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No. 21-80 7f~~?
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
Rayrrond B, Hobaugh, Jr., also knom as Raymmd B. Hobaugh,
In the Estate of and also kn= as R. B. Hobaugh ,deceased.
To Register of Wills for the County of Cumberland, In the Commonwealth of Pennsylvania.
Petltloner(s)Is ~ the execut rix named In the Last Will and Testament of
Raymmd B. Hobaugh, Jr. dated November 25, 1963
Decedent was a citizen of the United States and a resident of New CUnberland
~ (Borough), Cumberland County, Commonwealth of Pennsylvania,
Decedent died on ~bnday
the 1st
day of December
A,D. 19~, In the
County of Dauphin ,State of Pennsylv~t the age of &- years,
Decedent ~(has notl been married and illas((has not) had children born to him ~ since the ex-
ecution of the above described Will,
Decedent was possessed of personal property to the value of $10 ,000.00
and of real estate to the value of
none
as near as can be ascertained; said real estate situated as follows nl a
Therefore, your petitioner(s) respectfully apply(ies) for the probate of the said Last Will and Testa'
ment and for Letters Testamentary theron,
Dated Dec. ll, 1980
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,-,. ~- c Name and address
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Lo..__ ""c:: of Petitioner(s)
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Marv Jane Hobaugh
749 Carol Street
New Cumberland, PA 17070
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Mary Jane Hobaugh
t ss
j
named in above application, being duly sworn according to law say(s) that the
statements set forth in this petition are true to the best of her knowledge and belief.
~rn and subscribed before
( 6-/
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me Dec. 1 i-
'71
321d(j
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Filed:
Decenlber
18, 1980
Atlorney
Jon F. LaFaver
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LAST ;JILL ,UID TEST A;.lEl<T
OF
RAY,.\OIID B. HOBAUGil, JR.
I, RAY;'IOND B. HOBAUGH, JR. of the Borough of Ne.. Cumberland,
County of Cumberland and State of Petlllsylvani.a, being of sound mind, IIlemory
and understanding, do hereby ;nake, publish and declare this as and for my
Last \-1ill and Testalnent hereby revoking and making void any and all other
wills by me at any time heretofore made.
I direct that my Executrix hereinafter named shall pay all my
just debts and funeral e).,llenses as soon as conveniently may be done after
my decease.
All the rest, residue and remainder of my estate, whether real,
personal or mixed, and "rheresoever situate, I hereby give, devise and
bequeath unto my wife, }lary Jane Hobaugh, if she survives me by a period of
thirty (30) days. If my said ~rife does not survive me by a period of
thirty (30) days, then this gift to her shall be divested, and I then give,
devise and bequeath my entire estate unto my children, in equal shares.
I hereby nominate, constitute and appoint Mr. and :4rs. Harry J.
Dec.<man, Jr. as Guardian of the persons of my minor children if my wife,
Mary Jane Hobaugh, should predecease me.
I hereby nominate, constitute and appoint Cumberland County
National Bank and Trust Company as Guardian of the estates of any minors
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who may take a share under this ,Iill.
I hereby nominate, constitute and appoint my ~rife, Mary Jane
Hobaugh, as Executrix of this my Last Hill and Testa.'1lent. If the said,
Mary Jane Hobaugh, should predecease me, or othenlise fail to qualify, then
I nominate, constitute and appoint Cumberland County National Ban": and
Trust Company as Executor.
IN ,oJITNESS .,IHEREOF, I, Raymond B. Hobaugh, Jr., the Testator
I
have unto this, my Last Hill and Testa.'1lent, set my hand and seal this ;;5~
day of November, A. D., 1963.
LAWOf'l"lclCe
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) J/;-//M/<J/> //~Lfi&-/
JON ,.. LA...AVIER
.'0 T...lftD eTftCET
, HCW CUMIIEI'U",AND, PO"".
Page one of two Pages
1.AWO....IC...
.JON pr. LArrAYll:R
S'OTHlftCJ .TRen
. NEW CUM_lunAND. ....
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SIGNED, SEALED, ?UBLISlBD and DECL.\R8D by Raymond B. Hob'lIIr,h, JI'"
the above nalned Testator as and for his Last H1.11 and Teotrunont in tho
presence of USI who have hereunto subscribed our nxncs an .,tl.t.ntJ:luoo at. hiu
request, in the presence of the said Testator and
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OATH m' SUBSCRIIIING WITNESS
COMMONWEALTH OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND
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I
11th December BO
This day of A.D,,19
before me, Register for the Probate of Wills and granting letters of Adminislration in and for said County of Cumberland, in
the Commonwealth of Pennsylvania, personally came
Jon F. LaFaver and George Kohler
the subscribing witnesses to the foregoing instrument of IVritiTlll.pu!'porting 10 be IhL last Will and Testament of
Raynond B. Hobaugh, Jr., also knom as Rayrrond B. Hobaugh,
and also known as R. B. Hobaugh Dated Noverrber 25, 1963
late of New Cunberland Borough.
Cumberland County Pa., deceased who being duly
=rn according to law, depose and say, that
they were
present, and saw and heard the test" tor
Raynond B. Hobaugh, Jr.
sign, seal, publish. pronounce and declare tbe said
Testament and Last Will, and at the time of so doing he
instrument of writing as and for h is
was of sound and disposing mind memory and understanding, to the best of
knowledge, observation and belief.
their
SIDrn
and subscribed before
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Register
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u:orge, ler I - v
AFFIDAVIT OF IlEATH
COMMONWEALTH OF PENNSYLVANIA t ss:
COUNTY OF CUMBERLAND \
Mary Jane Hobaugh
being duly
=rn
says that as nearly as can be ascertainerlthe said decedent
Rayrrond B. Hobaugh, Jr.
died on
M:mdav tbe 1st day of
at or about 8:00 o'clock, P. M.
SIDrn and subscribed tbis
11th day of December
December
A.D,,1980 ,
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Register
OATH OF PERSONAL Rt;PRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ss:
COUNTY OF CUMBERLAND
Before me, the Regisler for the Probate of Wills and granting of Letters of Administration in and for the County of
Cumberland, personally came
Mary Jane Hobaugh
who, being duly smm
,do es
depose and say that as
Executrix
of the last Will and Testament of
Raym:md B. Hobaug):l, Jr.
deceased
she will well and truly administer the goods and chattels. rights and credits of said deceased according to law. And
also will diligently comply with the provisions of the law relating to Transfer Inheritane~s. Swom and subscribed before me.
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Dec. 11
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DECREE
Be it remembered that on the
lOth
December 80
day of ,A,D..19_, there was probated and
ReYlTlond E. Bolbaugh. Jr.~ a/k/a Raymond B.
lIolJaugh. a/k a R. B. Honaugh late of
~ew Cumberland
,Cumberland County, Pennsylvania,
recorded the last Will and Testament of
Deceased. Letters Tes tamen tary were granted to
Witness my hand and official seal the day and year aforesaid,
~'ary Jane Hobaugh
6.09.
~!~,~ (2, ~~
~ Regilol4r ..
R-EV-449 EXi (3.80)
COM"'ONWEA~ TN OF PENNSY~VANIA
DEPARTMENT DF REVENUE
TRANSFER INHERtTAHCE TAX
RESIDENT DECEDEHT
*'
AFFIDAVIT OF
FIDUCIARY
(Instructions on R.y.... Sid.)
Raynmd B. Hobaugh, Jr., a/k/a Raynond B.
Estate of HobaURh, a/k/a R. B. Hobaugh
Lost AddressJA9_CaroLStreet___
Dote of Death
December 1, 1980
Social Security Ho. 576-24-9014
-.NeILCunberland.....PA
(CIT't) (STAdEl
lZ07.(L_
Bureau Fil e Ho.
(ZIP)
County File Ho. 21-80-782
J. Decedent died:
( ) Intestote (without 0 will)
(X) Testate (Ieoving 0 lost will--copy attached)
2. Is the filing of a Federol Estate Tax Return required for this estate? Yes_ Ho X
3. l X) ~Executrix
) Administrator! Administrotrix
Home J19ry. JRJ1e Hnh'l11gh
Address 749 Carol Street
~land, PA
(CITY) (STATE)
17070
(ZIP)
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4. All correspondence should be moiled to (X ) Attorney
) Fiduciary.
S. If on al!omey is representing the estate, indicate,
Home Jon F. LaFaver
Address 317 'Third Street
New Cunberland, PA
17070
ICITY)
(STATE)
(ZIP)
List 011 safe deposit boxes registered in the decedent's individual namehor jointly with, or os on agent or deputy
of another, or in decedent's indiyiduol nome with right of access by anot er os agent or deputy. Include the nome
and oddress of the bonk or other institution where the safe deposit box is locoted, the nome (s) in which the box
is registered and the relationship of the joint holders to the decedent.
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DEcEaENT MA'NTAINED A SAFE DEPOSIT BOX
NAME OR NAMES 'H WHtCH
SAFE DEPOSIT BOX t5 REGISTERED
RE~ATIIlNSHIP OF JOINT
HOLDERS TO DECEDENT
Under penalties of perjury, I declare that I haye examined this return, including accompanying schedules and
statements, Gnd to the best of my knowledge and belief it is true, correct and complete.
DATE
PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of 1961 provides thi1t the following persons shall prepi1re and file
a return:
a. The personal representative of the estate of Ihe decedent as 10 11Iopcrly 01 the decedent mlminislered by him
and such additional properly which is or may be subject to InhUlitancc Ti1X of which he/she sl1<l11 hi1ve or
acquire knowledge;
b. The transferee of property upon the transfer of which Inheriti1nce Tax is 01 Ilwy be imposed by the 1961 Statute,
including a trustee of property transferred in trust, provided that no SCpi1fi1te return need be made by the transferee
of property included in the retulll of a personal representi1tive.
2. PLACE FOR FILING
The return is to be filed in duplicate with the Register of Wills of lhe coullty wherein the decedent resided.
3. TIME FOR FILING
The return is due nine months 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. FAILURE. TO 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 ultimately found to be due or $1,000
whichever is the lesser te be recovered by the Department of Revenue as debts of like amount are recoverable by
law."
5. TAX RATES
Inheritance Tax is payable at the rate of 6% on transfers to lineal descendanls, 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 months after the decedent's death. Interest
at the 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 the Register of Wills of the county wherein the decedent resided and are
received subject to the final determination of the Department of Revenue,
7. FAILURE TO PAY
The taxes imposed, logether with any inlerest thereon, are a lien upon real property, which lien remains in effect until
the taxes and interest have been paid in full. The taxes may be sued fer 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 reporl required of him shall, in accordance with Sectien 793 of the
1961 Statute, be guilty of a misdemeanor and, on conviction thereof, shall be sentenced to pay a fine not exceeding
$1,000 or undergo imprisonment not exceeding one year or both.
REVH\51 (1080)
COMMONWEALTH OF PENNSVLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*'
(llIstruer;ons on Reverse Sidel
Estate of Ravmmd B. Hobaugh. Jr.
ESTIMATED DEPARTMENT
ITEM DESCRIPTION UNIT MARKET VALUATION
NO. VALUE VALUE (OFFICIAL USE DNL YI
1. 1977 01dstrobile Sedan autambile 2,500.00
2. 1971 01dstrobile Station Wagon autOllObile 300.00
3. 1972 Ford Truck 600.00
4. 1974 Chevrolet Truck 1,000.00
5. 1967 Chevrolet TRuck 200.00
6. 1967 Chevrolet Truck (!.aOOPT Truck) 1,200.00
7. 1973 Ford Truck 800.00
8. 1978 Chevrolet Van 3,000.00
9. 1972 Chevrolet Van 600.00
10. 1967 Chevrolet Pickup Truck 300.00
11. 1976 Yamaha l-btorcyc1e 300.00
12. 1975 yamaha l-btorcycle 300.00
13. 1947 'Whizzer Bike 200.00
,
TOTAL THIS PAGE /1. ,J"~ ~'-O II. J /"11. ~
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INSTRUCTIONS FOR COMPLETING SCHEDULE "6"
Schedule "B" 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 Bonds and Tentative Trust Accounts, must be listed on
Schedule "B".
Tangible personal property should be listed first. Examples of tangible
personal property are jewelry. wearing apparel, household 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 "B".
A completed Partnership Interest Report (REV-894) 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 closely-held business
interest or sole proprietorship reported on Schedule "B".
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years 01 death, make any transfer of any material part of his estate wilhout rp.ceiving
valuable and adequate consideration? (Answer "Yes" or "No".}-$S-
2. Did decedent, within two years of death, transfer property Irom himsell/ hersellto himself/herself 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 the transfers are claimed to be nontaxable, provide the lollowing
information: n/a
a. Age of decedent at time of transfer.
b. Copy of death certificate.
I c. Affidavit by the allending physician indicating the state of decedent's health at time of transfer.
d. All other information supporting nontaxability of transfer.
I
I' .. 4. Did decedent, in his!hef lifetime, make any transfer 01 property wilhout 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
I
: 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? nta
5. Did decedent in his/her lifetime make any transfer without receiving a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves lor 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. nta
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 bffieficial 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".) no
nEV.453 (l.SO)
COMMONWEALTH OF PENNSYLVAN'A
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESt DENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
*'
(Instructions on Reverse Side)
Estate of Raym:md B. Hobaugh. Jr.
BErlEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY
DECEDENT BIRTH
Mary Jane Hob"'lgh Wife Yes Adult Entire Estate
7!J.Q ,.~-,
New Cumberland. PA 17070
The above beneficiaries are living at this time except for tbe following:
NAME
DATE OF DEATH
INSTRUCTIONS FOR SHCEDULE "0"
1. List full names and addresses of all who have an interest in the estate
either vested. contingent or other interest,
2. Indicate the beneficiary's relationship to the decedent, Specify if
stepchildren or illegitimate children are involved,
3, Indicate "Yes" or "No" if the beneficiary survived the decedent.
4. Indicate the date of birth of the beneficiary if the interest is a life
interest, term certain interest or a future interest,
5, Indicate the interest of the beneficiary in the decedent's estate.
For example: Specific bequests of a diamond ring, savings bonds
or cash of $5,000; bequest of 25% of residue; remainder interest; etc.
(3, At the bottom of Schedule "D" state those beneficiaries who are not
living at the time the return is being filed and include date of death.
REV04!S4 EX. (3.BO) '*
COMMONWEALTH OF PENNSYLVANIA SCHEDULE "E"
DEPARTMENT OF REVENUE
TRANSFER tNHERITANCE TAX JOINTLY OWNED PROPERTY
REStOENT DECEDENT
{Instructions on Reverse Side}
Estate of Ravrrond B. Hobaugh. Jr.
TOTAL PE VALUE OF DEPARTMENT
ITEM DESCRtPTION MARKET \ DECEDENT'S VALUATION
NO. VALUE tNTEREST (0 fflcial Use Only)
T
IDNE 0
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TOTAL THIS PAGE 0 .~---t...
-41.3
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, Soth tangible and intangible property are to be
included, List real 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 "S", Include the name, address and relationship 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.
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REV.51B Fa t7-801
.
COMMONWEALTH OF PENNSVLVANIA
CEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
NOTICE OF FILING OF APPRAISEMENT
Ms. Mary Jane Hobaugh
749 Carol Street
New Cumberland, PA 17070
RE:
Estate of
County of
File No.
Raymond B. Hobaugh,
Cumberland
21-80-0782
Jr.
Dear Ms. Hobaugh:
You are hereby notified that the original
appraisement in the estate of Ravrnond B. Hobaugh, Jr.
has been filed in the office of the Register of Wills of rnmnp,.,1 ~nil
County an September 25 , 19 81. Said appraisement reflects the fallowing valuations:
Real Estate
Personal Property
Jointly Owned
Transfers
Total
NONE
S 11 ,~nn_no
NONE
37,900.00
$ 49,200.00
As to such tax that is paid within three months from date of death, a five (5%) percent
discount is allowable. As to any tax that remains unpaid after nine (9) months (fifteen months
when death occurred from December 22, 1965 to June 16, 1971, inclusive; and twelve months when
death occurred prior to December 22, 1965) from date of death, interest at the rote of six (6%) percent
per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within sixty days
after receipt of said notice as provided by Section 1001 of the Inheritance and Estote Tax Act of
1961,72 P.S. 2485-1001, P.L. 373.
Date
September 25, 1981
4J.u4-
Chief Appraiser
Si gned
Title
NOTE: This is not a bill.
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REV..... EX+ (HO'
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
21-80-0782
File Number
Estate Name
Raymond B. Hohaugh, Jr.
December 1, 1980
Date 01 Death
576-24-9014
Social Security Number
REPORT OF INHERITANCE TAX APPRAISER
Q Original
o Supplemental
o Remoinder
I, the und.rllgn.d duly appointed Inheritance Tax Apprahor In and Iar the County 01 Cumberland
Pennlylvanla, do relpectlully report that lltave appralled the real and perlonal proporty as reported In the loregolng
rehlm at the valulI sot forth oppollfo each Item In thltlast column to tho right In Scho ItS "A", "B", "C", and "E"
il
September 25, 1981
Datltd: ~
INHE ANeE TAX APPR R
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VALUE AS APPRAISED
ADJUSTMENTS
(HARRISBU RG USE ONLY)
INVENTORY
Root Properly (Schodulo A) . S
NONE 00+
11,300 00 10+
NONE 20+
37,900 00 30+
49,200 00
40-
Personal Property (Schedule B)
Jotnl.Hold Pr.porty (Sch.dulo E)
Tronllo.. (Schodulo C)
TOTAL GROSS ASSETS
Le.. Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
OLlie Estate
o Annuity
~
FACTOR
PRtNCIPLE
CODE
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
6%
15%
Tax on $
Tux on $
Tax on $
Exemptions
Total Estate
TOTAl. TAX
INTEREST FROM
BALANCE
TO
LeIS Credits
DATE OF PAYMENT
AMOUNT PAtD
S
tNTEREST FROM
BALANCE DUE
REMAINDER APPRAISEMENT
CODE
92+
93-
VALUE
CODE
COMPUTATION OF TAX
$
$
$
$
$
S
$
$
TAX CREDIT
S
REV.455 (1.SD)
COMMONWEAL!H OF PENNSYLVANIA
DE1>ARTMENT OF REVENUE
TRANSFER tNHERITANCE TAX
REStDENT OECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
*
Raymmo B. Hobaugh, Jr., a/kraR.3.~ B:--- --,- ,-----.
Estate of I-ln"""gh, ,,/k/f'l R R Hnhsl"gh Date of Death Decanber 1. 1980
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
File No, 21-80-782
Claimant M3rv Jane Hobaugh Relationship to Decedent Surviving SpOUSe
Claimant's Address 749 Carol Street, New Cunber1and, PA 17070
ITEM DATE NAME OF PAYEE REMARKS AMOUNT
NO.
'bry Jane Hobaugh "'ami1y Exemption 2,000.00
~Q:ister of Wills jetters & Certificates 38.00
CCNB Bank, N. A. !2 of balance due on m::>rtgage 21,958.01
'ea1er' s Flower Shop ~era1 Flowers 64.66
-bsselman Funeral Hane f\mera1 Expenses 2,722.90
IDlling Green Cemetery Jigging Grave, Markers and Lot 2,125.00
iInterna1 Revenue Service L980 Incooe Tax 8,330.16
DA Deot. of Revenue ...980 Incare Tax 454.81
"est Shore Tax Bureau 1980 Tax 194.95
~gister of Wills ~ling Fees 8.00
Ton F. Waver Legal Fees 2,460.00
Recorder of Deeds Wiling Release 25.00
....;) ::~i"f.fo7
TOTAL THIS PAGE I 40,381.49
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral
expenses and expenses of administration submitted to the estate a deductions for Inheritance Tax purposes,
; , ~ -&. tJ-<~eJ Sf
SIGNA un OF ATTORNEV/FIDUCIA V DATE
OFFICIAL US
ONLY
:( {I'
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'.. .
AT
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PERCENT,
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S . J (.
/J-c1/-P
DATE
GENERAL INHERITANCE TAX INFORMATION
..
Unsatisfied liabilities incuned 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,
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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 for paying the debts,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
'*'
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
DATE \. ~c..J!'"" ,/-0 3. /9 C (
ESTATE - Ri.\1l -r... ,'"' I B -q~J'n" , ~/ ~,
~ . A ~ ~-r.
FILE NO. 0{ I. f'd ,'7 Voi
COUNTY C.J-Yo1 (~/' / /. _, a
DATE OF DEATH ~~( _ I J q 7'6
Appraised Value of Estate:
Real Estate
$
---
Personal Property
+ J I .'::\ ()d () 0
,
+ ,3') 9d 0 o(J
$ 4ft fJu(J 00
,
- 110 3 1{ I. fl.?
$ Y,f:I'K5'1
.
Jointly Held PropenylTransfers
Total Gross Estate
Total Approved Deductions
Clear Value of Estate
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
5(::01(
c./
,~
$
Amount Ta,able @ 6% Rate
$ ?~ 'if / K-, )1
tax due
$
5" ;)9 /1
Amount Ta,able @ 15% Rate
tax due
lO-,1
. TOTAL PENt'!5YLVANIA INHERI,ANCE TAX DUE )$
"/ -'-,0 '/.d IJ. _.:7 . f:-( J (.OIS:3'/
$
* * . * . * A five percent discount totalinn
will be grantad if the Inheritance Tax is paid by
S:i7.0?3
less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
$ S..3 7, <\=,
/d),-3-g'-/
$ S~'1.11
$ i(. , d
+
$
=
+
=
+
=
Interest Dccrues at the rate of six (6) percent per
on the unpaid balance of Inheritance Tax from
to date of payment. Inlerest due if paid by
annum
'71 \; I H
$ ~fd.::h'1).k~l
\"
Assessed by, . n C -:./ )
See Information on Reverse SIde ....--, AQmtforthllC mmonwnUh
\ l"l
'< J -(~r.\\.f\ -'c
:'~l~L ill', ,-,I ..Il~~
is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
"- --- -'- --- ---"- . -.- .- -- ---
INFORMATION
To insure propor credit to your account, lho nnmo at Iho estate and fila number should be cloarlv print.
ad on the check or money order.
This assessment is made in accordance with Section 708 of tho Inheritance end Estate Tall Act of
1961 (72 P.S, ~ 2465,706).
To the extent that inheritance tax is paid within throe (3) months after the death 01 the decedent. a
discount of five (5) percent is allowed (72 P,S. \ 2465,7161.
Inheritance Tax. other than tax on a future interest, is due at the date of the decedent'S death and becomes
delinquent at the expiration of nine (9) months after the decedent's death (72 P.S. S 2485.7111. Inheritance
Tax on B future interest is payable within three (3) months after the translcr takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. ~ 2485.712). Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using tho following interest table:
------------ --------- ---------- -- - ---- - ----- --- - - --- - --- -------- --- - -- - -- --
1 month .005 4 months .020 7 months .035 10 months .050
2 months .010 5 months .025 8 months .040 11 months .055
3 monthS ,015 6 months ,030 9 months .045 12 months .060
1 days ,00017 1 I days ,OOt65 2 I days .00352
2 days ,00034 12 days .00203 22 days ,00369
3 days .00051 13 days .00220 23 days ,00366
4 days .00066 14 days .00237 24 days .00403
5 days .00065 15 days .00250 25 days ,00420
6 days .00101 16 days .00267 26 days ,00437
7 days .0el11 6 17 days .00264 27 days ,00454
6 days .00135 I 6 doys ,00301 26 days ,00471
9 days ,00152 19 days .00316 29 days .00466
10 days .00169 20 days .00335 30 days ,00500
-------------- ------- --- - -- - ----- -- -- - --- -- - --- -- --- - - ---------- ----..-
Any party in inlerest. including the Commonwealth ilnd the personal representative, 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 19G1 172 P.S. \ 2465,1001).
Make check or money order payable to;
"Register of Wills, Agent"
Mail to the address listed below:
! ..._...... __ ~ ~ _~ ~ - - ~ - ~ - .. _A _
1 II':AEV.'112U:-<- ,~~:-;- .' ,- '-, ~", - - -, - - .
f~>~;"<,,:: .. ..... . . C()MMONWEALTH OF PENNSYLVANIA .
; 4 NOl(> 69850. .' .. . .. DEPARTMENT OF REVENUE. .
;\'.' .... ... '.. . . OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
! If'
--
.
If
II
=
If
~
~ RECEIVED M8ry Jane Hobaugh
Jj FROM .
...........'...'...'......
,':;'-",' ",:;\:;';
. ;',1:";';
" '..-'....
, ....
TAX AT 6%
TAX AT 15%
TAXAT_%
ADDRESS
.-,,\
...
'--EsTATEmFORMAT~N:--------------------------
DA TE OF DEATH
ESTATE TAX
TOTAL TAX CREDIT
9529.11
FILE NUMBER
DATEOFPAYMENT
m
om
LESS DISCOUNT
PLUS % It>OTEREST
IFROM9-1-81 TO 12-'-8] e, n
(.01534)
TOTAL AMOUNT PAID ...17 ~n
NAMEOFOECEDENT
COUNTY
------------------- ----------- -- -- -----
POSTMARK DATE
. REMARKS.
~
SEAL PAID IN FULL
RECEIVED BY
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SIGNATURY v _JI
REGISTER OF WILLS
------- --- --- -------------------.-