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INSTRUCTIONS
ASS ET S:
RECORDer" oc:"
REGI: T' '
TYPE OF ASSET _Indicate whether the as.sct is real estate, personal property, transfer or jointly-owned.
DESCRIPTION _ List all assels awned solely by the decedent or owned joil-8(1 wW.VaiMhe~.1>'pitY'or porties as tenants in
cammon or as joint tenants with right 01 surYivorship at the time 01 death. Include the decedent's percentage of ownership,
the name (s) and rolatianship to the decedent of the surviving joint awncrs ond the estimated market value 01 the decodont's
interest as of the date of death. Include intangiblo personal property titloH..lif~ n"Q;;'\!I-'~~lh~rdecedent but payable at death
to another party or parties including but not limited to P.O.D, U .S, Savings B.Qj/,I\fJll.(~nta\'iYe trust accounts. Li st ony
property transferred by the decedent within two years of death for which he/she did not receive valuable and adequate
consideration.
Describe all real estate located in Pennsylvania by lot and block number, street address, number of acres and include a
general description 01 the land and buildings" Also, include the book and page number in which the deed is recorded ond the
C'ltoct title as indicated on the deed.
DEBTS & DEDUCTIONS _ Unsatislied Iiabilitios incurred by tho decedonl prior to his/her death arc deductiblo against
his/hcr ta,xablc estate. In odditic..n to debts incurred by the decedent, other items orc claimable including the cost of
admini stration, attorney fees, fiduciary fees, funcral and buria I expenscs including the cost of a bu rial lot, tombstone or
grave marker. List the dote on which cach debt was incurred and/or paid and the names of each payee. Provide 0 brief
explanation of the nature of each debt claimed and the amount being claimed
Evidence to support the decedent's or the estate's liaLility for the debts being claimed should be attached to this return
A family e'lCcmption may be claimed by 0 spouse of a decedcnt who died domiciled in Pennsylvania. If there is no spouse,
or if the spouse has larfeited his/her rights, then ony child 01 the decedent who is a mamber 01 the same household con claim
the e.emption. In the event there is no such spouso or child, the e.emption can be claimed by a poront or paronts who arc -
members of the same household as the decedent.
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IHFORMATION
PLACE FOR FILING _ The return is to beliled in duplicate with tho Register of Wills of the county wherein the docedent
resided.
TIME FOR FILING _ The return is due nine months after the decedent1s death, unless an c'lCtension for filing has been applied
tor and granted by the Secretory of Revenue within the nine-month period.
FAILURE TO FILE RETURN _ Section 791 01 the 1961 Statute provides that or , . .any person who willfully fails to lile a
return or ather report required 01 him shall be personally liable. . .to a penalty 0125'; 01 the to. ultimately laund to be
due or S 1,000 whichover is the Ie.. to bo rocovorod by the Department of Rovonue as debts af,like amount aro recoverable
by low."
NOTE: Fees paid to an estate representative: namely. an executor or administrator. lor serYices performed in ad.
ministering an estate is reportable for Pennsylvania Income Tax purposes. This taxable income item shoud be reported on
form PA_40.lndiYiduallncome Tox Return.
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R~.'l. FO (7.801
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NOTICE OF FILING OF APPRAISEMENT
COMMONWEAI..TH OF PENNSVI..VANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD DPERATlONS
Helen J. I1rc.z
3653 Cheotnut Street
Camp lIill, Pa. 17011
RE: Estate 01
County 01
File No.
Stephen A. Hrc.z, Sr.
Cumberland
21-80-0738
Dear Mrs. Hraz:
You ore hereby notified that the innolvent
appraisement in the estate 01 Stephen A. Hraz, Sr.
has been filed in the office 01 the Register of Wills 01 Cumberland
County on January 22 , 19 81 . Said appraisement reflects the lollawing valuations:
Real Estate
Personal Property
Jointly Owned
T ranslers
Total
-0-
3,500.00
-0-
-0-
3,sea.ao
As to such tax that is paid within three months Irom dote of death, 0 fiye (5%) percent
discount is allowable. As to any tax that remains unpaid alter nine (9) months (filteen months
when death occurred from December 22, 1965to June 16, 1971, inclusive; and twelve months when
death occurred prior to December 22, 1965) from dote 01 death, interest at the rote 01 six (6%) percent
per annum is charged.
Any party in interest who is aggrieyed by this notice may object thereto within sixty days
after receipt of sold notice os proYided by Section 1001 of the Inheritance and Estate Tax Act of
1961,72 P.S. 2485-1001, P.L. 373.
Dote
Jc.nuary 22, 1981
Signed
,f/f.M;.!1/'7'f'/~1/.",j )
Title Chief Appraiser
NOTE: This is not 0 bill.
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
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ESTATE
TO:
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DA TE OF DEATH . /' /I/i;,-I./J '7 /11,W
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Appraised Value of Estate:
Real Estate
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Personal Property
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Jointly Held PropertylTransfers
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Tolal Gross Estate
Total Approved Oeductions
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Clear Value of Estate
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
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taxdu,e,>.:J"- l/(V(~L .:'>:'~J 2:.<./
Amount TaKable @ 6% Rata
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Amount Taxable @ 15% Rate
tax dUB --.~
TOTAL PENNSYLVANIA INHERITANCE Tf:&/iuf;k.'--l~.v \' t' /?i-~~a~
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.. .. ... .. .. .. A five percent discount totaling S
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
$
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$
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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. . , -->1} . /--
BALANCE OF PENNSYLVANIA INHERITANCE TAX DiJE::".: i_'1b.[.:,L?"L,::.:...,)t/t--I.!";
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Assessed by:
See Information on Reverse Side
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INFORMATION
To insure proper credit to your account, tho n3me of the estate and file number should be clearlv print.
ed on the check or money order.
This assessment is made in accordance with Section 708 of the Inhernance and EsttltC Tax Act of
1961172 P.S,! 24B5.70B)_
To the extent that inheritance 18X is paid within threo t31 months after the death of the decedent. 8
discount of fiva 151 parcant is allowad (72 P,S, \ 24B5.716),
Inheritance Tax. other than tax on 8 futuro interest. is due at the date of tho decedent's d~ath and becomes
delinquent at the expiration of nine (9) months alter the decedent'S death (72 P.S. ~ 2485.711). Inheritance
Tax on a future interest is payable within three (31 months after tho trDnsfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P,S, ~ 2485-712). Calculate interest from the delinquent date shown
on the faco of this form to the date of actual payment using the following intercst table:
--------------------.. - ---------------- --------- - - - -- - --- -------- -- -- -- - ----
1 month ,005 4 months ,D20 7 months ,035 10 months ,D5D
2 months ,Dl0 5 months ,025 8 months ,040 11 months .055
3 months ,D15 6 months .030 9 months ,045 12 months ,D6D
1 days _00017 11 days ,OOlB6 21 days ,00352
2 days ,00034 12 days ,00203 22 days .00369
3 days _00051 13 days ,00220 23 days ,00386
4 days _0006B 14 days ,00237 24 days ,00403
5 days ,00085 15 days ,00250 25 days ,00420
6 days .001D! 16 days _00267 26 days ,00437
7 days ,0011 B 17 days _ 002B4 27 days _00454
8 days .00135 1 B days ,003Dl 2B days _00471
9 days ,00152 19 days ,00318 29 days .00488
10 days .00169 20 days ,00335 30 days _OD500
- -- -------- ----- ----- --- - --- ----- --- - ------ - --- ----- - -- --..------ -----..
Any party in interest, including the Commonwealth nnd the personal representative. not satisfied with
the assessment may object thereto within sixty (601 days after receipt of this Notice 8S provided by Section
1001 of \halnharitance and Estata Ta. Act of 1961 (72 P,S, ! 24B5-1001),
Make check or money order payable 10:
"Regisler of Wills. Agent"
Maille the address listed below: