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MART&ON a SNELDAKER
ATTORNevS AT LAW
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LAS.T WIl.L AND 'l'ES'l'l\~lr~N'r
I, JACOB BOOKS, ,JR., of the 'l'ownship oj' Monroe, (;oull':yof
Cumberland and COnlltlOllWCill th of punnsyl vtll\ia I bei!'Jg oL sound
and dispos i.ng mind, mcr,lOry and undcrsl:all<li.ng, do m<lke, publish
i'lnd declare this as and for my l,ast \-li11. and 'l'"stament, hereby
revuJd.ny ami making 'laid all fOJ:r,.er Hi lls '1n<1 co,llcih; by m,e
'J t. "ny time hel,e tofore :,Vtde.
f!JlS'l'. larder and direct that all my just debts and
funeral expense!! be paid by my EX2.cutri.:< or Executor, as the
case :.l<'IY be, hereinafter named, as soon as conven:LElntly may be
done 3 iter my decease.
SECOND. I :Jive, d€.'li,;c and bequeath 'all the rest, resid1.1e
arJ,d r:emainder .of my Estate, r.eal, personal and :nixed, whatsoever
and wheresoever situated. unto my wife, ELLEN M. BOOKS,
absi':llu tely and in fee r:irnpl~, if 3he .31.1rvives lne.
THIRD. If my wife, ELI,EN M. BOOKS, does not survive Ole,
"
then and in that €.vent, I give, de\-ise and bequeath my' said
entire estate unto my :;on, JACK R. BOOKS, absolutely and in
fee simple.
Should my said son predecease me, I order ar~d direct
that the lawful issue of my sai.d son shall be substi,tuted herein
for hi.m, they to receive the distribut,ion hereunder which my
said son would have received had he survived me, per stirpes
by representation and not per capi.ta.
FOURTH. I nc,minate, constitute and appoint THE HARRISBURG
NATIONl\L BANK AND TRUST COMPANY to be' t1:le Guardian of any property
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MART60N a: SNELDAKER
ATTORNEYS AT LAW
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which passes, either under this, 'l1y Lilst will ilnd Testament, or
otherwise, to a minor an<1 witll )"espect to whicl1 I am authorized
to appoint a ';]u<1rdi'\l1 and ll<lve not otherwise speci.fically done so.
[,ASTI,Y. I nominate, constitute and a!Jpoint my wife, ET,LEN
N. nOOKS, to be the Executrix of this, my Last Will and 'I'estament,
but if for any reason she should not quali fy as such E:~ecutrix
or. cease so to serve, then I nominate, constitute and appoint my
son, JACK R. BOOKS, to be the sole Executor hereof; but, if,
however, for any reason neither my said ,~ife nor son should
qualify as my i?Grsonal representative her.eunder, then and in that
event, I nominate, constitute and appoint THE HARRISBURG NATIONAL
BANK AND TRUST CmlPANY to be the Executor hereof. I t is my will
and direction that none of the foregoing named be required to
post bond or other security as a condition of qualification as
Executrix or Executor., as the case may be.
IN WITNESS WHEREOF, I, JACOB BOOKS, JR., have hereunto set
my hand and seal to this, my Last will and Testament ",hich con-
sists of two (2) typewritten pages to each of Which I have
affixeel my signature this",;t 7 i~
day of July, A. D., One
'l'housanel Nine Hundred Sixty-eight (1968).
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(SEAL)
The preceding instrument, consisting of this and one (1)
other type",ritten page, each identified by the sign<lt1.1re of the
Tc.stator, was on the date thereof signed, sealed, published
and declared by JACOB BOOKS, JR., the Testator therein named,
as and for his Last will and Testament, in the presence of us,
who, at .his request, in his presence, and in the presence of
each other, have subscribed our name.s aG- witnes.ses hereto.
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OATH OF PERSONAL REPRESt:NTATlVE
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
Jack R. Pooks
Cumberland, personally camc
who, being duly sworn
des
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depose and say that as
Jacob Books, Jr.
Executor
deceased
of the last Will and Testament of
~ he 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 Inheritances. sworI1gnd subscribed before me.
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Dec. 23,
80
A.D.. 19_
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DECREE
Be it remembered that on the
30th
day of
December
80
,A,D..19_. there was probated and
recorded the last Will and Test'lment of
Jacob Books, Jr.
late of
Honroe Township
. Cumberland County, Pennsylvania.
Jack R. Books
Deceased. Letters T es tamentary were granted to
Witness my hand and official seal the day and year aforesaid.
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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----- ------.--..-. ----. ---- ----- -.-.- - -~ ------- .-.----
Jack R. Books
being duly sworn .. _.._____ according to law, deposes and says that he __i.s
Executor n______,___..._'__ of the Estate of Jacob Books, Jr.
late of R nil? Rn;' ; ng Spri ng". , Cumborland County, Pa., decoased and that the
within is an inventory mado by ___JacJs.. 8..._.B9.oJ<S -..- --.--, tho said-IDle.Qil:..Q):'
of tho ontiro ostato of said decode nt, consisting of all the porsonal proporly and roal estato, except real estate outside
the Commonwoalth of Pennsylvania, and that the figures opposito each itom of the Inventory roprosent it's fair value
es of tho dato of docodent's death.
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and subscribod bolo,o me, \
/ 19 81
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Ex.~utot . ~trrio'
January 14
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Addr.,
Dale of Death _..2.'~tL,____,
Day
June
Month
1980
Yur
INSTRUCTIONS
I. An inventory must be filed wilhin three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional a..ets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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Invontory of the rool ond po..ono! ostoto of
Jacob Books , Jr.
decoasod.
1
Account No. 00l-00-00457
State Capital Savings
& Loan Ass.
1,803 24
2
Checking Account No. llO-637-6
First Bank & Trust Co. Mechanicsburg,
(Ellen M. Books, wife pre-deceased)
103 83
Property jointly owned with son:
3
Two (2) tracts of land with improvements
situate in Monroe Township, Cumberland
County, Pennsylvania by Deed dated July
10, 1974 and recorded in Deed Book 25,
Page 837, Harold S. Irwin and Dorothy B.
Irwin to Jaob Books, Jr. and Jack Ralph
Books as joint tenancy with right of
survivorship $60,000.00
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30,000\ 00
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4
224 Shares of AT&T Common stock, Certificate
No. 06248066 registered in names of Jacob
Books, Jr. and Jack Ralph Books, Joint Tenants
$11,885.89
5,942 94
318 27
5
12 Shares $636.74
6
AT&T _ Thirty (30) year 8 3/4% Debenture due
May 15, 2000 No. 82181415 $88.12
TOTAL
$38,212 34
44 06
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PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of 1961 provides that the following persons shall prepare and file
a return:
a, The personal representative of the estate of the decedent as to property of the decedent administered by him
and such additional property which is or may be subject to Inheritance Tax of which he/she shall have or
acquire knowledge;
b. The transferee of property upon the transfer of which Inheritance Tax is or may be imposed by the 1961 Statute,
including a trustee of property transferred in trust, provided that no separate return need be made by the transferee
of property included in the return of a personal representative.
..
2. PLACE FOR FILING
The return is to be filed in duplicate with the Register of Wills of the county wherein the decedent resided.
3, TIME FOR FILING
The return is due nine months after the decedent's death, unless an extension for fil ing has been applied for and
granted by the Secretary of Revenue within tile 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 to be recovered by the Department of Revenue as debts of I ike amount are recoverable by
law."
5. TAX RATES
Inheritance Tax is payable at the rate of 6%on transfers to lineal descendants, such as father, mother, husband, wile,
son, daughter, grandchildren, grandparent, son-in.law and daughter-in.law and at the rate of 15% as to all others.
6. PAYMENT 0 F 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, I F TAX IS PAl D 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 tile Register of Wills of the county wherein the decedent resided and are
received subject to the final determination ollhe Department of Revenu:!.
7. FAILURE TO PAY
The taxes imposed, together with any interest 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 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 witlfully 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 thereof, shall be sentenced to pay a fine not exceeding
$1,000 or undergo imprisonment not exceeding one year or bOU1.
REV"4~O ,t-eo,
COMMONWEAL TH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
ESTATE OF ->LQ._C_Q.J:LBo9ks, Jr..
ITEM
NO.
NONE
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SCHEDULE "A"
REAL PROPERTY
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(Instructions on Reverse Side)
DESCRIPTION
ESTIMA TED
MARKET
VALUE
DEPARTMENT
VALUATION
(OFFICIAL USE
ONLY
TOTAL THIS PAGE
REV.4s1 (i.so) .
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
'*'
SCHEDULE "B"
PERSONAL PROPERTY
(Instructions on Reverse Side)
Estate of ,T<l"",h RI'lok!'l, Jr.
ESTIMATED DEPARTMENT
ITEM DESCRIPTION UNIT MARKET VALUATION
NO. VALUE VALUE (OFFICIAL USE ONL Y!
1 Account No. 001-00-00457
state Capital Savings
& Loan Ass. $1,803.24
2 Checking Account No. 110-637-6
First Bank & Trust Co. Mechanicsburg
(Ellen M. Books, wife pre-deceased) 103.83
TOTAL THIS PAGE $1,907.07 \ C{ G-l, C 1
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INSTRUCTIONS FOR COMPLETING SCHEDULE "B"
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
iisted 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".
REY..~Z (I'"eol
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
ESTATE OF _ Jacob Books , Jr.
SCHEDULE "C"
TRANSFERS
.
INSTRUCTIONS:
1. Answer the questions on reverse side.
2. If the answer to any of the questions on the reverse side is "Yes," provide a description of the property transferred per
Schedules "A," "B," or "E," its estimated market value at date of death, dates of transfer, to whom transferred and
relationship of transferees to decedent. Attach a copy of any trust deed or instrument relating to the transferred properly.
ITEM
NO.
ESTIMATED DEPT. VALUATION
MARKET V ALUE (OFFICIAL USE ONL YJ
DESCRIPTION
NONE
..
TOTAL THIS PAGE -0-
1. Did decedent, within two years of death, make any transfer of any material part of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No".) ~n
2. Did decedent, within two years of death, transfer property from himselflll6l-S4JUto himself/-lle!$IlIt.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 following
information:
a. Age of decedent at time of transfer.
b. Copy of death certificate.
c. Affidavit by the aUending physician indicating the state of decedent's health at time of transfer.
d. All other information supporting nontaxabili ty of transfer.
4. Did decedent, in hisJRir lifetime, make any transfer of properly without receiving a valuable or adequate consideration
therefor which was to take effect in possession or enjoyment at or after his/R.ei death? (Answer "Yes" or "No".) No
a. Was there any possibility that the properly transferred might return to transferor or his/her estate or be subject
to his/Ilel-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 adequate consideration therefor
under which transferor expressly or impliedly reserves for his/ll8f life or any period which does in fact end before his/heL.
death:
a. The possession or enjoyment of or the right to income from the properly transferred? (Answer "Yes" or "No".) Nn
b. The right to designate the persons who shall possess or enjoy the properly transferred or income therefrom?
(Answer "Yes" or "No".) No
6. If the answer to five b. above is "Yes," state whether the right was reserved in decedent alone or others.
QUESTIONS CONCERNING PROPERTY TRANSFERS
7. Did decedent in his/ll6llifetime 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".) iIln
8. Did decedent, at any time, transfer property, the bffieficial enjoyment ofl'ffiich 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" ,)
REV'-453 u.ao)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "0"
BENEFICIARIES
*
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(Instructions on ReVIJrSe Side)
Estate of Jacob Books, Jr.
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY
DECEDENT BIRTH
Ellen M. Bnoks wife No
T~~'" D o.,.,,.,k,,,
R. D. #2, Boilina Sprq.
PA 17007 son Yes bl-24-47 Entire residue
--
---"- ----- ------------
The above beneficiaries are living at this time except for the following:
DATE OF DEATH
NAME
Ellen M. Books
. .' .-
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include a\l 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. List real estate first.
1. Describe all real property as indicated in the instructions for SC'ledule "A", Describe all personal propertY
as indicated in the instructions for Schedule "B", I nclude 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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REV0457 (1.1S0)
COMMONWEALTH OF PENNSVLVANIA
. DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
INHERITANCE TAX
APPRAISEMENT
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Estate of
Jacob Books, Jr.
File No.
21-80-080?
County
Cumberland
Date of Death
June 9, 1980
In the event that any uture Interest In thls.statels transferred In possession or enloyment to collJtoml heirs 0 the ecedont a tllr t ,e 8lCp'rat'on 0& any
estate for Iif. or for years, the Commonw831th hereby 8xpressly rM8r\/8S tho right to appraise and auoss transfer InherItance taxes at the lawful coUater.' rat..
on any lOch futur.lnterelt.
PROPERTY REPORTED BY THE ESTATE
DEPARTMENT'S
APPRAISED VALUE
1. TOTAL REAL PROPERTY - SCHEDULE "A" . .
2. TOTAL PERSONAL PROPERTY - SCHEDULE "B"
3, TOTAL TRANSFERS - SCHEDULE "C" . . . .
4. TOTAL JOINTL V OWNED PROPERTY - SCHEDULE "E"
none
$ 1,907.07
none
TOTAL REPORTED PROPERTY
$38,431.12
$38,431.12
PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH
TOTAL UNREPORTED PROPERTY
none
TOTAL GROSS ASSETS
$38,431.12
LIFE ESTATE OR ANNUITY CALCULATION
I do hereby certify that the above appraisement is made in conformity with Pennsylvania law and has been filed this day
with the Register of WHls.
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APPRAISER
March 27, 1981
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~"I~~i(~;Nii:>..;'d'; , ,',COMMONWEALTH OFPENNSVLVANIA' '
'''''''''''K "'''' ,. ",', "':, ',' , " DEPARTMENTDF REVENUE '
: 4 ~~~y QQQ4.43:6":FICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
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TAX AT 6%
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TAX AT 15%
ADDRESS
ESTATETAX
Esq.
TAXAT_%
TOTAL TAX CREDIT
1,000.00
'--eSTATeINFORMATic;N';'Jim;-,---i980-
DATE OF DEATH '
21-80-802
FILE NUMBER
Januaxy 27, 1981
DATE OF PAYMENT
NAMEDFDECEDENT JACOB !!OOI<S, Jr.
COUNTY CUIllberland
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LESS DISCOUNT
PLUS % INTEREST
(FROM TO_I
j
TOTAL AMOUNT PAID
I
1.0001,00
ODSTMARK DA TF.
.."MARKS: "PAID Olll' ACCOUIi1'1'''
SEAL
RECEIVED BY
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/ I I ' ( ,/.j L: ,/ J-;wl,.-,(.:L/
! ~.~"OUII; a
I Reqlater of WiDl
I
REGISTER OF WILLS
.-_.... -- -~ -- -~ ~ -- ~ -.
!. ~~#~;iKci6537 " ,,',' ',' ,COMMON=~A~~J~TO; :E~~~:VLVANIA '
i ~'.. , '.' ,.,' OFFICIAL RECEIPT' PENNSYLVANIA INHERITANCE AND ESTATE TAX
, "
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.
.,
"
=
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. ,
I RECEIVED Jack a. Book.
FROM
I
-
TAX AT 6%
TAX AT 15%
8r.
t;JAXAT_%
ty..
ADDRESS
148 S. BaltiJDon Street
Dill.burg. Pa. 17019
TOTAL TAX CREDIT
740.00
ESTATETAX
'--~frteT~I~~~ATI0N,i~;-9, --1980-------------
21-80-802
LESS DISCOUNT
PLUS % INTEREST
IFROM TO_I
FILE NUMBER
Marc:h 9, 1991
DATE OF PAYMENT
m
m
TOTAL AMOUNT PAID
NAME OF DECEDENT JACOB BOOleS, JR.
740.00
Cwaber:land
, ) COUNTY
~-----------------------------------------
tPOSTMARK DATE
REMARKS:
PMD Olf AecOOtll'"
"UZ
RECEIVED BY
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SEAL
I
REGISTER OF WILLS
REV.455 (l.80)
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
1'RANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
*
,. .'
. ,:r }\
.-.---_.- ----.-. -- .---
----------
Estate of Jacob Books , Jr. Date of Death June 9 , 1980
WHEN CLAIMING THE FAMIL V EXEMPTION, COMPLETE THE FOLLOWING:
File No, 2l-RO-802
Claimant Jack R. Books
Relationship to Decedent
Son
Claimant's Address R. D. 112. Boilino Sorinns. PA 17007 fMonro.. Twn.)
ITEM DATE NAME OF PA VEE REMARKS AMOUNT
NO.
, ~~/~ ~ tlnif-on "'0' ~ .~ nohf- nf ',n+- " ')~ ')~
2 07/11 Met-Ed Debt of Decedent '>.l,R3
3 07/10 Community Physician, Inc. Expense of last illness 35.00
"- 07/')1 .~ ~..___.,1 U~mo "'''nor~ 1 ._- ') "-Q~ nn
5 08/15 Holy Spirit Hospital Expense of last illness 196.00
6 09/22 Kunkle Surgical Group Expense of last illness 198.00
7 10/07 F. H. N. Assoc. Inc. Exnense of last illness 186.96
8 12/30 Register of wills Letters Testamentary 31.00
9 OlW~l. Christine Yost Notarv fee 3.00
10 Ol/27 Register of Wills Filing Inventory & Appraisal 6.00
11 04/28 Richard Snelbaker Witness fee 10.00
12 04/28 Florence B. Lascher witness fee 10.00
13 04/28 Jane N. Alexander Attorney fee 600.00
14 Register of Wills Filing Debts & Deductions 3.00
Familv E ., ~n ~, ~, mo,o ? nnn,nn
.
TOTAL THIS PAGE I $5 82~. 02
1 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 submit d to th estate as ~c1iO s for Inheritance Tax purposes,
. ~ . 13 ' . J~, :r/
/' SIGNATURE OF ATTOR EV/FIOUCIARY DATE r
(J OFFICIAL USE ONL V
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S 5,\- a?,j.J. AT (: r) I PERCENT.
.
III G\.'\0) C.':jII\l"\~'W '-\~.11 7r I '1 ~ (
\REGI1TER OFWIL~?L' '.' I\) QA 1
-'.J'- L'kIt>\~
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the deccdcnt prior to his/her death am 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,
allorney fees, fiduciary fees, funeral and burial expenscs including the cost of a buriatlot. 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 52.000 may lle 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 memllers 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
OEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
*'
COUNTY FILE NO: ;;( ~ - J;:' () - K () a-
'\';.<.' ok if< B 0 ll.c-
TO:(' r /,\ \\("'''-k 1....... r;" ~ '?'" ,., ,I ('-
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W ( _ (a... J '7(\ I 7
DATE
/'rljC,^! '7 )~PI
ESTATE (~\'.. g~CJ~.(J, ~Q
" .;; J - ..Y (\ " K (~CJ..
COUNTY { A.M-:r:;. ~'-A:JL~_--L
(\ '
DATE OF DEATH ,J IAN 1 (1 / (1 ,~O
u
FILE NO.
(h~
Appraised Value of Estate:
Real Estato
Personal Property
$
+ I 9 (I '7 rl7
+ ~r-- <; ;} </ ,\~
, -
$ -=\\( l-/sl Ie(
e;- ft ;J.'7 (\~
;
$ ~d (- () 'i I 0
;
-
Jointly Hold ProportylTransfe,s
Total Gross Estate
Total Approvad Deductions
Clear Value of Estate
Less: Approved Charitable Eltemptions
Amount Taxable @ 6% Rate
.L..,;"-::";'"\ (~t'> (,/, / d
$ 3c:l (DO Lf ' / () tax due
$
/9Sf- .;),(..1..
'.
Clear Value of Estate Subject to Tax
Amount Taxable @ 15% Rate
tax due
* . . . . . A five
will be granted jf the Inheritance
TOTAL PEN~SY~ANIA INHERITANCE TAX DUE
.JtV~ 3-1'- el- S-q-N
(010
percent discount totaling $
Tax is paid by
$
/9 I:)'=-. ~7~
~. I '7
/ 9' 5 e .. ,/-1
less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
,:<j '7
= $ !O()O,OO
= 7LJQ 0 ()
= .),Ix L/(
I '15k ,t.;I
..L:.. ~ 1-- 'if
'5.q - f/
5-'7-5<'1
,
$ / O(J('\.OO + $
'7 L/ ('\ (){j +
.) II" .:l.y.+
-- $
Interest accrues at the rate of silt (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of paymont. Interest due if paid bV
is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE $
Assessed by: . I
See Intormalion on Reverse Side Agenlf r h,eCo
i{l-.Cil~i i i, I: Uf:. \" l~_,
INFORMATION
To insure proper credit to your account. the name of tho estate and file number should bo clearly print.
ad on the check or money order.
This assessment is made in accordance with Section 70B of the Inheritance and Estato Tax Act of
1961 (72 P,S, ~ 2485,708).
To the extent that inheritance tax is paid within three (3) months after tho death of the decedent, a
discount of five 15) percent is allowed 172 P.S. ~ 2485.716).
Inheritance Tax, other than tax on a futuro 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 2485.711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer takes effect in possession and
enjoyment and is delinquent thereafier (72 P.S. S 2485-712), Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using the following interest tablo:
-------..----------------------- --- ------ ------- - - --- - ----------- -- -- ----- --
1 ",onth ,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 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 18 days .00301 28 days .00471
9 days ,00152 19 days .00318 29 days ,00488
10days .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 sixty 160) days after receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961 (72 P.S. 9 2485,1001).
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below:
.----- -- ~. . --- ------- -- ------ --........... --
1 ~"I;~&.N?!i:N)~;f:'::<.F,~'{{.............. ','COMMONWEALTH OF PENNSYLVANIA . ,
'%""1("" . ", ,..... .
\ 4:~~:",;~',~5Q1:d~~'~;Al RECEIPT . PE~::~~~:r;;;~FI~~~~~:ANCE AND ESTATE TAX
. "',..,."..,,,...'. ' ..' .
"
.
'II
II
=
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.-"\ RECEIVED
FROM
TAXAT 61.
TAX AT 1&%
Jac}: R. Books c/o
Jane H. Alexander
1':so.
lAX Al_"
\
148 S. Baltimor~ St.
ESTAI[1AX
ADDRESS
,
:~ .
Dillsburcr PA 170E1
.--E"s'i'ATEINFCiRM/iTi1iN:-------------------- -- - ---
DATE OF DEATH June 9 B0
FILE NUMBER
21-30-302
Ma 7 19S1
DATE OF PAYMENT
m
m
Jacob floo}(S,
r
NAME OF DECEDENT
COUNTY
--------------------------------------------
, POSTMARK DATE
I .""."
Paid in Full
RECEIVED BY
SEAL
I
IlEGISIEI1 or WILLS
IDTAL TAX CREDIT 216.24
LESS DISCOUNT 2.17
PLUS % INTEREST
tlHDM TO_I
:<.17
TOTAL AMOUNT PAID
218.41
~". ~,J/;J
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// 1(,'/ . 7{.rI'....
/ (/' SIGNATURE