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Home My WebLink About80-00765 'il/tl :~ ~ " , ' ',,-::" .,,', ',.i' .,.;. --: -:;~'~.: 1/.. ,.... 'i"f".",,' ......... " , , .', ",.-. Q - CO 0 . - M t.J - . III 0 - tit ~ Z LLI '" ".y ,...~. . .',!il ":"({'fJI.. . ')~'{,~}'$;T , i;'ii:\~~ 'i~~f~!~i~~ ._-___ __ ~ ~ -=-- ~ _.,. ~ - . _a. , ~'iuV;'i'eZ'EX~';I'i-:':;""':"""~'"':";":'-:'''' ':_.' , . " " -".' " ' I 1~;i~~;,1",i".'(~:~1:i4/,~\1;}'.(,:,',.;,,'(,"'" 'COMMONWEALTH QF PENNSYLVANIA ',' , I ~',., h", " ", :'" . DEPARTMENT OF REVENUE' , , : 4 l~il:~~~~.~:O,'bFFICIAL RECEIPT' PENNSYLVANIA INHERITANCE AND' ESTATE TAX !, ~""""'_"""':d"" ",' "., " 1 'II II a i ~ I ~ RECEIVED I \l"~ FROM Ii \" ADDRESS ...chanicabur I r - TAX AT 6% TAX AT 15% TAXAT_% ESTATE TAX PA 17055 TOTAL TAX CREDIT f3.198.63 .--esTATEINFORMATIDN'-------------------------- DATE OF DEATH FILE NUMBER 21-80-765 DATE OF PAYMENT LESS DISCOUNT PLUS % INTEREST (FROM TO_I COUNTY m ------ --------------- ---- - m TOTAL AMOUNT PAID 83,198.63 NAME OF DECEDENT POSTMARK DATE 1 REMARKS. ~ "'AID ON ACCOUNT" SEAL RECEIVED BY t REGISTER OF WILLS . . . . _____0______--- _____ ----------.------- '" " o ... Ii: :! l1J~ti~ (!)<~:i O..l~> mt-WU'I .. z z N>~ffi ~ " .. ....~t-ci 0::: 0 In IX l1J~~~ m<tIlU'} ..J (II ~ oC( ~ :I: U ~ " \.t-l ':. a: I ..Q - - ~ . > r.l ... III ~ '. ' . "'" ,...., ~~~~~:t lU~lt, ml~( '@;~~htnl~ltt BE IT REMEMBERED THAT I, JESSIE V. GOUFFER, of the County of Cumberland and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking and making void any and all wills and Codicils, or writings in the nature thereof, at any time heretofore made by me. ~: As my personal representative, I nominate and appoint ALBERT Z. BOGERT, ESQUIRE, to be the Executor of this LAST WILL. In the event ALBERT Z. BOGERT, ESQUIRE, is unable or ceased to act for any reason whatsoever, I nominate and appoint CCNB BANK to succeed as Executor of this LAST WILL. SECOND: I direct that my debts and funeral expenses be paid as soon after my death as is practicable by my Executor. !!!!!!!? : I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated, that shall become payable by reason of my death in respect of all property comprising my gross estate for death tax purposes, whether or not such property passes under this LAST WILL, shall be paid by me Executor. FOURTH: I give the sum of $1,000.00 to the United Methodist Church located on Simpson Street, in Mechanicsburg, Pennsylvania. ~: lITRUST" I give, devise and bequeath all my property, whether real, personal, or mixed, wherever situated, including any property over which I may have by power of appointment, to CCNB, NA, Cumberland County, Pennsylvania, IN TRUST, to be held, administered, and distributed, in accordance with the following provisions: A. The Trustee, shall pay to or apply for the benefit of my son, CHARLES TAYLOR, from the net income of the TRUST or from the principle if necessary, the sum of $1,000.00 per month. B. The Trustee may at any time pay to or apply for the benefit of my son, such additional sums from the principle of the TRUST estate, up to the .-. . '. whole thereof, as the Trustee in his discretion deems advisable for the proper care, support and maintenanc" of my son. Anything herein to the contrary notwithstanding, my son, CHARLES, shall take no part in any decisions to invade TRUST principle for himself. C. Upon the death of my son, CIlARLES, or in the event that he shall not survive me, then upon my death, I direct that all the rest, residue and remainder of my estate, real and personal, or the then remaining balance of the TRUST estate, as the case may be, shall be held by the Trustee for the benefit of my granddaughter, LISA TAYLOR. 1. If my granddaughter, LISA, shall have attained the age of thirty (30) years, then the entire principle of the TRUST including accumulated income shall be paid to her in approximatelY equal installments on an annual basis over a three-year period. 2. If my granddaughter, LISA, shall not have attained the age of twenty-one (21), then the Trustee may at any time pay to or apply for the benefit of my granddaughter, LISA, sums from the principle or the income of the TRUST estate, up to the whole thereof, as the Trustee in his discretion deems advisable for the proper care, support, maintenance and education of my grand- daughter. 3. When my granddaughter, LISA, shall attain the age of twenty- one (21), the Trustee shall distribute one-third (1/3) of the principle of the TRUST to LISA upon her written request. When my granddaughter, LISA, shall attain the age of twenty-five (25), the Trustee shall distrH"lte one-third (1/3) of the principle of the TRUST to LISA upon her written request. When my granddaughter, LISA, shall attain the age of thirty (30), the Trustee shall distribute the balance of the principle including any accumulated interest to LISA upon her written request. 4. If my granddaughter, LISA, shall die before the entire principle of the TRUST fund held for her benefit has been distributed, the then principle of such TRUST fund together with any undistributed income shall be distributed to the United Methodist Church, Simpson Street, Mechanicsburg, pennsylvania. -2- OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND Before me, the Register for the Probate of Wills and granting of Letters of Administration in and for the County of Cumberland, personally came 4~,8C/Z r ~ Z?CJ6' c.a.-/ S F C?l ~ "'-- who, being duly.?" .wtA "J , do 8 S depose and say that as .-,- of the last Will and Testament of ... /' E S S / E 6'C drr cr'L deceased 1./. will well and truly administer the goods and challels, rights and credits of said deceased according to law. And also will diligently comply with the provisions of the law relating to Transfer Inheritances. x.wt.,,) and subscribed before me. /---;)' ~ Dec. 5 A.D., 19~ C::A~::V ~~ ~/U/ Ii ~,,/./C~) fiE-- Register 1.1') ~ f" L.L. o -' -' - ~ :,.; : Cll : '" : tll : ~ :Cll :~ 0:: ['1' r~ : "". .~ : b: ai .. 0....: .. : ['1 H Ul co <iI ":l 0: 0): a> ,-tr . <1'\ U i C1l: n: ~: 0): '*\ 1 ~ ..... ..... .~ ~ = .~ u: E-<: fU; N: <t: lfl: "~i %'0 tll p.. 11 .... .~ ~ 'tl Cll 'tl .. o " ~ 'tl s:: tll o 00 . - M ~ 2l S '" ~ o Z DECREE Be it remembered that on the 9th December 90 ,A.D.,19_, there was probated and day of recorded the last Will and Testament of Jessie V. Gouffer late of Silver spring Township , Cumberland County, Pennsylvania, Deceased. Letters Testamentary wcre granted to Witness my hand and official seal the day and year aforesaid. Albert Z. Boqert 5"7 ... ':'-'. ~h/-;~ (!, ~~;J . RegIster . REV0449 EX+ (3.80) COMMOHWEALTlt OF PEHHSYLVA'UA DEPARTMEHT OF REVEHUE TRAHSFER IHHERITAHCE TAX RESIOEHT DECEDEHT AFFIDAVIT OF FIDUCIARY (In.,ructlons on Reverse Side) * Estate 01 . T P!l sie_V.._Gouff pr Dote 01 Death bIo"emb'i't' 8, J 980 200-36-5793 Lost Address 17 Yorl<,..C:!J:c1e Mechanicsburg, PA 17055 Social Security No. ICITYI (STA TE:.) (ZIP) Bureau File No. County File No.9 I. ,Y1: -'7 (; 5 1. Decedent died: ( ) Intestate (without 0 will) ( x) Testate (leaving 0 lost will--capy attached) 2. Is the Iiling of 0 Federal Estate Tax Return required for this estate? Yes_ No X 3. (X) Executor/~ ) Administrator! Administratrix 4. All correspondence should be mailed to ( Attorney ( X) Fiduciary. n . ,- CD ",'" gl"'1 ..... ...,'" _:0 on ..::.. ~~ __0 CJ, ~ ....,?} M,t.:l ..tr;l ;lJ:t... ~..r" r:o I ",Q f...:: -.J ; ~.~ '';J~ .,-\ " ., .- v C l~' I " '.-) ,'-' -. ~.; " '.*': Nome -Albert: Z, Bogert ,.J:.s.quirp. Address ?? F.asr M..in f;rrppr Mechanic!lburg. PA 17055 (CITY) (STATE) (ZIPI 5. If on al!arney is representing the estate, indicate: Nome Murrel R. Walters III Address 22 East Main Str~et M",..h..ni <,,,h"'-g PA 11055 (CITY) t~TATE.) (ZIP) List all sole deposit boxes registered in the decedent's individual namel or iointly with, or as on agent or deputy 01 another, or in decedent's individual nome with right 01 access by anatner os agent or deputy, Include the nome and address 01 the bonk or other instituti~n where the sole deposit box is located, the nume (s) in which the box is registered and the relationship of the joint holders to the decedent, HAME AHD AODRESS OF BAHK OR OTH ER IHSTITUTION IH WHICH DECEDENT MAINTAINED A SAFE DEPOSIT BOX NAME OR HAMES IH WHICH SAFE DEPOSIT BUX IS REGISTERED RELA TlnNSHIP OF JOIHT HOLDERS TO DECEDENT None Under penalties of perjury, I declare that I hove ey,amined this return, including accompanying schedules and statements, and to the best of my knowledge and beliel it is true, correct and complete, iJi; '7/fil aAfE PENNSYLVANIA INHERITANCE TAX GENE~^lINFOHM~,TION 1. PERSONS RESPONSIBLE FOR RETURN Section 701 of the Inheritance and Estate Tax Ac( of 1961 provides that the following pelsons shall prepare and filp, a return: a. The personal representative of the estate of the decedelll ilS to properly !lllhe decedent administered by him and such additionill property which is or lIIay be subjeclto Inheritance Tax of which he/she shall have or acquire knowledge; b. The transferee of property upon the transfer of which Inheritance Tax is orllliiY be imposed by Ihe 1961 Statule, including a trustee of properly transferred in trusl, provided that no separate return need be made by the transferee of property included in the return of a personal representati ve. 2. PLACE FOR FILING The return is to be filed in duplicate with Ule Register of Wills of the coullty wherein lhe decedenlresided. 3. TIME FOR FILING The return is due nine monUls after the decedent's death, unless an extension for filing has been applied for and granted by the Secretary of Revenue within the nine-month period. 4. FAILURETO FILE RETURN Section 791 of the 1961 Statute provides that" . . .any person who willfully fails to file a return or other report required of him. . .shall be personally liable. . .to a penalty of 25% of the tax ultima(ely found to be due or $1,000 whichever is the lesser to be recovered by the Department of Revenue as deb(s of like amount are recoverable by law." 5. TAX RATES Inheritance Tax is payable at the rate of6% on transfers to lineal descendants, such as father, mother, husband, wife, son, daughter, grandchildren, grandparent, son-in-law and daughter-in-law and at the rate of 15% as to all others. 6. PAYMENT OF TAX The tax assessed on the transfer of property reported in the return is due 9 monlhs a(ter the decedent's dealh. Interest at tlle rate of 6% per annum accrues thereafter until payment is made. All payments received are first applied to any interest which may be due with any remainder applied to the tax. IF TAX IS PAID WITHIN 3 MONTHS AFTER THE DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED. All checks should be made payable to Ule Register of Wills of the counly wherein lhe decedent resided and are received subject to the final determination of the Deparlmen( of Revenue. 7. FAILURE TO PAY The taxes imposed, together with any interest thereon, are a lien upon real properly, which lien remains in ellect until the taxes and interest have been paid in full. The taxes may be sued for against any real property in the decedent's estate or against any property belonging to a transferee liable for the tax. 8. FILING OF FALSE RETURN Any person who willfully makes a false return or report required of him shall, in accordance with Section 793 of the 1961 Statute, be guilty of a misdemeanor and, on conviction lhereof, shall be sentenced to pay a fine not exceeding $1,000 or undergo imprisonment not exceeding one year or both. REV-4!lO (1-1101 COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "A" REAL PROPERTY ,"' :~~~,~ ~<m~' ~ ".\.!~l . I,~,lj, t 1," .. .'~, ~'r/.jl;#~:,' (\n~lruclions on Reverse Side) ESTATE OF Je,SJ,tie_V~.GoufJe~ .- ESTIMATED . DEPARTMENT ITEM NO. DESCRIPTION MARKET VALUATION VALUE (OFFICIAL USE ONLY) -NONE- TOTAL THIS PAGE -IJ~ - 0- REV0451 EX+ (3.S0) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY .. , (Instructions on Reverse Sidel Estate of Llp!=;!=;ip V, Gouffer ESTIMATED DEPARTMENT ITEM DESCRIPTION UNIT MARKET VALUATION NO. VALUE VALUE (OFFICIAL USE ONL YI 1. Checking Account #331-688-2 7,611.13 CCNB Bank, NA I 331 Bridge Street , New Cumberland, FA 17070 2. Savings Certificate of Deposit Account No. 002-19-03990 20,040.83 State Capital Savings Association , 108 North Second Street Harrisburg, FA 17105 3. 1955 Dodge Sedan 200.00 i I I I I I I i I i I TOTAL THIS PAGE 27,651. 96 ,;z7,~ ~/. 96 I , 1{j I A INSTRUCTIONS FOR COMPLETING SCHEDULE "B" Schedule "S" must include all tangible and intangible personal property owned individually by the decedent at the time of death. Property owned , jointly with another party or parties should be listed on Schedule "E" . ,Jointly Owned Property. Intangible personal property, titled in the name of the decedent, but payable at death to another party or parties, including but not limited to P. O. D. U. S. Savings Sonds and Tentative Trust Accounts, must be listed on Schedule "S". Tangible personal property should be listed first. Examples of tangible personal property are jewelry, wearing apparel, huusehold goods and furnishings, books, paintings, automobiles, boats, snowmobiles, aircraft, etc. Intangible personal property includes cash,on,hand and in the bank, stocks, dividends, bonds, mortgages, treasury certificates, notes, together with accrued interest, salaries or wages, insurance payable to the estate or fiduciary in said capacity, partnership interest, etc. An interest in any undistributed estate or income from any property held in trust under the will or agreement of another even though located outside of Pennsylvania at the time of death should be listed on Schedule "S". A completed Partnership Interest Report (REV,S94) must be attached for each partnership or joint venture, and a completed Closely Held Corporate Stock Information Report (REV,893) must be attached for each c1osely,held business interest or sole proprietorship reported on Schedule "S". QUESTIONS CONCERNING PROPERTY TRANSFERS 1. Did decedent, within two years of death, make any transfer of any material P;lit of his estate without receiving valuable and adequate consideration? (Answer "Yes" or "No".)..Ye.s- 2. Did deceden(, within two years of death, transfer property from himsel fl hersel! to hlmsel f!hersel f and another party or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) ~ 3. If the answer to one or two above is "Yes" and tile transfers are c1armed to he nontaxable, provide the following information: a. Age of decedent at time of (ransfer. b. Copy of death certificate. c. Affidavit hy the altending physician indicating Ihe state of decedent's l1eallh at lime of transler. d. All other information supporting nontaxability of transfer, 4. Did decedent, in his/her lifetime, make any transfer nf property without receiving a valnable or adequate consideration therefor which was to take effect in possession or r:njoymenl alar aHm his/her dealh? (Answer "Yes" or "No".) Yes a. Was there any possibility that the property transferred might relurn to :Ians(e:or or hislher estate or be subject to his/her power of disposition? (Answer "Yes" or "No".) No_ b. What was the transferee's age at time of decedent's death? 5. Did decedent in his/her lifetime make any transfer without receiving a valuable and adequale consideration (herefor under which transferor expressly or impliedly re:;erves for his/her Ii fe or ,my period which does in fact end before his/her death: No a. The possession or enjoyment of or the right to income flam the property transferred'! (Answer "Yes" or "No".) - b. The right to designate the persons who shall possess or enjoy the property transferred or income tl1erefrom? (Answer "Yes" or "No".) G. If the answer to five b. above is "Yes," state whether the right was reserved in decedent alone or others. 7. Did decedent in hislher lifetime make a transfer, the consideration for which was transferee's promise to pay income to or for the henefit or CalC of (fansferor? (Answer "Yes" or "No".) No 8. Did decedent, at any time, transfer property, the bmeficial enjoYlllen( of which was subject to change, because of a reserved power to niter, 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, "mend or revoke the interest of the beneficiary reserved in the decedent alone or the decedent and others? (Answer "Yes" or "No".) No REV-454 (loSD) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTL Y OWNED PROPERTY *'..:r~ ' " : ~ (Instructions on Rt?Verso Side) Estate of .TeRRie V. Gouffer P TOTAL E VALUE OF DEI'ARTMENT ITEM R DESCRIPTION MARKET 1, DECEDENT'S VALUATION NO. VALUE N INTEREST (Official Usa Only) T -. I . None I TOTAL THIS PAGE ..-~ ..- - IS A 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. !.ist roal estate first. 1. Describe all real property as indicated in the instructions for Schedule "A". Describe all personal property as indicated in the instructions for Schedule "B". Include the name, address and rclationsilip to the decedent of the co'owner (s) 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. c: "" Cl n ;.- t'1 > ~ Z ;.- 0 0 v Vl Cl C\ n c: v ~ z :: 7- t"' m m :>- 0 0 t"' ;, Z ;;;: Z z t'1 ~ m ~ I z 9 tT1 9 ..... -< Vl Vl Z 0 Vl 0 -l 9 ." ." ;ll ~ I > 0 -l 'rl 0 :::! I z 0 > I t"' I r.: I Vl tT1 I 0 , Z t"' -< -< -< ~ m m > > I ;;;: ;;;: I I I Albert z. Bogert Attorney at La\~ 22 East Ma~n street P.O. BOX 2477 Hechanicsburg, pa. 17055 5t1:t:\lfiE CA~~1fA!L ~~~~~fjj~ ASSOCIATION 00 DATE: January, 19" 1981 , DECEDENT: JeSSJ,e \. Gouffer D.Q,J).- 11-8-80 "~': ,,' ~~CE AS O~ DAT~ OF DEATH ACCRUED nrrEREST DATE OF DEATH VALUE DATE ESTABLISHED ~lATURITY DATE Hrs. Jessie V. Gouffer $ 20,000.00 , 40.H::l $/.O,IHU.HJ 4iQQ2:""!.2.. -{) 3 990 ACCOUNT TITLE 41'_-_- BALANCE AS OF DATE OF DEATH $ ACCRUED INTEREST DATE OF DE.l\.TH VALUE $ DATE ESTABLISHED HATURITY DATE ACCOUNT TITLE .u. BALANCE AS OF DATE OF DEATH $ 'ir_-_- ACCRUED INTEREST DATE OF DEATH VALUE $ DATE ESTABLISHED MATURITY DATE ACCOUNT TITLE .u. a~CE AS OF DATE OF DEATH $ 'Tl'__ ACCRUED IliTERESr:( DATE OF DEATH VALUE $ DATE ESTABLISHED !.lATURITY DATE ACCOUNT TITLE THE PENALTY ON PREMATURE I'1ITHDRA\'1ALS OF TERM INVESTMENTS IS WAIVED PRIOR TO THE INVESTHENTS RENEWAL DATE. TO ACT UPON ACCOUNTS HELD IN AN ESTATE I'IE REQ'UIRE A SHORT CERTIFICA'i'E OF CURRENT DATE; A DEi\TH CERTIFICATE ON JOIllTLY HELD ACCOUNTS. CONTACT US FOR ANY FURTHER INFOrMATION. 'I BY: /,(:"{t/.!.-/i /7. / "'.'" .- :",...:i.."",.", ,',,',' ,~./' . / ~ . - /~_.... ,'- :~ .,: - Account 002-25-00673 Closed 9-3-80 Hrs Jessje V. Gouffer $ 20, 207 .72 "''- <. ,J / -'-- '-'.~ c ,~, ~1I111\: 1t, ~1"\'l . .;:.... ..:.1,,; . ", ,.: ,:.' ,';, . ~~(/ ! '. "I :' ':' ii:" l f~,~J~l ..--...... --- , ~,'!! 1~.1~;,>Hl'!~[CU.:,;:~;.. ~'. REV.4~7 EX+ t7-eO) COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT INHERITANCE TAX APPRAISEMENT ~~ ~A.~::.t.h'~ "j.,~\, r, .,:~I.. ,..1i..W\!1,..... ',- :\~:1.;.~,. 1iJ0RIGINAL _ __._ ~~~._ .~ ._.~,,"......:T-n~"~-:;;;.<"::JUn.=-:::r.:- o SUPPLEMENT AL Estate of Jessie V. Gouffer File No. " 21-60-0'/65 Coun ty Cumberland Oulo 01 OculI. Novombur 8, 1980 -----.-- ---'-' --- --- _.--- --.' - In the ovent that cny future inll!re~;,f in this estate j. .rondo"..,J In poti."..I(", 01 ftlli.>Yllldlll III (ullolt>rul h.ln of the decedent after the expiration of ony estale for Iif., Dr for yoars, the Commonwnallh h,,'nhy 1Ulfll""I... I"'.l.t fl'b th.. t1uhl 10 lII1plnl.. ond 0..0.. Iton.l., inheritance taxes at the lawful callotl!rolllll" on on such futuro InloH.,t. ._--- -.-.-- ------. ,,-- p.---- PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH --.-----------.-..-. --. ....-.------ _.__._~__ _______ ____u___. -------.-------.-.. .--------- _____._._.__. __ _ __ __un ASSET SUMMARY DEPARTMENT'S APPRAISED VALUE 1. Total Real Property _ SCH. "A". . . ... S __None_____.._ 2. Total Personal Property - SCH. "B". . . . $ .--21_,.65L96-,- 3. Total Jointly Owned Property - SCH. "E" $ ---1Ione..--,-, 4. Total Transfers _ SCH. "C". . .'. . . .. $ ----55,,000,.00 Unreportad S Unreported S Unreparted $ Unraparled $ $ NOD" S :>7,1\<;1 OM $ --Hnn~ $ 55.000.00 S 82,651.96 .------ o LIFE ESTATE TOT AL GROSS ASSETS DANNU~~~_____D!EMA.I~o.':~____-_-_ ..- --.-------... -----.. ,-_,_~-"._' ._-_._------~- -. -..-.---'---" .--------. ----.-------.-.-.-- ~. .-_. --..-.. ----~--_.--~---.-._- ______.-___.__...__ _.. .__.n_.n _.... ___ .,.____..__.._.n_ TOTAL VALUE s .-------.-'.- -....---- I do hereby c,,,lily thel the alJO,e appraisemenl is 1110de in conformity wilh Pennsylvania low and has been liled this day with the Register of Wills. /~_ j /,' c:/ -;;:/~'g;,;Ic',.,- /.;1; L-Jft:"'-~- Au~st 14. 19B1 7/- AP~~A'SLH 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 e~,penses including the cost of a burial lot, tomhstone or grave marker. All debts being claimed against an estate are subject to the a:Jproval 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 S2,000 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. c "" " n > ,." > ~ > 0 0 " '" 0 z Cl n c: " ..., z 3: z t= ," '" ;:0; z > 9 0 z ;::> ..., z z '" -l '" 9 0 -l -< tIl ,." - tIl Z 0 tIl 0 -l ." ;::> 0 ." ~ ~ 0 - '!l 0 '!l - ~ z n -' 'C.,.. - .. '.:' " > .' (', ,-' t'"' '.'~ Z-, c.- :z..c-. c:: t. 4- tIl r- ~'". .::: '" c \ p.. - 0 e>-- o::.Ci: Z \.4U~ -' r.";..Jj - 'co. !( p'- =- ..'- ~l" ,'-.J- -< -< 0- ct:::> ~ ",<:J ~r...> '" '" w"" ~ > > 0:;"'- u ;l:l ;l:l 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 for paying the debts. 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. C "0 " ('l > tTl > ~ > 0 0 " CIl " Z Cl ('l c: " >! z 3: z t'"' tTl tTl :>:: z 9 9 t'"' " -l Z Z Z t'l -l t'l 9 9 -l ><: CIl tTl Cii Z 0 CIl 0 -l 9 'Tl " ;.:: ~ ;:j 0 - .." 0 .." - Z ('l - ,.-' ~, " > c ~, ." -' t'" ." :_,-, c: I;..., .;::-, Ul c" f~~ t'l L~r- - 0 u.1L'. ~5: 01 'c Z 0::: v": cc IU.' !( OCj ""CD -<: -<: <'>w 0.: 'I: ~<r w:::> tTl tTl ~ ~ .....(.) > > <.> ;;0 ;;0 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 for paying the debts. RCC-~ (4-7J) APnlCATION FOR CHARITABLE EXEMPTION FROM PENNSYLVANIA TRANSFER INHERITANCE TAX (Aclo' Moy 28, 1956, P,L, 1757, ond Act of June 15,1961, P.L. 373, as omended) i+- ~ COMMONWEALTH OF PENNSYLVAtHA OEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Application is hereby filed far the approval of an exemption from Pennsylvania Transfer Inheritance Tox on the transfer of the property described below: 1. Bureau File # 21-80-765 November 8 1980 2. Date of Death .. 3. Date of Approval -L~ .;?~ l</iY I 4.. fD d JE~IE V.-GOUFFER . I,amc 0 eca ent 5. The Commonwealth's appraised value 01 the property far which an exemption is claimed is S $1,000.00 (Note: Where the property is other than a specified amount of cash, the exemption cannot be approved until the value of the property has been established by appraisal by the Commonwealth, except in those cases where the amount of the gift or bequest represents a stated froGtional or percentage portion of the entire estate or the entire residue. In those cases enter such fractional or percentage amount above). 6. Check the manner in which the transfer was effected and submit a copy of the document authoriz.ing the transfer, unless such material has been previously filed. WILL X9i DEED 0; TRUST INDENTURE 0; SURVIVORSHIP 0; OTH ER 0; (If ather, explain) 7. Correct Business Name and Address of Charitable Organiz.ation receiving property: NAME GRACE UNITED METHODIST CHURCH ADDRESS Simpson & Market StS., Mechanicsburg, PA 17055 o See listing on reverse side lor additional charitable organizations covered. 8. I certify that the information contained herein is~ to the best of my knowledge and belief, true and correct. Signature 01 Applicant ~..~.c. ~..C- ----~ . --7 ~-:7 _, ~~ '" .. '~;'..'- I....... .. .... Address of Applicant 22 East Main St., Mechanicsburg, PA 17055 Official Title Executor Date August 27,1981 This form must be completed In triplicate and 011 three caples delivered to the Register of Wills for the County In which the decedent resided, or In which letters were Issued for a non.resldent decedent's estate. If the decedent was a non.resldent of Pennsylvania and letters wore not Issued by a Pennsylvania Register of Wills, deliver all three copies to the Director, Buroou of County Collections, Penna. Department of Revenue, 26 S. 4th Street, Harrisburg, Po. , 00 not write below this line. Far Ollicial Use Only APPROVED: Far the Secretary of Revenue REFERRED to Bureau Headquarters Approved 0 For Secretary of Revenue Denied" 0 (Initials of Register of Wills) (Authorind Signature) (County) (Title) (Date of Referral) (Date of Action) .. Soe reverse side for roo sons MUST BE FILED IN TRIPPCA'!'': INFORMATION To insure proper credit 10 your account, tho name of lhe estate and file number should be clearly print- ed on the chock or money order. This assessment is made in accordilncr. with Section 700 of the Inheritance and Estate TalC. Act of 1961 (72 P,S, ~ 2485,708), To the extent that inheritance tax is paid within Ihteo 131 months after the death of the decedent, a discount of five (5) percent is allowed (72 P,S, S 2485.716), Inheritance Tax, othor tho" tax on a future interest, is duo at Ihe data of the decedent's death and becomes delinquent al the expiration of nine (9) months after tho decedent's death 172 P.S. ~ 2485.7111. Inheritance Tax on a future interest is payable within threo (3) months ahor the transfer takes eHect in possession and enjoyment and is delinquent thereaher (72 P.S. 9 2485.7121. Calculate interest from the delinquent date shown on the faco of this form to the date of actual payment using the following interest table: ------------ -------- - ---------- --- ---- --------- - - - -- - --- ---------- - - - - - -- -- 1 month ,005 4 months ,020 7 months ,035 10 monlhs ,050 2 months ,010 5 months ,025 8 months ,040 1 1 months ,055 3 months ,015 6 months ,030 9 months ,045 12 months ,060 1 days ,000 17 11 days ,00186 21 days ,00352 2 days ,00034 12 days ,00203 22 days ,00369 3 days .00051 13 days ,00220 23 days ,00386 4 days ,00068 14 days ,00237 24 days ,00403 5 days ,00085 15 days ,00250 25 days ,00420 6 days ,00101 16 days ,00267 26 days ,00437 7 days ,00118 17 days ,00284 27 days ,00454 8 days ,00135 19 days ,00301 28 days ,00471 9 days ,00152 19 days ,00318 29 days ,00488 10 days .00169 20 days ,00335 30 days ,00500 -- ------------------- --- --------- --- - ---- -- - --- ----- - - - --------- ------ Any party in interest. including the Commonwealth and the personal represenlative, not satisfied with the assessment may object thereto within sixty (60) days after receipt of this Notice as provided by Section 1001 of the Inheritance and Estate Tax Act of 1961 In P,S, S 2485,1001), Make check or money order payable to: "Register of Wills, Agent" Mail to the address listed below: ~r~~-r.~~:-O.';~~