HomeMy WebLinkAbout80-00750
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ASSETS,
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II-IST RUCTIOI-IS
TYPE OF ASSET _Indicate whether the Disct h rcol cs.1011:, personal property, transfer or jointly.owncd.
DESCRIPTIOI-I _ LI.t 011 a55ats owned .alely by the docedent or owned jointly with another party or partie. a. tenant. in
common or os laint tenants with right 01 .urvivarship ot the time 01 death. Include the docodent's percentage 01 ownership,
the nome (.) and relationship to the decedent 01 the .urviving joint awne" and tho estimated market value 01 the decedent'.
intero.t a. 01 tho dote 01 deoth. Include intangible porsonal property titled in tho name.1 the docedont but payable at doath
to another party or parties including but not limited to P.O,D. U.S. Saving. Bard. and tontativo trust accounts. List any
property translorrod by the docedont within two years 01 deoth lor which he/she did not receivo valuablo and odequate
consideration.
Describe all real estate located in Pennsylvania by lot and block number, street address, number of acres and include a
genora1 de.criptlon ollhe lond and building.. Also, include the book and page number in which the deod i. rocardod and the
('ltcct title 05 indicated on the deed.
DEBTS & DEDUCTIONS _ Unsotislied liabilities incurred by the decodont prior to his/her death ore doductlble ogainst
his/her t01Coblc estate. In additjc." to debts incurred by the decedent, other items arc claimable including the cost of
administration, attorney fees, fiduciary fces, funeral and burial cJ(pcnscs including the cost of a burial lot, tombstone or
grave ma.rker. List the do to on which oach debt was incurred and/or paid and tho nomos 01 each poyee. Provide 0 briel
c1Cplanatlon of the nature of each debt claimed and the amount being claimed
Evidonce to .upport the decodent's or the estato'slio~ility lor the dobts being c1aimod should be ottachod to this return
A lomily e.omption may be c10imed by 0 spouso 01 0 decodont who died domicilod in Pennsylvania. Il there i. no spouse,
or if the spouso has lorleited h,i./hor rights, thon any child 01 the docodent who i. 0 membor 01 the samo hou.ehold con claim
the e,emption. In the ovent thero i. no such spouse or child, the exemption con be claimed by a parent or porents who ore
membcr~ of the samc hou schold as thc decedent. . .
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II-IFORMAT101-1
PLACE FOR FILlI-IG _ The roturn is to beliled in duplicote with the Register 01 Will. 01 the county wherein the docedent
rcsided.
TIME FOR FILlI-IG _ 'The return is due nine months oltor the decedent's death, unle.. on exton.ien lor IIling has boen applied
for and granted by the Secretory of Revenue within the nine..month period..
FAILURE TO FILE RE1URI-I _ Section 79101 the 1961 Statute provides that" " .ony person who willlully lail. to lilo a
return or othor report required 01 him sholl be personolly liable. . .to 0 'penally 0125'; 01 tho to. ultimotely lound to be
due or 51,000 whlchover i. the Ie.. to be recovered by the Deportmont 01 Revonuo os debts olliko amount ore recovorable
by. law.'~r
NOTE: Fees paid to an eslate repre.entative: namely, an executor or odmini.tralor, lor services performed In ad.
ministering an estate Is reportable lor Pennsylvania Income lax purposes. lhis taxable income item shoud be reported an
farm PA.40.lndlviduollncome Tax Return.
RCC.4Z. (...71.
COMMONWEALTH OF PENH5YLYANIA
, DEPARTMENT OF REVENUE
AUG O? 1980
1/ ~r'l;
I(, t'-
UANK NO.
60-8~
DATt: FI1-~D
Submit in truplicate wit
the deoth.
HOTICE OF OECEDEHT ACCOUNT STATUS
August 6, 1980
STATUsor ACCOUNT NOI (JOINT, TnuST. Oft INVE[;TMENT
RETURH COMPL ETED
FORMS TO LOC AL COUHTY
IHHERITAHCE TAX OFFICE
.
8 2 65
SOCIAL. SI!CURITY NUMBER(SI
NAMES ON ACCOUNT
Kathryn E. SipB or
RDbert B. Sipp Dr
Margaret 5. Hoke
DECEDENT INFORMA H
NAME
SURVIVING DEPOSITOR (B.n.llcl.~IINFORlAA TIOH
Robert B. Sips ~~l.~~~~~S~~~. NAME
Margaret S. Hoka Hueb~nd-Daugh. Kathr
ADDRESS
Unknown
BANK/INSTITUTION ADDRESS
Dauphin Deposit Benk and Truet Co.
Attn: DASD
213 Market Street
Harrisburg, Pennay1venie l710l
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BAHK AUTHORIZA TlON
1 HEREBY CERTIFY THA.T THE iNFORMATION CONTAINED HEREIN IS A
CORRECT REPRESENTATION of INI""ORMATION IN OUR FIL.ES IN ACCORD
WITH SECTION 742 PI&. E T AX ACT OF 19610
A.DDRESS
335 Weeley Drive Apt )01
CITY
Mecheniceburg
BAL.ANCE OF ACCOUNT AT 000
INTEREST ACCRUED AND COL.L.ECTIBL.E AT 000
ToTAl.
SIGN#o"'Uj).~F1INA~.CI NYESTlGATOR
// /' 'Z .
D' '( /~ _/A' I.
DATE OF DEATH
B 5 aD
COUNTY
ZIP COOE
DATE
86 eo
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REV-4":S t...19~'
. 'COMMONWEAL TH OF"PENNSYLVANIA
DEPARTMEI<T OF REVEI<UE
NOTICE OF DECEDENT ACCOUNT STATUS
Submit in triplicate within 10 days alter knowledge 01
the death.
NAME
ADDRESS
RETURN COMPLETED
FORMS TO LOCAL COUNTY
INHERITANCE TAX OFFICE
SURVIVING DEPOSITOR B.neflc:lar ItlFORMATIOH
AELA nON SHIP
TO DECEDENT
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SANK/INSTITUTION ADDRESS
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BANK NO.
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CATE FILED
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STATUS OF
CCOUNT NOI tJOINT. TRUST. ORINVE5TMl:NTI
1(':. nt
ESTABLISHED DATE
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NAMES ON ACCOUNT
SOCIAL SECURITY NUMBERlSI
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DECEDEI<T II<FORMA TION
NAME
DATE OF DEATH
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CITY
COUNTY l';l~ ':~ "":J.'l;.:.fl.(
ZIP CODE
,,'L;'Jy~.cnl,ul'f;, ~"",
BALANCE OF ACCOUNT AT 000
INTEREST ACCRUEO AND COLLECTIBLE AT 000
TOTAL
$ 1.~,;::;J;";
$
$ "J~, ," ',~
BANK AUTHORIZA. TION
I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A
CO~RECT REP RESENTATION 0 F IN FORMATION IN OUR I'1LESIN Aceo RD
WITH SECTION 742.P I 6; E TAX ACT OF 1961.
SIGNATURE OF FINANCIA\. INVESTIOATOR
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