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COMMONWEALTH Of PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
HEV-4"9 (8.78)
RESIDENT DECEDENT
COUNTY OF _QJ)M~ERLAND___
__._..__._ m..'__"
IMPORTANT,
Thi~ rtl1llrl lllll'll h',' ["JI!'I,I,'!\'.j III dc'!atlal'd filed In dl1r,lil:l1c, Idlh :dl ;lII<I("l1l'II, ,....lth till' I(q\lstn nt Wills Ill" tile
(\lIlIlIY wllt'r.' dl'l~i..'dl''11 fl"d,kd; Ih'!I"~1 IS dill: WlI 11 III 111m' 01'1"\11)0.; :1111'1 .!,llt' III ,!!oath, lIuk..:, ;lIlI';<\Prlsioll is f:ri\ltlcd
hy till' S"UC\,II \ ul :~~ "','rH~l~, (S:'cl ~"11 70.1 of 1111.' In!Jcrir;llltl: ill1d 1".,\iI:'- I'il.\ '\l't 01 11161.J
.-----_._-~---
. - -.......
.~_...._._ "_..;';:_":';;;;,"..~..._:....;.__;:~='.;.-=o.c,~,,,,,,,,,,,,,-:,,,,,;,:,;,,;;---
IN TilE MAT'rE'~ OF TIIF FST.\TE ilF
} ,\!.HllAYII OF
-- -. --- ~~I~~~"~
"t1\!1~~f'~l'1t1lt
County
THEDA I. CUNNINGHAM
.-..------- ('S"Tt..T0:u l:t.--I7:\MI~;;;:=U-;7f:i~~~,--- -.--
Laic of _Cum1;>Ei!_r.1amL
S'o'o ,I _R~nl!s.Y~.Y-~!li,~.-----. __m___ )
} ~,s:
Cou,,', 01 .(;.J.!!!llJ.Ei!:r1,.an9.-_. -------
. . _.J:oJIIl__Q_.__C_uJl.nipghl3.\11'-m--_-------- -- ..----.---
/rJmmr!inmm of lhn 'Htatt' 01 the ab('lvr,-namlld ti",cl'!dr.nt being duly sworn, dcpo'}l'! 5
lJ.,gir_______ l::ll:.(~.u.~r
U1lli soy S
Det.:c:dC:llt ,lied November Z-B__o_
(MC\I,'lH)
HOl'lfl and addreu 0' ollorMY or 1
other oUlhorllOd rflprl'lltlnlative 10 ....horn (
011 cOHnSilOndl'lnce shCluld be mailed. )
That us slH:II.__..!!eir _._dl'l'nncnt is fllllliliur with lhe alTair:-; Ilr said c~.;lale ilntllhe pn1jlcrly constituting
I EX l:: CV TO R-.\ OMI:,! 15 rr~ AT,'" R'
\(11,(1
, ]9l.!2-..J :-....cW,o..''O....i~..d......iu..-:-r>'J'_r-.J.i.Jl-i..Io.-..~4('l..uc...:il-etl. )
'YI::/.I~oWl"'-1!"'fe intestate
..1..Q_htl_~_._2.!.ik~_-E-~1,!j.re ,__~-,-_9.!._lio){-73L-_Q~IllP- Hill,
Pennsylvania 17011
the assets llll:rellf and lheir l"air market value.
That al lhe time uf death there was no safe (kposit hox registerL~J ill decedent's llllli\ ldualname, or jointly with, or
as agent or ueputy of another, or in decedent's individualll:lmc, willt right ui aCl.:ess hy itlllllhe,r <IS agent or d~llUlY, with the
exception of the foilo\\ ing.: -
That the contents or ~llit..l safe deposil hox or hOXl:S an: ilemilcd under S\::hedulc~'.___of this return,
wi lh tht.'. exception of the following, for tlH~ rl~a~.;ons her~ inafter S(~t forth:
Thut Schedu/o A att...dH~d hereto and made part hereof sets forth fully ,tlul in detail all the real property
in the Commonwealth of Penn:-:ylvania of whkh decedent died having all intcfrsl !herein. It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving lhe amollnt still duc at
death, name or morlgagcc, dale, rale of illterr..:SI. and book JIllI pagc (If record thereof. 11 als\l sets forth in lhe
columns prov.ided thcrefore thc assessed valuation of c:ach of sail! parct:ls, the cstinllltcl{ lllurkct value thereuf
as of datc cr Jt.:3th of decedent.
That Schedule B attached herclo and mllde part hereof ~ds forth fully and in uc:tilil :JIlIlCrSOJ1a! property
wheresovcr sittllltCJ owned by the decedent at lite lime of death; alllllO!wys left by the decedent at lhe time of
death, wh(~ther in 1.lcl:l'dl'nt's immediate rns:->l~ssil)ll, s:andi,]g 10 d(~l'Clh:II(" ,.'rrdi! in hanks of dt:pusit, savings
hanks, trust COl1i;::1ll1es, or othl~r jl1c~litl1tion-;. \\'!H~!her illuivid\Jally, or ill trm,1 !'or allY olher person Ilr 11crsons
giving also scparatc.iy the, .\ccrued inlcrn;l thereon, if any, dowll 10 the In:-.t tql"f':st Jay prit')f to decedent's
dc:ath in the case uf savings banks, and 10 the d.llc of decl~dt'lll'~ lka!h ill Ill! \l1l-H'~ c,,~\t.;';; <lit bonds. postal
savings. treasury ccrlifkalcs or lh11t:S and ',!\:,_:- l~\'idl'll":C p{ iwlehll:dll"~SS III' the tinitd Stales tn the dl~-
Cl,;dcnt; ...1.\ (Ihligations, whether 11:,- slatult: l\f dg,l.:'~ili::ll( ll:,'y :If\.' ,k~,I~:,li,IIl'd as lail. t!Cl:, tll the lh.,ited Sl:l!l:~:,
or nny state, or political subdivision lhercuf, or of allY foreign cnunlry, which ,HL' u\~!lcd .Itthe time of JCi.llh;
all wcaring apparel, jcwelry, silvcrware, picture..;, bouks, wmb or MI, hllu!'i~llOhl fUfnilme, horscs, cUfTia~cs,
llutomobilcs. hoa'", :ll1d .\ny and all olhcr personal dtultcb of \\hal~(lc\n l;ifld or natule. I,t.:f! hy dl~l:cdcnt,
together with the fairly estimated malket \'all1l.~ thcreof; all blinds ami ~l(llt}!.:~ges held hy (\ccl:dcnf am! of all
claims due and owing dCL"I:del\l at the IlInc tJf dl~i1\h, and .111 promissory noll'S or Olhn instrumenls in writing
for the payment of money of which decedcnt died possessed, of wh;ltsoe\'er Ilature, with inlerest thereon, if
nny, giving the face v.due and estimated fair m.Hket value thereof, and if such cslilllaled fair market valul~ be
less than lhe face v.ltuc, il sets forlh hriefly thc reasons for stich dl'pf'~I'iation J.~I tn each itcm; all moneys
payable to lhe estate from life insur:l.ncc policies carrilod hy tkCl'llcllt, all :u:nuily anu endowmenl nmtracts
the proceeds of which were payable upon IJ1I' lkalh of Iht: dl.'t:l.'t1ent: illl ,1I1l1 lhe cllq'01'alc stocks and dividends
due then':(1n and unpaid us of the (!all. f!! lkalh. h,Huh and a cOlii'll 11ltl'tl'st l!H'rl'lIn 10 IIH~ uate of decedent's
death Rnd other invc<;tfllenl ~\'curjli\'" fI"nl~J 1,\ thl.' ~Inl'dt'''! at I hI.' 111111' III' tkalh. y.ilh tlw :11 <Hk l'. I utlue therc-
of at such t im(~.
__---1
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In till:' ('/IS'!' 01' sf'eHrILlt!s of ~!II'i" fir 1'111'111,'. ,,;rrH J'[lllf'Tl';, ll:" -,'tlll"S rl'pnrtf!c1 nrc IlS I'nr /IS
l'os!';ihlH ~mhstlLl1t.llIll~.1 by flrlluH~llll SUll.t'lIll'!lt~, ..1' (II" li"]:'!lll!)!l'., ~;\to....ln;~ 1 lit' "....~,..ts /lIpl Ilaldlltl(.s
thl'reol' liS nf tile i111t.e oj' tlPUt!!. TIll! scl1l'dllll' Ill';" "l't ; 1",,1"111 t.!l" iI11."'l".!. Ill' (!I~(~I'll"lIt III I Ill! l.lrnl' of'
dellth in lm~' cn-pHI.tnershlp ()f' l,u!iJnt'ssl fllId III SUP!"II'l 01' Ii,.. \'"Illl' 1,1' ~;llf'll Illt,l.rl'st. 1.11'~rl' Is Itfln(o.(~!<1 1.0
snit! SClll,dllle, 1'1111llwlnl st.nLI'W'1l1" !~hn\'ilnr.lllf..1.~;o;l.t.. .tnrl J l.'lhlltll"" qf' ';llld "(I._p",'ul"rshlp tJr hllS!llll$lh
j\ cop~' or tht"' cn-pfu.tnershlp 1L1!,1'I.'l'mf'nl.., (II' ('rill, to SI'lt('r'1'~1l1 sp!ll,,!'. f'urth till' I\fllllrp of'!.tlP fA!~rl'l'lllont)
to,~'!lhor with II st.f1ltWU'llt sel.tlllJ~ furlh UIl' l'hlll'flCU'I' "I' f~I" l,:t,>:'l1'~;~, It,~: IOI'IIt.lull, /11111 suet! otlll'r t'/if;t.S
pl~rtl\tIl111P; t.o lIl1' IlIlslncss /is (llIIY Ill' 1"'l'lllll'lI!' 10 It r/ill' /l1l<! .11''i1 npPI'/llslll or till' rlt!et!lh~rlt's llll..,'I'!>!,
tl1pl'flin IlllL~lllCSllbllllttf'(t. It shollltl "Iso Sl't l'orih III It"lIll/l'd r('fllI, 11lj',I'I,l11'I' wltll til'! f'fl.lr l1l/ll'l((>t VIL!llf!
t!WI'f'OI', l\1I~' ol,l1('z' propt!rt.~' OWIII'tt or ht~q\ll,"tlll'd hy lhl' ,;..j'..,I"I:1 111 tIll' t 11lJt~ or t\t'uLh.
Tile Schedule C llttl1chf.'11 hl'("l~lo flflll llllHll.' 1'/II't, }'I"''''II' sl'ls f'oz"l.h 1I I.rllp ItTlswer t.o (~Ileh inqutry
contnlllef! thnrein /111ft tnt.he cnsooj't!'/lllsf'l!rsuf'pl"OP"I'ty, 1'1'/11 Of' l"!r!,HIIitI, 'f,'II.hln t.wo )'t~nrs of f1p.cr>dent'R
th~ath, in contemplulioll of df!(~,'df'nt's Ilentll, (II' Int.I'lldl'd loll to,l:n 1'['1'+'1:1. In \HlSSf'ssloll or en,lnyme!lt ut or
after l1enth, slltll SClllHiule sets for 1.11 UW 1llltllrl~ /llld \ I', :,111' of s1Jl~h Pl.np....rt.y, t,n whom trtUlsferred, t.lle
relationshIp of the t.rllnsfcree!i (.n tile df~(~f'd(>nt., I.itl' P"'lj)fll'l,l'JIJlllt' ~;ll1Ir" I'(~el"'lvl~cl by cllch trMl!il'f!rep. anti
all other filets of n pertinent nllture rf'~llrdlfl~~ ",dol l.T"lIlsl".'rs. III I tit! I'IIS!! of' U'tlllsfcl'S intnndctl to
tll.ke effect tn possession or en.lo~'f111!llt lit. or /trtPI' dr'HIll. 1.1t"n~ h 'llsl' ILttnehed t.o the 5clledule It cOllY
of' the deed, trltst agrcf1ment or other Instr'.!llwlll. erl'llt,ll1~ th'~ t.rust. Thl~r'~ is also !wt f'orth In saId
schedule 11 list of' nIl propel' I.)', I'enl nllt[ persflllul. wllh it~ Vlltlh!, ,;hieh llilf:St1'S flt tfeced('tlt's C!f!flt.h by
virtue of t.he exercls.e hy decedent. either lndlvlfhllllly. Ol'.lnlllt,ly wI1h flllot.llpr, or Imy power of' il.JlJloint.-
ment vested indeceltent, either In<ltv1duI\11y or .101111,ly. 1)~' t.ilp wIll, (te\!d, or otllt~r lllstrmnent of' nnothnr,
with n cON' of' t.ill' lnstrumen!. creut.inA Ruch powf'r 111111clli"'d to the ~,chf!dlllc.
Thnt Schedulp D Iltt..nchecl hereto 1\tIt! mll(lI~ pl1rt. 11PI'POf' sl'l,:; forth t.1l1! 1I1UnNi IUlII nlldrm;ses 01' 1111
persons henet'icially interested In t,h1s cstnt.e Ill. till' li;n(' of' t11.'cP.dent,' '" Ile/tth, t.lle nntllrl' of their rf!S-
pective 1nterests, t.heir relul1onshlp, if /lny:, t.o tl1l' d(~Ct~(lelltJ t,IIV,I!thcl' wtl.h the llges nt the time of
decedent1s death of' 1111 minors, annuitflnts I\ncl IWlll!l'l~1llrll's fOl' Ilf'e lIIuter rlecedent..'s Will. It also
contains n stlltement showing which of Ul{! henef'lcilll'Jns Illlmed III nu? d'-~ccdcnt,'s will, if Ilny, (lied prior
to decedent, the dntes of their dent-h, t.heir is:.,lIe~ ILnr: tli~ reln1.lollShlp 01' such issue to the beneficiary.
That S.:/1t?dule E nttached Iwretn l\nll flIll1le 1\ plll'l. hr>ren{' sets forth /lll property, renl Imd p(~r-
sonnl, owned hy the decedent jointly with fUloth(>r or Ot!l"'rs. IrwllltlhlJ.; Inlnnglhle, stnnding in the nllme
of the decedent Ilnd othl'r5, plus tl\f~ dnte /lnd l)lll~(> or rfl('fJl'(1 of 1nst..rurnents (d'f~cting the ..estiture of
renl estnte luul the dot.e of' Ilcqulsltlon of' persmJldt.y, plw. the nlllT\f', IIrldrcss /lnll relationship, if nny,
of co-owners to the decedent..
That. Sc/?t?dule F attached hereto and '"fide tl pill'\' hereof' sets forth fillly nnd in detail 1111 debts
and deductions claimed for flnd on behalf ()f this d('cerh~III'S estllt.e, including f\m~rn.l expenses paid;
famil~' exemption, where appl icnblej costs of /lclministrlll.ioH of this est.ate: counsel fees and fudiciarJ,t 5
commissions ptLld or to lw pnld; cost expended for hurinl trllst.s, tombstones or gr(l\,cmarkers, und reli-
gious services, in consequence of the den.th of' t!w decedent; dl~ht.s /IPd cl fdms owing aOft unpntd Ilt time or
death; taxes llccrued chllrgeahle for pel'lod prior 1.0 dl!eed'~Il:,ls I!p;ILh (I~X{'\~pt those flllowcd. under Section
651 of the Inheritance lind Estate Tllx Act); together wll.ll II stntt!!Ilfmt of' cnlln!'crlll pledgelt for obliga-
tions, if nny. It i,5 ngrelH1 that !,he f'tducinry will presi"'nt l'l'oof of' sIl1d cltllmerl nllligr1tions ul)On re-
quest.., t1111t if the amount act.ually pnid In settlement of /\flY rl~e, commission or debt is less thon the
estimated amount cll.timing nnd fl.llnwed, th/lt till! SIlItIH will l)fl rL'll{)rtt~d to the Hegtster of Wills, llnti that
the Elmount of' tax flSSCSSClt elm llC re'lssess,~d .In llCl'nrllanc" t.hl!:'I!wl t.h.
That the totuls of the appropriate colunIns in Schedules 01,\", "B". "t:", "E", nnl' "1"" as d1rected therein,
have been cllrried forwn.rd and properly regist,(,l'cct in the Sllmmltry,
SUbS~Cri~ ~d sworn tO~be re me this _/
........ / day of _. <... U-^1J 19"..(:
l I/, J j ,pi /l'
"" " .. n,,,' ' (;:'};L4>>. "I: .- [{("Lr<.....-J- [;.l-.. ~
nC!r.'lil S. ~',\C~usri", ~b!clry PIJb!ic
Ill.v (CI,'I~hliOI1 h;ilrl lu~1 1. 1984
(.n,p Hill, PA Cumb~r:illlJ (ounty
B(!f'ore slgn'1np; nffJclllvJ!' l11nk,~ sure
In with detlllls or the \wrcl "~ollt~".
li.......~~ .!:....".;.".....".
. ~Ki~*~1r
105 39th Street
..."............,...... .............m....'......m."_..h"......M~.
( Sf:reet Numb...)
Avalon. New Je.:.se.:t 08202
(Citl! or Town and Stdte)
SOT":
fi lIl'd
1111
hllln1;: s}';..:'<"i In
,I".
Il!.C\lt'1\'1t II lid scht>d1l1l's ullllf."xed Ill'e
aucl III
ellS" ,11"
IIS~l' Is
tllt'lllo\e rllrl' HUrl ulIllSl.erl sl'cllrltil~st
l'O-}IIII'tIH'rsldp or hIlS11H'SS, tllllt. thf~
St'h,'dllll,' "n" nrl' II t t.nell(>(t. ,\ 1 so mnkl~
seCl1rlt.ll~s of' cJo:o:;e or f'llmtly corporH1I'lllS or Illl InU'rl':;\ 111 Illl~'
dutn nne! sllltomtmts rf'fjll1rt,d 11II1h~J' ill;' i~:lrahr':Lrh !!1~')"" ",'llIltld' 101
Cf!rtllin thnt column #1 tn the "SIlHlI-nl~I')'" hits hl.'l,'n lli"nl,,'rly l'lIlllpll'!"'} liS 1l11\)\'p-dtl'f'ett~tl.
REV-452 (8-78)
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
~l.
;~.
RESIDENT OECEOENT
SCHEDULE "C"
TRANSFERS
(1)
(2)
i
(3)
Did decedent, within two yean of doath, mako ony transfec.,.of lIny mDturiul part of his CStlItC, without recoiving a vuluablc" .J
adequate consideration therefor? (Answor yes or no) -1!~_
Did decedent, within two YOlln of doath, transfor properly from himself to himself und another or others (including a spousel
in joint ownership? (answer yes or no) _.No_
If the lInswer to (1) or (2) above is in tho uffirnHltivu stutl!:
(a) Ago of decodont at timo of tmnsfor _ _.__
(b) State of decedent's hoalth at timo of makin!J tho transfur. (Note 1).
(c) Couse of d.cedent's doath. (Nato 1).
Did decedent, in his lifetime, make any transfer of property without roceiving a valuablo or adequate consideration therefor
which was to take effect in possession or enjoyment at or after his death? (Answer yes or no) No
(0) Was thero any possibility that tho property transferred might return to transferor or his ostato or be subjel' to his
power of disposition? (Answer yes or no)
(bl What was the tnmsferce's age at time of decedlmt's death?
Did decedent in his lifetime make any trander without receiving a valuable and adequate consideration therefor under which
transforor expressly or impliedly reservos for his life or any period which docs not in fact end before his death:
(a) The possession or enjoyment of or tho right to income from the property transferred? (Answer yes or nol Nn
(bl Tho right to d.signato tho p.rsons who sholl po..... or enjoy the prop.rty transferred or income therefrom?
(Answer yes or no) No
If the answer to (5) (b) above is in tho affirmative, state whether the right was reserved in decedent alone or others
(4)
(51
(6)
(7) Did decedent in his lifetime mllko a transfer, the consideration for which was transferee's promise to pay income to or for the
benefit of care of transferor? (An.wer yas or no) Nn
(8) Did decedent, at any time, transfer property, the beneficial 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 y.s or no) No
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the interest of the benefiCiary reserved
in tho d.c.d.nt alan. or the d.c.dent and others? (Answer yes or nol
NOTE 1: Th. answers to theso qu.stions should be supported by affidavit by the att.nding physician as well as a copy of the deeth
certificate.
NOTE 2: If answer to any of tho above qu.stions is Y.S, s.t forth below a description of tho property transf.rr.d, it's fair market
value at date of death, dates of transfers and to whom transferrod, with relationship of transferees to decedent, if any. Submit
copy of any trust deed or instrument, if transfers are claimed to be non-taxable, also submit detailed statement of facts on which
said claim is b.1sod.
NOTE 3: List applicabl. prop.rty below in mann.r in which providod in Sch.dul.s A, B, or E.
ITEM
MARKET VALUE
(Estimated)
DEPT. VALUATION
(Dept. Only)
DESCRIPTION
NONE
I
i
i
I
I
I
I
Insert this total opposite "Transfers". Schedule "e" in the
"As Reported" column on the last page of this return.
NONE
N6->'10
~
REV:4a318-781
CO~t.lONWEALTII OF PENNSYLVANIA
TRANSFER INIIERITANCE TAX
RF.sIDENT DECEDENT
SCIIEDULE "D"
BENI~FI(,I"RII:S
-, - - - --
IlE"'EFICIARIES AND AIJllR!;~SES IlELATIONSIIII'
(Stutc fullllllmcs 11I\d IIddresscs flf ull wllo (If ~lep..dlUd'cn or SlJRVIVI':1l "ATE tNTEllEST ""
11IIvc nn interest, vestcd, contingcnt or othcr.. illcgitimatc childrcn IIEel,IlENT OF BENEI'I('I,IRY
wise, in estatc) lire involvcd, sel STATE YES Il!RTII IN FST,ITE
forlh this fllct,) OR NO
--, ---
John D. Cunninl?:ham / J
105 39th Street Io/It'( )..'-1
08202 Yes ot ---
Avalon, New Jersey son age
Raymond F. Cunningham J /
-
120 Glenwood Avenue Iltl c, I "./
6f -~._---
Winnetka, Illinois 60093 son Yes age
-
-
--
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
~
StIJ~
"<t -
:0- 'It
~ - c
'c;l E
._ ~ :I
E- -
-or... 0
E U
'10"
~ U .
S...."E
= ~ -
U = ~
~ e g,
>< u
!::! ~
I{enl Property_.
Pl:rsonal PWpcl'lY
Trllllsfcrs_
SlIM,IIAR\'
(Sl,.:h. HAlt) 1-
(Sch. liB") i-
(Sdl, "l"') '\>
~
~
.~
Gross Taxable Estate
f- '""
~ Z "
'" UJ ~
" ::; "
;.. "
UJ U
'" " ..J
- Q <(
.-.: <II
e>: u. .~ :;;;
c..
c.. 0 c '"
" "-
" < "w - "-
,.c W "cf- -, <(
ci f- f-.-.: 'r.
;:I:: C 0
Z c E- ~ f- c z
0 tJl "
U. W "- <(
0 ~ t-
" 0 '"
.9 e>: -5 0
- W "-
" ~
~ E- " w
- ~ '"
'" f- 0 ~
'c < ~ c
::; c t, 0
- 'E u = E
:::"0 ;; . ~
c
::::-'t ..J U U
(I)
(As l~cplHlL'd)
(2)
(As Determined)
$
$
$
~
$
$
File Number
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
21-81-0023
REV-4U EX+ 1&-1101
Estate Nome
Theda 1. Cunningham
o Original
o Supplemental
o Remainder
Date of Death ________~ov':":ber 28, 1979
Social Securi ty Number
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inharitance Tax Appraiser In and lor the County of Cumberland
Pennsylvania, do raspectfully report that I hava appraise.! the raal and parsanal property os reported In the laregaing
return at the values set forth opposite each item in the last column to the right in Schedules "A", liB", "C", and "E"
Doted: April 1, 1981 .---/1//1-'(14 )-If'ft'4fHt/.)
INHERITANCE TAX APPRAISER
ADJUSTMENTS REMAINDER APPRAISEMENT CODE
INVENTORY vALUE AS APPRAISED CODE (HARRISBU RG USE ONL Yl
Rool Propert)' (Schedule A) $ none oat 92+
Personal Property (Schedule B) none '0+
Jolnt.Held Property (Schedule E) 25,285 57 20+
Transfors (Schedule C) none 30+
TOT AL GROSS ASSETS __~__~~l~~ Jl___
Leu Debts and Deductions 40- 93-
(SCHEOULE F)
CLEAR VALUE OF ESTATE
o Life Estate RATE FACTOR PRINCIPLE VALUE CODE
o Annuity
FOR USE OF REGISTER ONL Y
Tax on $
COOE
COMPUTATION OF TAX
$
$
$
$
$
6%
T ox on $
15%
Tax on $
T ox on $
T ox on $
Exemptions
Total Estate
TOTAL TAX
INTEREST FROM
BALANCE
TO
$
$
$
Less Credits
DATE OF PAYMENT
AMOUNT PAID
TAX CREDIT
S
$
INTEREST FROM
BALANCE DUE
~
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..-.... -- W'- -- .....
'-"REV"U62 EX '
~... .... ,', , ' ' COMMONWEALTH OF PENNSYLVANIA
4 NO. '. ' , . DEPARTMENT OF REVENUE
..KOq0408 OFFICIAL RECEIPT' PENNSYLVANIA INHERITANCE AND ESTATE TAX
If '
~
...
II
II
=
Ii
..
~_.-..~
TAX AT 6%
TAX AT 15%
RECEIVED
II FROM
ADDRESS
Amold, Slike " Bayley, Att
2109 Market Street
ESTATE TAX
-TAXAT_%
Cup Hill, Pa.
17011
'--ESTATE~FORMAT~N~-.;::---28---i979----------
DA TE OF DEATH -. . ,
m
o
POSTMARK DATE
I1EMARKS · PAID ON ACCOUNT II
--
',i~"
,/ ;' . /./ (l ( ir' ,<~, / I
Iota t;:S2G~Wk .r.'
RegZ'f.ter of Will,
SEAL
RECEIVED BY
I
REGISTER OF WILLS
I
I
~\.../ .f...!
~ - - - - -- -- ,--. ._--- --- - - --- -- - -- --.-. -- - -- - --- -- - - - - - - - - - --
.!
OFFICE OF THE
REGISTER OF WI~~S
,
, I . () I
RECOfW["" -F''''
STf1;~EMENT OF DEBTS
AND DEDUCTIONS
'81 .IAN 12 I'~ - ;1
THE SUM OF
)
OEDUCTlDNS A~LOWED IN
REV.4~' (8-781
OF Cumberland COUNTY
AND AGENT OF THE COMMONWEA~ TH
C;'_! :,/','1"': .'"
ESTA TE OF
CUM8EBI....I;t' ('1 ,
Theda I. Cunningham LATE OF Borough of Camp Hill
DATE OF FILING APPRAISEMENT .J/-/ -~'I
DATE OF DEATH November 28, 1979
DATE NO. OF NAME OF PAYEE REMARKS AMOUNT
VOUCNER
Mvers Funeral Home j;',- ,~o 1 154 0
Various Nursing care 80 10
Professional Pharmacy Drugs and medicine 126 4
Blue Ridge Haven Nursing home expense 989 4
Various Flowers 75 )0
Various l1isc. adminis tra ti ve expensE 86 0
\"~LC v C~ , , c~..../
Register of Wills Filing fees 9 )0
Arnold, Slike & Bayley Attorney's fee 600 DO
~
,
.
3,121 18
COMMONWEAL TH OP PENNSYLVANIA I
COUNTY OF CUMBERLAND ss:
I. JOHN D. CUNNINGHAM 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 AOMIIHSTRATION SUBMITTED TO THE ESTATE OF Theda I. Cunnin ham
DECEAS.D. AS DEDUCTIONS FOR INHERITANCE TAX PURPOSES.
f" 1":
SUBSCRIBED BEFORE ME THIS
19~
(L.s.)
(, .EU.A..<L- _<......~
Th.lm' S. Mcc,di..tlobrl ?"~tt
Mv (omrn;lIivn bj.lirl's Jv!v r. 1984
Camp Hill, PA Cumt:.ctland CoI.I:1I,