(s) respectfully ~!,i!t~ for the probate
of the said Last Will ond Testament and for Letters Testamentary thereon.
Dated Octobet' 15 , 1980
Name and address
of Petitioner(s)
L'j ""j I
!.'Jl' '~/I' </, ( I,' (')d'~,"_.'/
G~a~e I. Adams
1127 Baldwin st
!.!p.chAnic"h11T'". FR. 170C:;C:;
"'
7 t' 1 . !"'-h
/ /Lc /"1 Ie j;.- ~.'7-
" Glenn H. ~'elty /
h06 Rich V~lleYlo~d
Carlisle. .R. 1 01
COMMONWEALTH OF PENNSYLVANIA ~
ss
COUNTY OF CUMBERLAND
Grace 1. Adams and Glenn H. Feltv
named in above application, being duly
say(s) that the statements set forth in
SHorn according to law
this petition are true to the
best of
the ir
knowledge and belief.
Sworn
and subscribed before
~_'..",' .~ /. I
c' ( . ,././
me, OotoMr 15 ~ 19 80
, /I ./, . ~
~~. ~d.~ ., Register
'; (
/ ~J'1'1,11
")1, 7.. ".P'1-ck.
! J ,.....'- ~/ . /'
,
--;~,;1
Attorney: J. Robert Staurrer.~~~
. I~/
1..//6
Filed: october 22, 1980
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OATH OF SUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLVANIA t ss:
COUNTY OF CUMBERLAND \
'l'his.........,..... .......... .....2.(.([/.... ...... ......... ..... ......... day of. ........ ........5??~.'?~~.7....................... ..... .. A.D., 19...f>.9.,
Mar~ c. Lewis
before me n;,l.... E. !....h. ..8f1, 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 ..............
...,:T"...B.9.R~.r.~...~~.!!-.V:f.r~.!..,f!:!:!?-...~.~.!\?I~ ..X:....J??~.~...... .... .... ... ..... .................... .................. ..........................
the subscribing witnesses to the foregoing instrument of writing purporting to be the last Will and
Testament of ...Laj;.t.i.~..~A ...f.~.1..ty........ .......... ................... ........... .............. Dated ...~~.:P. ~.:...l!...~~.~I.......
late of .......~~ .~.\1~.x:\~~.!?~).?.~.EL...................... .................................. ......... .,. Cumberland County Pa., deceased
who being duly .......;;.WQ.r.P.......................... according to law, depose and say, that ..~.r::~}'...~~;:.~..................
present, and saw and heard the testa..t.d,l;\....................., ......);..<?t!;J.~..!:\......f.~}..~l...................................
sign, seal, publish, pronounce and declare the said instrument of writing as and for h~.r............ Testament
and Last Will, and at the time of SO doing ........~.l.':~..................................was of sound and disposing mind
memory and understanding, to the best of ..........1h~J.r.........................knowledge, observation and belief.
...7$iIct!~/~..........m
,.....id~..W~~.................,.
...S-wer.n................................ and subscribed before
r1!!1~~g~~...............v
..................................................................................
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA t ss:
COUNTY OF CUMBERLAND \
................. .~:r:.f!: ~!'!.. I. ~.. /:. ~.~?:~...'?: ::.~... ~.!: ~ ::.~. .::.:... ~.~. ~.~.r............... ................................................ ..being duly
.........~!'f.9.r.!!............................ sayS that as nearly as can be ascertained the said decedent ..........................
,...................~~.~.~ ~~...~.!.:...~~.~~Z.................. ......................... ........................ ..........................................died on
Thursday 31st July BO
................................................ the ................................day of ..................................................... A.D., 19.......,
at or about .......................................... o'clock. ....M.
.........~i'!.9.r.)'.I................................and subscribed this
...............J.?~!?-...................... day of ..Q.\\~.9.p.!':X'......
19, .~R..., before
........ :~.... :.:' .:. ;'. ';- :.:..::... ....;... ..... ::. :.: t...-; :;'; '/.~:;-.-;-:::..... .... ......
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R..I.", d E. .., ..An, Re~t~;.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PI~NNSYLVANIA} ..
COUNTY OF CUMBERLAND SS:
Before me, the Register for the Probate of Wills and granting of' Letters of Administration in and for
the Coanty of Cumberland, personally came ...O.r./l..c.ll...l....(\.P.Il>.l!l!l...\\nR.Jn.!l.n.l.l...~.~...f..~.t~.~.....................
who, being duly ....5w.o.nn.............. do .......... depose and say that as.....~.<\!l.Cf.\l!;.9.r.!'!......................................
of the last Will and Testament of .......);,.9.!;.tJ.!'L~L.....f.!lJJ~X...............................................................deceased
...~.h!1.y.............. will well and truly adminisl.er the goods and chatl.els, rights and credits of said deceased
according to law. And also will diligently comply with the provisions of the law relating to Transfer
I h 'ta S\1orn d b 'b d
n en nces. ............................ an su sel'l e
before me.
....9.!?'~.Qp.'il.r........1?.~....~......... ........ A. D.. 19J;\Q......
..:..~~..e:.:. ...: ... .................................
Hi'-- . "V ......rJ.I., glster
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DECREE
Be it remembered that on the ......J~.~~....... day of ..............!?E~.?~~.7:.................. A. D.. 19 ...~~., there
was probated and recorded the last Will and Testament of ......l,QJ;.t.ir...kl.....EftJ.!<y....................................,
late of ...............I1.~.\\h.~uJ..c.~.J:i.l.l.r.ff..............................., Cumberland County, Pennsylvania. Deceased. Letters
............f.~.l!.x~!!!~~.~.!l:!:I............... were granted to ....~::.~~~...!:.:...~~.~~.1.:...~.?~...~~~.~~..~.:...:.:~:.~.!............
Witness my hand and official seal the day and year aforesaid.
.9&~.e..',~C;;~m.
(<<'Fe,! 'rl'" . RegIster.
.
. .
Rcc-n (9-681
, COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
, BUREAU OF COUNTY COLLECTIONS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
'*
DATE 0,.,- 2/
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby mode for CMsent 10 the transfer of the following securities of a Pennsylvania
Corporation or 0 National Banking Associalion located in Pennsylvania:
;lechunicsbur:,. i'u.
(0) ..h ((..,) ,,},.(b) The Fit'lIt "Qnk und 'j't'''~t C~-eU-(c)~ePIIlIeIl <:;tQQk
(NOTE: In describing securities enter in (0), ab Ole, either the number of shores of stock or the face amount of
registered bonds, in (b), the nome of the issuing company and in (c) the closs of stock or the stated interest rote
and maturity dote of registered bonds.)
on 5/7/57 nnd 1 sharo issued on 5/27/66
ISSUED ON c; ",",II""!! lR""Arl/, and having a TOTAL MARKET VA-LUE OF 5 '10.0')
(Date)
os of the dote of death of the decedent, 'cttJ.s :.. '-1I1ty
(Name of Decedent}
. on
r"ly 31, 19f~()
(Date of death}
who was late of 11;:>7 1'\t'lrhr\J:l "" , '~e('b"ni cah""C
(Streot nnd Number) (Post Offico)
l..lu:nb n ,.., (l Mr.
(County)
,:Annn...
(Stot.)
The securities ore registered os follows: ;:ervin .c. Felty or ;'11's. Lottie ;.'clty
(Homo or names In which certificates arc registered)
n. j'elty-406 rlich Valley hoad, Carlisle, i'a. 17013
I. Ad!:'.~s-1127 5aldl-dn St;.. l1t'!chanicllburr;, Po.. 1'1055
(Name) (Addross)
NAME OF APPLICANT ---J..-+'"b~pt _. t!l.uf~'el', !~ tt;;-.
!'.o.r!:e t ~:qual"e .:.)ld~.
COUNTY FILE NUMBER 21 eo- '" 71( ADDRESS OF APPLlCANT~. .. f _,.., '
-
BUREAU FILE NUMBER SIGNATURE OF APPLlCAN.
NOTICE: IF YOU FAIL TO PROPERLY FILL 11'1 AtlY PORTION OF THIS y,Pi I ATlOtl, IT WIL
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU fOR COMPLETlOtl.
Glenn
ADMINISTRATOR) Grace
EXECUTOR )
r:'-
~
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE &it
CONSENT TO TRANSFER SECURITIES - "'.'J (O"",,
DATE .' C>( '"")- I rrv
I hereby consent to the transfer of the above securities now registered in the nome of the aforesaid
Decedent and waive the filing of 0 certificate certifying to the payment of the transfer inheritance tax to which
the property of said Decedent is mode subject pursuant to the provisions of the Act of June 20, 1919. P.L. 521,
os amended and the Act af June 15, 1961, P.L. 373, as amended. This is also in accordance with the provisions
of the Act of April 9, 1929, P.L. 343.
This Consent to Transfer the herein described property operates only in reference to the estate of the
above-named Decedent.
~\...
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Signed f~r the Secretory of Re.venue
,::>j~1'/7 ~ X .)
By~-f.<:(~ . to . ~ '/N~
~' 0 .IS;g Me) :) ~
-11:i1!f--~'J (j~..d
p,le) (County)
.
-I
: RCC-72 (V-681
J COMMONWEALTH OF PENNSVLVANIA
I DEPARTMENT OF REVENUE
I BUREAU OF COUNTY COLLECTIONS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
DATE_cZ,.z~-L
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for ccr.sent to the transfer of the following securities of a Pennsylvania
Corporation or a Notional Banking Association located in Pennsylvania:
Nechanicsburg, Pa.
(0) s lx ( 6) shs(b) Th~ Fi T'S t BllnlLanll Trl.l.lit-.C..o.rnpanY-Oi'I_ (cL.coromon-S.tMk
(NOTE: In describing securities enter in (a), ab Ole, either the number of shares of stock or the face amount of
registered bonds, in (b), the nome of the issuing company and in (ci the class of stock or the stated interest rate
and maturity date of registered bonds.)
on 5/7/57 and 1 share issued on 5/27/66
ISSUED ON l) shares issued/, and having a TOTAL MARK ET V A LUE OF L8lil._O_Q
(Dote)
os of the dote of death of the decedent, '."r.r.~" 1.; "'Alt.y
(Name of Decedent)
,on_~uly-~l, lQ80
(Date of death)
who was late of 11 ?7 Rill "wi n St Lo-MacllanLcSbJJ.I!g
(Street ond Number} (Past OHice}
c U!!lbSl ~1.<U'\Q.
(County)
Penna.
{Stote}
The securities are registered as follows: ;'lervin S. Felty or i'll'S. Lottie Felty
{Namo or names in which certificates are registered}
H, Felty-406 filch Vallay Road, Carlisle, Pa. 17013
I. Adams-1l27 Bald~lin ::it., HechanicsburG, Pa. 1705.5
(Name) (Addross)
NAME OF APPLICANT _--J~_Rober-t-.S.tau.1:i'Ar, il Hii'.
~arket Square Bldg.
COUNTY FILE NUMBER21 eo Vl't ADDRESS OF APPLICANT -1" ~burL' p
BUREAU FILE NUMBER SIGNATURE OF APPLlCA1!I _ :t (
NOTICE: IF YOU FAIL TO PROPERLY FILL 11'1 AtlY PORTIOtl OF THIS P,PLlCATION, IT WILL 1'10
CONSIDERED COMPLETE AND WILL BE RETURtlED TO YOUJ'OR COMPLETIOtl.
Glenn
ADMINISTRATOR) Grace
EXECUTOR)
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE ~
CONSENT TO TRANSFER SECURITIES . -="_'"
DA TE '~.y
I hereby consent to the transfer of the above securities now registered in the nome of the aforesaid
Decedent and waive the filing of a certificate certifying to the payment of the transfer inheritance tax to which
the property of said Decedent is made subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521,
os amended and the Act of June 15, 1961, P.L. 373, as amended. This is also in accordance with the provisions
of the Act of April 9, 1929, P.L. 343.
This Consent to Transfer the herein described property operates only in reference to the estate of the
abave.named Decedent.
~~
/j ': ~/? ".j(\
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Signed for the Secretary of Revenue
a]~. /J~ ~
By _~.&td _C. _ pr .
~ ISi,! u,e) ~
----If/;-:J.f':-,u..---u~22c.1'-&L~~cd
{j,e} (County)
(q'f'j
RE"~4~ EX. 13.80)
COMMONWEAL TH OF i'EHNSYL V AtH A.
DEPARTMENT OF REVENUE
TRANSFER INHERITAHCE TAX
RESIDENT OECEDEN1
*
AFFIDAVIT OF
FIDUCIARY
(Instructions on Reverso Side)
"
Estate of __,!.otl~El_ nM_~__~~_l ty
Lost Address _1_127_!?~ldw!.!:-._~t!,ee t
Mechanicsburg. Penna. 17055
July 31, 1980
Dole of Death
Sociol Security No, 191-40-9414
Bureau File No. 21-80-678
(CITY)
(STAlL)
{ZIP)
County File No.
1. Decedent died:
( ) Intestate (without a will)
(x) Testate (leaving a lost will--copy attached)
2. Is the filing of a Federal Estate Tax Return required for this estate?
Yes_ No X
3. (x) Executor/Executrix ( ) Administrator/ Administratrix
Name Grace I. Adams-1127 oaldwin St., Hechanicsburg, Pa. 17055
Address Glenn H. Felty-406 Rich Valley Road, Carlisle, Pa. 17013
(CITY,
(STATE'
(ZIP)
4. All correspondence should be moi led la ( x) Attorney
) Fiduciary.
5. If an attorney is representing the estate, indicate:
Name
J. Robert Stauffer
Market Square Bldg.
Hechanicsburg, Penna. 17055
(CITY) (STATEI (ZIP)
Address
List 011 sofe deposit boxes registered in the decedent's individual nome, or jointly with, or os on agent or deputy
of another, or in decedent's individual name with right of access by another os agent or deputy. Include the name
and address of the bonk or other institution where the safe deposit box is located, the name (s) in which the box
is registered and the relationship of the ja:nt holders to the decedent.
NAME AND ADDRESS OF BANK OR DTH ER INSTllUTION
IN WHICH DECEDENT MAINTAINED A SAFE DEPom aox
NAME OR NAMES IN WHICH
SAFE DEPOSIT BOX IS REGISTERED
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
None
Under penolties of perjury, I declore thotl have examined this return, including occampanying schedules and
statements, and to the best af my knowledge ond belief it is true, correct a!,d complete,
:~~" 7~' J,i~
SIGNATURE OF FIDUCIARY
/'l3,lEt!
DATE
'REV.451 (l.80)
COMMONWEALTH OF PENNSVLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEDENT
SCHEDULE "B"
PERSONAL PROPERT'{
*'
(lm'truc:t;o1lS un Reverse Side)
Estate of
Lottie }l, Felty
I
,
I ESTIMATED DEPARTMENT
I ITEM DESCRIPTION UNIT MARKET VALUATION
I NO.
, VALUE VALUE (OFFICIAL USE ONL YI
I
,
; (l) Six (6) shares of the capital stock of'
I
The First Bank and Trust Company of
I Mechanicsburg, Pa. 135.00 810.00
Certificate No. 309 issued 5/7/57 for
five (5) shares; and
Certificate No. 863 issued 5/27/66 for
one (1) share.
(Registered in the names of Mervin E.
Felty or Mrs. Lottie Felty. Hervin
E. Felty was the husband of the de-
cedent and predeceased her, he having
died on 11/30/63.)
:
TOTAL THIS PAGE 8l0.0C ,
,p 10, oOwn.R
"
REV."'ZC1-1I'31
COMMONWEALTN OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEDENT L tti
ESTATE OF _ 0 e
SCHEDULE "C"
TRANSFERS
.
H. Felty
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 descliption 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 trust deed or instrument relating to the transferred pmperly.
ITEM
NO.
DESCRIPTION
ESTIMATED DEPT, VALUATION
MARKET VALUE (OFFICIAL US€ONL Y/
(1)
Savings Account No. 600-523-5 opened 7/6/79
with The First Bank and Trust Company of
Mechanicsburg. Pa.. in the names of Lottie M.
Felty and Grace Adams.
Interest to 7/31/80
1,049.00
4.75
,
I
I
..j
I
I
TOTAL THIS PAGE
1.053.75
OUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any material part of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No".) No .
2, Did decedent, within two years of death, transfer property from himself/ herself to himself/herself and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) Yes
3. If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, 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 state of decedent's health at time of transfer.
d. All other information supporting nontaxabilily of transfer.
4. Did decedent, in his!her lifetime, make any transler 01 property without receiving a valuable or adequate consideration
therefor which was to take effect in posseSSion or enjoyment at or after hiS/her death? (Answer "Yes" or "No".) No
a, Was there any possibility that the property transferred might return to transferor or his!her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No".) N/A
b. What was the transferee's age at time of decedent's death? U/A .
5. Did decedent in his/her lifetime make any transfer without receiving a valuable and adequate-consideration therefor
under which transferor e~pressly 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 or the right to income from the property transferred? (Answer "Yes" or "No" ,) No
b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No",) Nn
6. If the answer to five b. above is "Yes," state whether the right was reserved in decedent alone or others. N/A
7. Did decedent in his!her lifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No".) No
8. Did decedent, at any time, transfer property, 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 operation of
law? (Answer "Yes" or "No".) No
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".) N / A
REV",'4 EX+ (3.80)
'COMMONWEAL TH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT OECEDENT
SCHEDULE "E"
JOINTL V OWNED PROPERTY
..
(Instructions on Reverse Side)
Estate of
Lottie M. Felty
TOTAL PE VALUE OF DEPARTMENT
ITEM DESCRIPTION MARKET \ DECEDENT'S VALUATION
NO. VALUE INTEREST (Official Use Only)
(1 ) Savings Account No. 500-879-2 opened
2/4/61 with The First Bank and Trust
Company of Mechanicsburg, Pa. , in the
joint names of Lottie M. Felty and
Glenn Felty. Account being over two
( 2) years old at the time of decedent'
death, it is reported at 50% hare in.
Full principal balance as of 7/31/80
Was: $17,498.61 17,498.61 50% 8,749.31
Interest accrued to 7/31/80----------- 72.91 50';'; 36.46
. .
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included, List real estate lirst.
1. Describe all real property as indicated in the instructions lor Schedule" A". Describe all personal property
as indicated in the instructions for Schedule "8". Include the name, address and relationship to the
decedent of the co-owner (sl and the date the joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3, Indicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest.
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REV-4S4 EX+ (3.S0)
File Number
21-80-0673
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
Date of Death
7-31-80
Lottie N. Fcl tv
Estate Name
Social Security Number 191 40 941',
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and lor the County 01 Cumberland
Pennsylvania, do respectfully report that I hove appraised the real and personal property os reported in the loregoing
retum at the values set forth opposite eDch item in the last column to the right in Schedules IIA", 118", "C", and HE"
Doted: January 22, 1981
,il,;h",,'J J-ft'r~J/.H.I)
INHERITANCE TAX APPRAISER
Real Property (Schedule A)
Personal Property (Schedule B)
Jolnt.Held Property (Schedule E)
Transfers (Schedule C)
s
VALUE AS APPRAISED
CODE
ADJUSTMENTS
(HARRISBURG USE ONLY)
REMAINDER APPRAISEMENT CODE
INVENTORY
TOTAL GROSS ASSETS
Lns Debts and Oeductlans
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
annuities. . . . . . . . . . . . . .
~
FOR USE OF REGISTER ONLY
Tax on $
T ox an $
Tax an $
Tax on $
Tax an $
ElCemptlans
Total Estate
TOTAL TAX
INTEREST FROM
BALANCE
Less. Credits
DATE OF PAYMENT
AMOUNT PAID
S
INTEREST FROM
BALANCE DUE
-0- 00+
810 00 '0+
8,785 77 2lH
1 053 75 30+
10,649 52
40-
92+
93-
FACTOR
PRINCI PLE
VALUE
CODE
fQ!!.F
COMPUTATION OF TAX
$
$
$
$
S
6%
15%
TO
$
$
$
DISCOUNT INTEREST
+ S S =
+ =
BALANCE S
TO S
S
TAX CREDIT
$
,
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RCC-U '4-77)
COMMONWEALTH OF PENNSY~VANIA
DEPARTMENT OF REYENUE
NOTICE OF DECEDENT ACCOUNT STATUS
DATE FILED
STATUS OF ACCOUNT NOI ~T, OR INVESTMENT
d-/3-P/
l. d...
NAMES ON ACCOUNT
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RETURN COMPLETED
FORMS TO LOCAL COUNTY
INHERITANCE TAX OFFICE
SOCIAL SECURITY NUMBER(S)
I CJ I - ~O. 9'7' /r
BANK AUTHORIZATION
I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A
CORRECT REPRESENTATION OF INFORMATION IN OUR FILES IN ACCORD
WITH SECTION 742 PI 6 E TAX ACT OF tlI61.
SIGNA TU.~ OF FINANCIAL IN_Y-5STIGA:zTOR :-
--/;--...... ,7"'~_ -'" ~~
.'-"'r-~ r:- 1"'/ t ~""--"~;.z:,~- (,~
SURVIVING DEPOSITOR (Benollclo..l INFORMATION
NAME H /J. REL.ATIONSHIP. C...."A-J NAME~
~t.-?'\- TO DEe OENT.~ .
/- .a I 'e/t,17, r.A-- i t-...u-U
ADORE 5
DECEDENT INFaRMAT N
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CITY
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BANKIINSTITUTION ADDRESS
BALANCE OF ACCOUNT AT 000 $
INTEREST ACCRUED AND COLLECTIBLE AT caD $
TOTAL $
The First Bank and Trust Co
MiCHANICi8Utla, PA. 17056
"
DATE OF DEATH
7..5/-80
7
.Co
CATE
REV.455 EX+ (J.KOl
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
: l-r.;J-(.:,/X
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
----.------.--..-- - "",,-,-,-.~-.....------.
*
. ,.
. ' \
Estate 01 Lottie M. Felt.... Date of Death-1131/80 File No.21-80-678
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant
Relationship to Decedent _.
Claimant's ~,ddress
-
ITEM DATE NAMe OF PAYEE REMARKS AMOUNT
NO.
Myers Funeral Home. Inc. Funel'al Expenses 2903.<n
Grace F. Adams Reimbursement for food. tele-
phone and miscellaneous costs
incurred for funeral 118.00
Mechanicsbur~ FamilY
Practice Cent er Medical Bill due. 24.00
Ginll:rich MemOl'ials Letterinl< I-1onument ,2.00
Rell:ister o~ Wills Let cers Testamentary 2".00 -
Seidle Memorial Hospital Hospital Bill due. 190.00
Register o~ Wills Filing Acoraisal '1.00
J. Robert Stauffer. Eso Attnyonevl" FAe 12<;.00
Register of Wills Filing Debts and Deductions 'I 00
.
TOTAL THIS PAGE I .93
I hereby certify that to the best 01 my knowledge and belief the loregoing is a just and true statement of debts, funeral
expenses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes.
'I J C' J . /
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ISIGNATURE of"" ^ TortN!!V/FIOUCI nv DATE
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF 51 2,i-.) ::J,.!J~
AT
(, ") Ii
PE RCENT.
~f (l~^f~)
EGISTER OF Ll.S
;{ -l/.-.PI
....- OATE
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 liled, 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 01 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 claimant's name, address and his/her 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/or 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 lor paying the debts.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*'
COUNTY FILE NO:
f '7 'r'
DATE
ESTATE
-- ~
FILE NO.
COUNTY
J'7U :5
DATE OF DEATH
Appraised Value of Estate:
Real Estate
Personal Property
$ -
+ <g'/eJ dD
I
+ 9t3"J ~)"
$ J I). (" 4 c, s-..-x
3 1/ d,) r:i3
$ 7 ~~d, r:., 5'1
--
Jointly Held PropertylTransfers
Total Gross Estate
Total Approved Oeductions
Clear Value of Estate
less: Approved Charitable Exemptions
Amount Taxable @ 15% Rate
$ 7 ::l. ) J; ;, c;
s f7 ./':J ~ "i 0 tax due 6 tf'J..:J, r:;t/.
- . ,
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE $ ,I- 3 '" 'iLj
-.
Clear Value of Estate Subject to Tax
Amaunl Taxable @ 6% Rate
'* '* '* '* * '* A five percsnt discount totaling ·
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
/(\-,:)~-8()
a-II.- (5'
AMOUNT PAID DISCOUNT INTEREST TAX CREDIT
$ ~ r.; (I {\ c.' + S I X. II;;. s = s :;,1., ? L/Ol
(,,1) I;J + = (,S 10:
+ =
T:J ,J f''f3_~.5t/
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
$ :1 ,/(,)'1 .,l-
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
Assessed by: - ,/ /.... /./ (:,.
Seolnformalion on Reverse Side Agentf~,thicammo~ I1h~..::.:.- . /
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