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PETITION FOR LETTERS OF ADMINISTRATION
I'"' / ' '. ,'. .. \ /' ,ii ,j IY
IN THE ESrATE OF ...."'.)..(.\...:.....~;..~;;".../.:'.'::..;I"I.:,...'~..,,..:,....~',.......: r)l~LEASE().
To ""."", """""",., """ ..,./1/,.,/!.. ,Ii.. ,j""""",.(,~, "",. /,.: :~'".. /;. .., : ",,,,c.,.,,
Register of Wills 1'01' the COllllt,\' of ClImbedand, ill Ihe ('omIIlOllll'ealth of Penlls.\'ll'allia.
The Petitioll of "" ,.'...t.//::,(, ,/I.,:.::"I.\~,./"1::.~'",, ".l::...:",\(<,,\:,:,:,~ '~::" ,(,(, ''':' ";""":""".:"""" ":"::'''':'' .
,,,,,,,,,.,,,,,,,,,, """"""','," '"'''''' "",."." I'espect flllly sholl'el h t ha t .,I,\,(J",,",,,;: ,. ";,,, ,'('I,:,'"~,'(,\f"",!"I.",1".',,:,,I.~(,(1 tfI
'd t I' 1//' '" /1' j ~, " \ I)' ::',; TOII'lIship (' I "1' let' 5t't. l' P I
was H reSl en 0 .. "L...,~...(.\......I..."".;.../....".....I.,"'~C",Hol'ollgh' . lIm WI ,Ul< ,Qun j., . cl e 0 ennsy.
, d C't' I' U't I St.t' 1 I ,t 1'.t":','I':":' t..t't . th C t. I' C!. { /'I/"'-/;'!/i/(/ci
vanta, an a l.lzen 0 nl c( a eSt am, (epa! C( Wi I t III e~ It e 111 e OUIl j 0 ...."....................1,,"
I') .'~ 'J" .f'
""",,,,,,,,,,.,,.,,.,,.,,,,,,,,,,,,,, alld State of ,.."", ",.,:~-::, ,/ !. ..( l.I""",,, ",."" .,.""", """'" ".".,.",.",,,,, ",,,,,,,,,,.,,,,,,.,,,.,,,,,,,,
'l./i G" (~(~I v th (' I 'N;' I' 'I' iil"(') c' /i'; (, ('-'I":' A D 19.j" (.
on ... .....I........I.L...... ....:--';.... e ........ ..t........................... (<l~ 0 ................................................... . 'J ...' .......,
at the age of "...f...~;.:'" yeal's,
." (,' '/. ,
That the said ""I'),,,{j::\:,::::,,,,.I:..,,:)..,~..::!,\.,,':,'j:LdjV....,, deceased. left surviving the following
named wido", or husband, heir's and next to kin. to lI'il:
Name
Relationship
..,..... ..\...!~ .r;....~;...l:.... ~~......
Residenee
,C~/l.,i~..,!J.,a..I~',,/...,/.I:,"~",..,',.,,' ","
..?',..'rf?S:.,:f.-:"r:::"8,.,.",B.4f.:-t.",t.,..,,
./~ {I!, f..r" ,I:"\'::.,..,,,..t..,,?', i", It ,12..f.C",
"l-:..,4".h,..,b,.",..,..,.....",..,.."""",.""
..""""";\:",(:".!{""",,,,,.,,
iJ /f C,';; ( 'f-' 1\
........................{:...................
"",\~".d;..,.:;."','",.,f:.,,:,h;,,,.../(u\/.o:)L/' lA'0
:/... . " IJ' 0
."."."".lr./:!...f.r:..0~..!...L/!.Le.Ij'..11 .
"'.'"",,, (,.6. ,'; ~,{J~. ,.f... (" /.It,!,,, Pi!.""
,.,.",:,k.::,/i:.A:."H.I.!.,J.:.t:!:.1t.t.l71 '
\ . '.
"....""".,.",...(,:";(.,....""",,,
That those above named include all of the next of kin, so far as known,
The said decedent was possessed of personal property to the estimated value of $""I.'!.t../!l::......t,r;.
and of Real Estate. less incllmhl'ance, to the estimated vallie of $".."""",(.."..."."".." as n;'ar as can be
ascertained.
That the said Real Estate in so far as is known is located in """""....,,,,,,,...,,,,,,,,.,,..,,,,.......,,..........,,,,
.................................................,...........................'......................................,..................."..............................................
Therefore. .1'0111' petitioner(s) )'espectfully appl~'(ies) for Letters of Administratioll in the above
named estate,
D dr,.,. I ,,' v ,". A I ,..' !
ate .""..,......\(..(,../,,". ,,,..I............... , ).. 1.1:.......'.., :'1 ,: . " .'i ,",
S ig nature and Addl'c~~ : ..',:. !.~I.~....".J. (.:.., " ,~/~(,,-:-:::L l);:.,I.i.~1.~.;~....\..1..~.-.';.............
or Petitioner(~)
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. 11/1 / _, / '1/1,/":,
......~.,...;.!.. .... t. ..,.:. !.t.l.......,./....-.;..;......................................
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".,. \~,.. .1. i.;. ,L I: /. A.!: .~~. ~..\ ',~;('" I... ..<L...... (...... {..'-.:.. .~~.........
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,.....",....."",.""""'.....',..,...,.,..",."..,...,,......'......":.'5......
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COMMONWEALTH OF I'Jo:N:-:SYLI'AI>:/A
I
} HH:
COUNTY OF CUMBI-:HLANlJ I
c( i ' /, . I .;' .
................, !.",.. ,6.. /......1.../1.../,:../., .d.:..'...,..:.:..,. ......:::"A,.:>...< ..,,',:'. ..~!.. If(,. ........" ....,..., ....."". ..........., named
in the ahove application hein~ dnl)' ......,!.:...::....:...i.\..y...........".... accol'</inJ( to law, sa)' that the factH set
forth in the ahove application arc trlle to the heHl oj' :..1,.,1,:/:.... kllowledJ(e and belief.
.b..e..f'o..r..e....m...e..,................ ...,..." .........,..... and Hn hHcl'ihed ) if' .,~;';.. ,... ." ".;'" .",., ";;"".. :';;;i'''''''''' .",,,, "., ""."......
~~ I, .O.l ,l\ (~l.'~~.l.t.'. '{,... ~llj.. ''';''.)',rl' ''''<-_J j~..'tY"",.Q.,~';kJ...;..:..
....Zj;;;....,..'.."..{i'~yr.....'.., A. lJ" 1 !l..,....... .............."...,.......,............,....,...........................
"''/.I(d1''''''.",:,.'7e~t:1.~,''..''.~~~'i~~~'~''''
Filed: . .......,;,:SLU,......,..,('1....!.:i...J....!.....,..........
OATH OF PERSONAL REPRESENT A TIVE
...".....,.................................................,...........................
(/ ') . I" ;'
, i - , (.,." ~, /
Attol'ney: "';--t..c1.,"" .,- _~ .-/ (T\t_.)...-'-<..ll'~_..,.(L-
'..""'...'('........'......'.'. '..........';'i"....:........'
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} ss:
c. 4& II ,.,1 {";I' I IV''''' 1'1;' \ '/ /i \- ," 1.1', /1 'If t't' ( )
......................[,.1.......... ..,'",\../,1......................., ..............,./"""...""."", ",..".. .." ..""....""....""....".."" pe 1 loner s
being duly ......"....!.'...\,V,,,,,,,,./.i.,,f!f.,,,,,,,,.,,......,, according to law do '.;"..,~".. depose and say that as the
. ' ') Ii' I.... '/'
.. . ~ . .)' ,J .' t'1 ..: '_ j., ,',,, y
adnunlstra-C.r"..t,,K.,, of the estate of .....,/.... "....C....",\-"""..". ,;...""..,..1.".....6....\......"./..../."....."............"...".
~~.~~~~~~. ...,.,',.~..J..:,~: :::.... ,.~.;;; ":~.;;. .~;;~., ~;~;.;. '~~~;~;~;~;. ~~~ .~~~~~.~~~' .~~'~.~~~.;~:. ';;.~~~~,.~~~.~~.~~';~~. ~~. ~~;~
deceased, according to law, And also will diligently comply with the provisions of the law relating
to Transfer Inheritances.
.."..,.......,...~~~.F.~......."..."......,..,'" and subscribed
before me.
...th1...q,~.!}",...~"".....?..". .A, D" 19,,(?L
R~i'i~1f...,e..,...O/,,~,..,.....,.,..,...,'"
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L,a..1./(,u;t.!";Y.!.L. ,'.t.:(J....*i(a...AP..;l:;!~,g::1::!:",..I..,
DECREE
Be it remembered that on the ......."..~.~9."........... day of ..."........J.~!W.~IY...........".... A. D.. 19.!?L.
L tt f Ad . . t t' . th t t f Bruco Ilonry, S laseman
e ers 0 mInIS ra Ion In e eR a eo................................................................... .......................................
....'".....",... ........"... ....." ........ "..,......,.,."...".",...,..,. .. late of ...,....."", .....~'!,?.~f!:, ~ ~.y.,~. )?~,~;1............. ............. .......".
Catharine M. Slaseman
Cumberland County, Pennsylvania, deceased, were granted to ."...".............................""............................,
........................................................................................................................................................................................
. Witness my hand and official seal the day and year aforesaid, .
';; . ~/
<:;; /1 iJ' ._, .
",.,..,,~:/2h:e:t.C,f....(;;.....,.::. dta4/............,.........
r J ' Register
COURT OF' COMMON PLEAS OF CUM13EHLAND COUNTY
PENNSYLVANIA ORPHANS' counT DIVISION
No. 21 - 81 - 18
Estate of Bruce H. Slaseman, Doceased
Six North Second Stroet
wormleysburg, PA 17043
FIRST AND FINAL ACCOUNT OF
CATHERINE M. SLASEMAN
ADt4INISTRATRIX
Date of Death: December 11, 1980
Letters Granted: January 9, 1981
First Complete Advertisement of Grant of Letters: February 2, 1981
Account state to June 30, 1981
SUMM.l\RY & INDEX
Assets at Date of Death $16,378.81 1
Assets at Final Account
before Expenditures 16,661.38 3
Less Expenditures 8,586.58 2
AND Fess
Balance before Di.stribution $ 8,074.86 3
\Jot" U9 fm 4uO
21-81
No................V~..........
Renunciation and Request
In the Maller of the Estate of ...............0....!]....,V!,,'~..,-:............/.!..,::~ji:...!V:.:......,...L'/~..,!l,J...C'":../..i!..!/ Ij/
To .........lv.I...l.f.../y........e..,......?..'?....A:...t...,j........,............,....,............. Esq" Regisler for the Probale of
Wills and granting Lellers of Administralion for the Cou nty of Cumberland. in the Commonwealth of Pennsylvania.
~ . " t
1 '!. ,-
/:) " ". .~'-I. "'t' .,'('["-.1 c\[.\./'t L-. / '.~
'" t,I;.,.., Ihe undersigned, bemg the ,.....SL...l..,....I..........."....i.....'....'t,........................,.....JL.....d:...~,.tlll... L./
..................................................................................................................................................................................................
..................................................................................................................................................................................................
...... ..........................................................................................................................................................................................
..................................................................................................................................................................................................
, ,/ I; ..1'--/.
L'"'-{ 1/1. . . . ~I {t.; l'b {(.. ,I'
do hereby renounce ....."..............";';,c..................................... nghl to have Letters .............(,y.......(Cj..(.[.h,J..."~., ......,', (.l.~
(/ 1
................................................."....................... on said ESlale issued to ".........(.2:~f.:!!.':!::Y........................."
....,....."..."..,........."."...........................""................................ ............"...........",....... and do hereby request you 10 grant
the same 10 ."........".c,..A:..r.h...4..,.IC......i...fI...,~,.,.,.".."IYl..,.......J.~l..,...i!:,:,f;:...t:....I!.::.:./-!.ll!......
Wilness..~..hand...............,and sea!...........". ..this................,.....d?.;?.;:/J........"..."................."............
day of .......~".1..kL,Y?'."",..,.......A, D. 19t:P....!
Sealed and deli\'ered in presence of
. ~/'."..4-!.....;?..J~(!;:!.1lJ..y...............
~!.~hr:;;.rC!?.~(:.::~:~-:::...........................
;M;~lr;~.;c::'?,~:.,.:.~:~~..............,',..........".
, 1&.
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................................................................................
................................................................................
................................................................................
.........................n.....................................................
'. <t~j;;/C...- 8, JJ. a..Q.f'1-!^<t1A/
.,................,,,..,.....................,..................(L.S.)
.....14.1.({;.w.".2......t.~...(L. S.)
t' C! '.
... ",.f..'?:J:..:z.<!.:-:.:!~:-:"'..'::)=.~,=.. (L. S.)
.........................,......................................(L. S.)
.....................,.............,............................(L. S.)
................................................................(L.S.)
.....................,..........................................(L.S.)
REV-!H1 (8-78)
COMMONWEALTH OF PENNSYLVANIA
aEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
__~___.___ ___.__._~___no__________'__"__-_'-__- -.---.---,---.-..,--+ _ ,
DA TE 2L~';,;-::.3 V. / ~ PI
APPLICATION (MUST BE FILED IN TRIPLICATE) - 'j
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby mode for consent to the transfer of the following securities of 0 Pennsylvania
Corporation or 0 Notional Bonking Association located in Pennsylvania:
'*
(0) $5t;0. 00 (b) tndustrt a1 Villley Bank f. Trust Company (c) Ronl{ subord~~~e~~~
(NOTE: In describing securities enter in (0), ab Ole, either the number of shores of stock or the face omount ;l1"C
registered bonds, in (b), the name of the issuing company and in (c) the closs of stock or the stated interest rate
and maturity date of registered bonds.)
ISSUED ON December 1, 1970, and having a TOTAL MARKET VAtUE OF S 560.00
(DolO)
as of the date of death of the decedent, Bruce f!. Slllsemdn
, on
12111/80
(Nome of Decedent)
(Dole of death)
who was late of 6 North f;ccond st;. ,
(Street and Number)
1,'Jorm1..c..Y.!;hl1r('t
(Post Office)
C:i1rnhi'" r1 ;'Inrl County, PA
(County) (51010)
The securities are registered os follows: ~..:...._H. ~nll!lemUn
(Name or names In which certificates are registered)
Sl.:.selr,an. I) I~. Second st. ,I1UI'ul1cy..bur\l, PI\
(Address)
NAME OF APPLICANT Catherine M. :51aseman
COUNTY FILE NUMBER 21-31-1/1 ADDRESS OF APPLICANT 6 1'lorttl Second street
~Iorme 1 ysburg. PA
BUREAU FILE NUMBER SIGNA TUR E OF APPLlCAN,Q<:zt,~.u:"", ~ 1111, d:-Ib J~-\Q.-14.
NOTICE: IF YOU FAit TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
ADMINISTRATOR) Catherine ~I.
EXECUTOR) (Namo)
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES "'":::; ~ iJ.;
DA TE-:( ,.... ."J Il}-P-(
I hereby consent to the transfer of the above securities now registered in the name of the aforesaid
Decedent and woive the filing of a certificate certifying to the payment of the transfer inheritance tax to which
the property of said Decedent is mode subject pursuant to the provisions of the Act of June 20, 1919, P,L. 521,
as omended ond the Act of June 15, 1961, P.L. 373, as amended. This is also in accordance with the provisions
of the Act of April 9, 1929, P.L. 343.
This Consent to Tronsfer the heroin described property operates only in reference to the estate of the
obove.named Decedent.
~~~
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/, :....0: ,1'
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Signed for the Secretory of Revenue
~i\
~"\..'~
By .' ,~J'}'",",
r "" "",,1-
/ ) 'J (51, aMO)~' '. ~ \
~i.~ J:\)_ti-11J- I. ~ j ~
, 1(:!i"1o\! oun y) ~
PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of 1961 provides thai 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 mlditional property which is or may be subject 10 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 tile Register of Wills of the county wherein the decedent resided.
3. TIME FOR FILING
The return is due nine montlls after the decedent's death, unless an extension for filing has been applied for and
granteo by t'le Secretary of Revenue within the nine-month period,
4. FAILURE -:-0 FILE RETURN
Seclion791 of the 1961 Statlile 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 debls of like amount are recoverable by
law."
5. TAX RATES
Inheritance Tax is payable althe rate of 6% on transfers to lineal descendants, such as father, mother, husband, wife,
son, daughter, grandchildren, grandparent, son-in-law and daughter.in-Iaw 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 whicb may be due with any remainder applied 10 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 tile Register of Wills of the county wherein the decedent resided and are
received slibject to the final determination of the Department of Revenlie.
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 flill. 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 persen who willfully makes a false return or report required of him shall, in accordance with Section 793 of the
1961 Stiltli\e, be gliilty 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.
REV"4~O 1\"SOl
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENl OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "An
REAL PROPERTY
~. E!~
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(Inslruclions on Reverse Side)
ESTATE OF -'--'3Ll.tCe.. ,H., SlasemarL
ITEM ESTIMAlED DEPARTMENT
DESCRIPTION MARKET V ALUA TION
NO. V ALU E (OFFICIAL USE
ONLY)
NONE
TOTAL THIS PAGE AlMA . .'-WI'
n,
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two yems of de<lth, lII<1ke <IllY lfilllsler of ,lilY III<1teli;1I p<lrl of his estale \',ithoul receivinr,
valuable and adeQu<lte consider<llion? (Answer "Yes" 01 "No",) -NQ..,_
2. Did decedent, witlrin two ye<lls of de<llll, ll<lnsfer ploperty Irolll hilllseW Ilerselllo hillisI'I L!llersel! "nd imolher party
or parties (including 0 spouse) in JOint oWllclslrip? \AIlSWel "Yes" 01 "Nu".) lIo~__
3. If the answer to one or two <lhove is "Yes" J:al :hc :~;l:J:;/CIS <Ill] cl:liraed 10 be nonl<lx<lhle, provide Ihe follnwillr,
infolllr<llion:
a. Age of decedent ollillle of transfer.
b, Copy of death cerlilicate.
c. Affid<lvit by tbe <lllending physici<lll illllicotlllg Ihe sl<lle 01 decedent's helllh ~i lillle of transfer,
d. All other infolllwtion sllpporlinr,llonl<lx:lIlilily of fransfer.
4. Did decedent, in his/her lifetime, Illilke <lny lmlls!er 01 property wilhoul receiving "v<lluilble or odequilte cOllsiderotioll
therefor which wos 10 toke effecl ill possessioll or enjoy",,:nt ilt or ilfler his/her deillh? (Answer "Yes" or "No".) No.
a. Was there any possihility lIwt the property trilllslefled mi,p,lrl retumlo :rons[eml or his/her estilte or he slihjecl
to his/her power of dispositioll? (Answel "Yes" or "No".)
b. What was the transferee's <lge iltlime of decedent's de:ltlr?
5. Did decedent in his/her lifetime mal~e <lny llilllsfel wilhout receiving a villunule iIIHI mle~uate consideriltiontherefor
under which transferor expressly or inrpliedly re:;erves for hiS/her II Ie or :111'/ period which docs in fact end before his/her
death:
a. The possession or enjoyment at or tile right 10 income fromlhe property lr<lnsfened? (Answer "Yes" or "No".) ~
b. The right to designate the persons who shall possess or enjoy Ihe plOperty lronstelred or income therefrom?
(Answer "Yes" or "No".) No.
6. If the answer to five b. above is "Yes," state whether the right 'rlns reselved in decedent alone or others.
7. Did decedent in his/llCr lifetime make a lrilnsfer, the consideration fOI which was Ilonsferee's promise to pay income
to or for the benefit or cme of transferor? (Answer "Yes" Oi "No".) No.
8. Did decedent, at any time, transfer property, the hl'lleticial enjoymenl of which was subject to change, because of
a reservcd power to alter, amend, or revoke, or which could rever I 10 dccerlent under terms of transfer or by operation of
law? (Answer "Yes" or "No".) No.
9. If the answer to eight above is "Yes," WilS the power to niter, nmend or revoke tile interest of the beneficiary reserved
in the decedent alone or the decedenl ond others? (Answel "Yes" or "No".) __
HEV.453 0.801
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
.'
(lflstmctions on Rrvers(.' Sid(.')
Estate of
:H'\.Icc II. :)\.dscnli.ltl
- ..- .=
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE 0 F INTEREST OF BENEFICIARY
DECEDENT BIRTH
Catherine 1.'1. SldSelO.:1l'\ ':Ii 1 e y t~ :~:i ~~-/.~}-()L 1/3
Wormleyshurq, lOA -
l,ester Sldscman '~on ye::; ::~-q-?11 ?-/9
Harr.Lsbucg, PA
~larie Loo!<er ;)auqilter' ves 2.-10-27 2/9
uoerun, 1-'/\
Earl SJ.aseman Son yes I,-G-31 2/9
Yorl< Haven, lOA
- ---_._-~------ -.-.-
--------- ----- ._--
----- ------- --------
I
.
'.
,The above beneficiaries are living at this time except for the following:
NAME
DATE OF DEATH
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. Botl1 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 "B", 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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INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
o Original
o Supplemental
o Remainder
File Number
21-18-0018
Estate Name
Bruce Henry Slaseman
Date of Death
12-11-80
Social Security Number
716-09-7223
I, the undersigned duly appointed Inheritance Tox Appraiser in and for the Caunty of ~~~WI ~,. !,7,.,,})
Pennsylyonia, do r..pectfully report thot I naye approised the real and porsonal property os reporte in t e faregoing
return at the values set forth opposite each Item in the last column to tho right in Schedules IlAIl, "Bit, "C", and HE"
REPORT OF INHERITANCE TAX APPRAISER
Doted:
March 27, 1981
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INHERITANCE TAX APPRAISER
INVENTORY
AaJUSTMEMTS
VALUE AS APPRAISEa CoaE (HARRISBURG USE aMLY)
$ None 00+
13,649 33 10+
None 20+
None 30+
13,649 33
REMAIMOER APPRAISEMEMT COOE
92+
Real Property (Schedule A)
Personal Property (Schedul. B)
Jolnt.Held Property (Schedule E)
Transfer. (Schedule C)
TOTAL GROSS ASSETS
----------------- ---- -._----
Less D.bts and Deductions
(SCHEOULE F)
CLEAR VALUE OF ESTATE
o Life Estote
o Annuity
40-
93-
!!ill
FACTOR
PRINCIPLE
VALUE
CODE
FOR USE OF REGISTER ONLY
Tax on S
~
COMPUTATION OF TAX
$
$
$
$
$
6%
T ax on $
15%
Tax on S
Tax on $
Tax on $
Exemptions
Toto\ Estate
TOTAL TAX
INTEREST FROM
BALANCE
TO
$
$
$
Less Credits
DATE OF PAYMENT
AMOUMT PAID
DlsceUNT
INTEREST
TAX CREDIT
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=
BALANCE
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GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the deccdent prior to his/her dcath are deductible against his/her taxable estate.
In addition to debts incurred by the decedent or estate, other items are claimilble 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 speuse 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 celumn.
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
COUNTY OF tJl>>lIIlHllNIII
DAUPHIN
I
J
55:
Catherine M. Slaseman
-.-~-----...- .-...--.---.-------..--.- .----.,. ,----..,---+ .-... -. .__....---- ..-.--- -_._.,-_._~._~--------_._"---_._-~_._-_.-
being duly sworn __'_'_ according 10 law, deposos and says thaI S ho _ is
__!~dminis1;.rilj;.r::ix__..___......._.__.. 01 Iho Eslale 01 ---E=~. SJ"""m"n
lal. 01 Wormlevsburq. , Cumberland Counly, Pa., doceased and that the
within is an inventory mado by ..~Cl~_herj._n~_~~_Slas~f!l~n___ ____, the said Administratrix
01 the entire ostate 01 said decedenl, consisting 01 all the porsonal proporly and roal estate, excepl real ostate outside
the Commonwealth 01 Pennsylvania, and that the ligures opposito each item 01 the Inventory represent it's fair value
as 01 the date 01 decedent's death.
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Executor . Administrator
Catherine M. Slaseman
6 North Second Street
Sworn and subscribed belore me,
February 5, 1981 W 81
Notary Publi';, Dcup~ h C:r':;l~Y, Pcnn~,/"'Jnia
My Cormnl.:.::.ion [;:;.:r;.:; Jcmrary 10, 1983
Wormleysburg, PA 17043
--
Address
Date of Death
December 11
Day
1980
Month
Yeor
INSTRUCTIONS
I. An inventory must be filed within throe months after appointment of personal represontative.
2. A supplement invontory musl be filed within thirty days of discovery of additional assets.
3. Additional sheets may bo attached as to personalty or roalty
4. Seo Article IV, Fiduciaries Act of 1949.
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Inventory 01 the real and personal estate of
uruc:_~.~~~~:.:~~_______ deceased.
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7,641. 32
5,448.01
560. 0
13,649. 3
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CCNB, N.A.
Savin~s Account No. 008-006959-4
Checking Account No. 18-00770-8
Industrial Valley Bank and Trust Company
Bank Subordinated De,'.:lenture