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REV,,!UlI EX+ (7-80)
COMMONWEAL TH OF PENHSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER IHHERlTANCE TAX
RESIDENT DECEDENT
INHERITANCE TAX RETURN
FOR INSOLVENT EST A TES
(Instructions on Rayerse Side)
COUNTY HO. :)../ - S" ,') - 7'7 <I
STATE HO.
Eltate of CLYDE L. OSTRANDER
Last addre.. 125 Fern Avenue
(STREET)
..
:z: Carlisle,
w Pennsylvania 17013
Q
w CCITY) (STATE. (ZIP)
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W
Q November 2, 1980
Date of Deoth
IDl Exec. ( ) Adm. Other
Mome Marguerite E. Ostrander
. -
Social Security Mo. 1.93-12-8819
,. 125 Fern Avenue
0: Address
..
U (STREET)
::l Carlisle Pennsylvania 17013
Q
u:
(CIT'\') ISTATEI (ZIP)
Under penalties of perjury. I declare that 1 have 8xamine(t. this return and
to the best of my knowledge end belief it \s true, correct end complete.
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/:{(t",/',:,,::.-,,l-" / (J:.r.:UA-/-<'..L 'c), ~ .
Social Security Me.
1.67-18-9044
Signature 01 FiduCiary
01.
TYPE OF AS$ET
OESCRIPTIDN
ESTIMA TED MARU T
VALUE
DEPARTMENT VALUATION
(OFFICIAL USE ONLY)
Checking
Account
CCNB - # 07 600 13052
$ 140.89
Personal
elongings
Clothes, shoes, etc.
200.00
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ALL OTHER ASSETS OWNED JOINTLY WITH InFE
AS TENANT BY THE ENTIRETIES
TOTAL
$ 340.89
.(.1,/-0. f1
I do hereby certify that the above assets were appraised in accordance with Pennsylvania law.
OFFICIAL
USE
ONLY
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APPRAISER
2-2 -
DATE
DATE
NAME OF PAYEE
MTURE OF CLAIM
AMOUNT CLAIMED
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Ewing Brothers Funeral Home
~ms1and Associates
Register of Wills
John F. Gory1, Esquire
Funeral expenses
Medical bills from last illness
Insolvent Inheritance tax retllrn
At torney fee
$ 2,383.00
1,157.00
3.00
70.00
TOTAL
$ 3,613.00
OFFICIAL
USE
ONLY
s .~fc,J.'1,1H
o ou c. TIONS ALLOWED
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REGI ER OF' WILL
ASSETS:
ItlSTRUCTIOtlS
"\
.
TYPE OF ASSET _Indicata whathar tha assat is real astale, personal property, transler or jointly.owned.
DESCRIPTIOtl _ List all a..ets owned solaly by tha decedent ar awned jaintly with another party or parties os tenonU !n
common or os joint tenants with .right 01 survivorship at the lima 01 death. Include tha dacedant's percentage 01 ownership,
Iha name (s) and relotian.hip to the decedent 01 tha surviving joint owners and the estimated market value 01 th~ decedent's
interest as 01 the date 01 death. Include intangible personal property titled in the noma 01 tha dacedant but payable at death
to another party or parlies including but not limited to P.O.D. U.S, Savings Bands and tentative tNSt accounts. Lisl any
property tronslerred by the decedent wilhin Iwo years 01 dealh lor which hn/she did not recaive valuable and adequate
consideration.
Describe all real estate loco led in Pennsylvania by la.t and block number, slreel oddre.., number 01 acres and include a
general description of the land ond buildings. Also, include the book and page number in which the deed is recorded and Ihe
O'l(oct title as indicated on the deed.
DEBTS & DEDUCTIOtlS _ Unsotislied Iiobililies incurred by the decedent prior to his/her death are deductible against
his/her taxable estate. In addition to debts incurred by the decedenl, ather items ore claimable including the casl 01
admini strotion, attorney lees, liduciary fees, luneral and burial expenses including the cast of 0 burial 101, tombstone or
glOve marker. List the date an which each debt waS incurred and/or paid and Ihe names 01 each payee. Provide a briel
explanation of the nature of each debt claimed and the amount being claimed,
Evidenco to support the decedent's or the estate's lial>i1ity lor the dobts being c10imed should be attached to this return
A lamily exemption may be claimed by a spouse 01 a decedent who died domiciled in Pennsylvania. If tlJere is no spouse,
or if the spouse has lorleiled his/her rights, then any child 01 the decedent who is a member 01 the same household can claim
the exemption. In the event there is no such spouse or child, the exemption can be claimed by a parenlal parents ';"ha '~r~ .
members 01 the same household as the decedent. .
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PLACE FOR FILltlG _ The relum is 10 be filed in duplicate wilh Ihe Register 01 Wills 01 the county wherein the decedent
resided.
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TIME FOR FILltlG _ The relurn is due nine months alter Ihe decodent's death, unless an extension for Iiling has been applied
tor and granted by the Secretary of Revenue within the nine-month period.
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INFORMATIOtl
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FAILURE TO FILE RETURN _ Section 79101 the 1961 Stalute provides thai" . . .any person who willfully lails to file a
return or ather report required 01 him shall be personally liable. . .10 a penally 01 25% allhe to. ultimgtely lound to be
due or SI,OOO whichever is the less to be recovered by the Department 01 Revenue as debts 01 like amount are recoverable
by 10":'_"
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NOTE: Fees paid 10 an estote represenlotive; nomely, an executor or administrator, lor services perlarmed in ad,
minislering an eslate Is reporloble lor Pennsylvanio Income Tax purposes, This toxable income item shoud be reported on
lorm PA.40.lndividuallncome Tax Return.
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INFORMATION
To insure proper credit to your account, tho nomo of tlm u$1010 and file number should bo clnarly print-
ed on the check Of money order.
This assessment is made in accordAnco with Section 708 of the Inheritance and Estate Tax Act of
1961 (72 P.S. ~ 2485.708).
To the 8xtent that inheritance ta)ll, is paid within three (3) months after the death of tho decedent. a
discount 01 live (51 percent is allowed (72 P.s. ~ 2485.7161.
Inheritance Tax. other than tall: on a future interest. is due at the dale 01 the decedent's death and becomes
delinquent al the expiration of nino 191 months after tho decedent's death (72 P.S. 9 2485.711). Inheritance
Tax on a futuro interest is payable within three (3) monthS after tile trnnsfcr takes effect in possession and
enjoyment and is delinquent thereafter t12 P.S. lj 2485.7121. Calculato interest from the delinquent data shown
on the face of this form to the date of actual payment using the following interest table:
--------------- ----- - - --------- -- - ---- - - ---- --- - - --- - --- -- ------ -- -- - - - -- --
1 month .005 4 months .020 7 months .035 '0 months .050
2 months .010 5 months .025 8 months .040 " months .055
3 months .015 6 months .030 9 mon1hs .045 12 months .060
1 days .00017 11 days .00186 2 I 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 18 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 representative, not satisfied with
the assessment may object thereto within siltt')' (601 days after receipt of 1his Notice DS provided by Section
1001 of the Inheritance and Estata Tax Act 011961 (72 P.S. Ii 2485.10011.
Make check or money order payable to:
"Register of Wills. Agent"
Mail to the address listed below: