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HomeMy WebLinkAbout81-00031 , , r ',~ ~ J:t: ,.. ..:l ~ cx:r 0 s . ,.. Woo N 0 ~ ~ . - 0 IlJ .-I - Z en L&J No. 21-81 PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY .)....1 ,)J , deceased, In the Eslate of To Register of Wills for the County of cumberland, In the commonwealth of Pennsylvania, olive R. Mauck petltloner(s) Is (ace) the execut or named In the Last Will and Testament of olive R. Mauck dated May 2, 1977 Decedent was a citizen of the United States and a resident of Lower Allen Twp. Township (itW!i!lI.it!1), cumberland County, commonwealth of Pennsylvania, Decedent died on Fr idav county of cumher.lilnd- ,state of _PA at the age of ~ years, Decedent liltS (has nol) been married and hM (has not) had children born to him (her) since the ex. ecution of the above described Will. Decedent was possessed of personal property to the value of $1,000 .00 the 14th day of November A,D. 19~, In the as near as can be ascertained; said real estate situated as follows N/A r , I \ \ \ I A.,P---.;.J2 c. ~ Frederick c. Mason and of real estate to the value of None Therefore, your petitioner(~ respectfully apply(ies) for the probate of the said Last Will and Testa. ment and for Letters Testamentary theron, Dated -~&"''',...''' I '-f J3~/1 \ ' c~c.,~ Fred e. Mason, aka Name and address of Petitioner(s) 1719 Argyle Drive York, PA 17402 COMMONWEALTH OF PENNSYLVANIA l COUNTY OF CUMBERLAND \ ss Fred e. Mason, aka Frederick e. Mason named In above application, being duly sworn statements set forlh In tris petition are true to the best of .sworn---., and subscribed before me,_ ~~~ 1981_ ___~12JL~~-~ ;;&-,~I I-r (J 'R'~- according to law say(s) that the his knowledge and belief, --- ~ 6~1lI' ~ _/~_ (.~-\i~ ".;, h L f'k All ,I,ie. 073," q . >. " orney "-,,,t' r j.. 3. s: ~,~... f.~ "I. '-/ov ~, (~, /7</-0) v I!}/~ I ~- .--.----..--.-----. Filed: January lS, 1981 J, \...\c<., ,,,.., v\ i ' .;</-fl -.31 I I ! I I I I .1 I . - 2 - i. H 1: I: Ii FOURTH: I hereby nominate, constitute and appoint i' ,: Frederick C. Mason as Executor of this my last will and testament; Ii il !i Ii have predeceased me or we should meet our deaths as the result il ii of a common disaster or under such circumstances that it cannot ;I II I: be determined as to which one of us died first, or if for any Ii " reason my said Executor should not be able to or not desire ii Ii il to serve, then, and in any such event, I do hereby nominate, i! 1; 'i constitute and appoint ',rhe Marine National Bank of l'lildwood, New I ~ 1; Ii Jersey as Executor hereof. n qualifying hereunder full power and authority of sale of real Ii !! and/or pl~rsonal property. \l Ii b" d " ii Executor shall not e requ~red to f~le any bon or account~ng ~n d !: this or any other jurisdiction. !i Ii IN WITNESS WHEm~OF I have hereunto set my hand and Ii seal this d71q day of )l~r /'177 in the year of our Lord one Ii thousand nine hundred and seventy-seven. I; 1: I do give unto my said Executor I do further provide that my said I' 1; ~ \ \l II I ~ " Ii y:: r.... [d,,"l.:-f- olive R. Cf, hLfJ-U/uA, [SEAL] Mouck I SIGNED, SEALED, PUBLISHED and DECLARED by th~ within .. '\ , '~ !; ,;7 . ,I ... '.r7tiU." k,4--_<"'i""' aC 7jrLt;.<w~' i / u,--,,--ro:~d,midi"'", 7F~-d.. H t: ~..", .. REV.45211-eol CDMMDNWEA~ TH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENOLIVE R. 110ueK ESTATE OF _ 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 property. ITEM NO. DEseRIPTION ESTIMATED DEPT. VALUATION MARKET VALUE (OFFICIAL USE ONLY) 1. Inter Vivos Trust wherein decedent appears as $159,950.60 Grantor and the Marine National Bank of Wi1dwoo N.J. appears as Trustee, dated May 2, 1977, as amended February 1979 (copy of Trust Agreement and Amendment attached) . A list of assets of the Trust and their value as of the date of decedent's death is attached hereto. TOTAL THIS PAGE S159,950.60 /:''1. Y :J(;16 t) ,413 1. Did decedent, within two years of death, make any transfer of any nraterial part 01 his estate witheut receiving valuable and adequate consideration? (Answer "Yes" or "No",) No 2. Did decedent, within two years 01 death, transfer properly from himself! herself to hilllsell/llOrself 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. N/lI b. Copy of death certi fi cate. c. Affidavit by the attending physician indicating the slate of decedent's health at time of transfer. d. All other information supporting nontaxability of transfer. 4. Did decedent, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consideratio,\! therefor which was to take effect in possession or enjoyment at or after his/her death? (Answer "Yes" or "No".) -~ 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".) 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/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".) .Yes- b. The right to designate the persons who shall possess or enjoy the properly transferred or income therefrom? (Answer "Yes" or "No".) Yes 6. If the answer to five b, above is "Yes," state whether the right was reserved in decedent alone or others. Alone Revocable Inter Vivos Trust QUESTIONS CONCERNING PROPERTY TRANSFERS 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 bmeficial 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".) Nn 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".) N/A .' 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 rioht of survivorship. Bolll tangible and intangible property are to he 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 I/Ias 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. !: '" CI Ii 6 M ;.. :;: Z ;.. 0 0 [fJ " - M C'l Ii c: 0 ...; Z '" Z t'" M r: Z ;.:I ;.. 0 ~ 0 t'" Z Z M ...., M ...; Z p p ...., -< [fJ M - <Jl I Z 0 [fJ 0 -l 0 "=1 "=1 ;:<:I ~ I ~ 0 ":i - ":i 0 - " I z Ii - >- l~. 1'"' t'" ~.. ...'" c:: :..;r t.t.. :~:~ [fJ ll.." tTl 't"" - :r:< elfl- "" "--, 0 WUi ..- ~i.'l: Z 0.... = t"' c:::'" a ,w 0(3 ~...::$ ><: ><: ><: u"" e:::5 ~ LtJa: - LdU tTl tTl 'l' 1'" _I ;.. ;.. u ;.:I ;.:I REV.51. FO 17..0) ,~~ .~... COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS NOTICE OF FILING OF APPRAISEMENT Mr. Fred C. Mason 1719 Argyle Drive York, PA 1'7402 RE: Estate of County of File No. Ol:ivp. R. M()1J~k Cumberland ~1-R1-00,1 Dear Nr. Mason: You are hereby notified that the original appraisement in the estate of Olive R. Mour:k has been filed in the office of the Register of Wills of CumberJend County an Seotember 25, ,19 Jll. Said appraisement reflects the following valuations: Real Estate Personal Property Jointly Owned Transfers Total NONE :1;:1,344.31 ~l()NR 1S0,OSO.60 $1h',::>94 91 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 rate of six (6%) percent per annum is charged. Any party in interest who is aggrieved by this notice may abject thereto within sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and Estate Tax Act of 1961,72 P.S. 2485-1001, P.L. 373. Date S;''''~yI~~ Ti tl e Chief A ooraiser Seotember 25, 1oR1 NOTE: This is not 0 bill. REY-U4 EX+ (&0801 File Number Estate Nome Dote of Death INHERITANCE TAX SUMMARY SHEET (BUREAU USE ONLY) Gl Original o Supplemental o Remainder 21-81-0031 OlivQJLJlQuck November 1/,. 1980 Social Security Number 198-18-5250 REPORT OF INHERITANCE TAX APPRAISER I, the unde..lgned duly appointed Inheritance Tax Appral.er In and far the County of Cumber~a~d Pennsylvania, do respectfully report that IlTave approlsod tho real and personal property as roparted In t e aregalng relum at the volu05 sot forth oppo.ite each Itom In the la.t column to the rl,ght In Sc dule. "A", "B", "C", and "E" Dated: Seot-ember ~5, 1 oR 1 ISER INVENTORY Roal Proporty (Schedulo A) Personal Property (Schedule B) Jolnt.Held Proporty (Schodulo E) Transfer. (Schedule C) TOTAL GROSS ASSETS Leu D.b.. and Deductions (SCHEDULE F) CLEAR VALUE OF ESTATE o Life E.tote o Annuity FOR USE OF REGISTER ONLY Tax on $ Tax on $ Tax on $ Tax on $ Tax on $ Exemptions Total Estate VALUE AS APPRAISEO ADJUSTMENTS CODE IHARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE $ 00+ 10+ 92+ 20+ 30+ 40- 93- Rill PRINCIPLE VALUE CODE FACTOR l CODE COMPUTATION OF TAX S S S S S 6% 15% TOTAl.. TAX INTEREST FROM BALANCE TO s s s Less Credits DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST + S S = + = BALANCE $ TO $ S s TAX CREDIT $ INTEREST FROM BALAHCE DUE ,,- None TOTAL REAL ESTATE SITUATED IN THE COMMONWEALTH ._..._-_.,....~.._.._-_.._--~_.- ---..--..------- __._."._ .__'.,. ,_, __ ^.__u TOTAL REAL ESTATE SITUATED IN THE COMMONWEALTH None REAL ESTATE OUTSIDE OF THE COMMONWEALTH None INSTRUCTIONS 1. This form is drafted tu meet the reqllirements of Seetinlls :3:301-3305 of the 1'.1'-1' Code. 2. See Section 3301 as to the necessity for filing Suppll'lIIelltal lnv"lItnry of after. discovered property. 3. Real Estate situate anywhere in the Commonwealth must be appraise,1 bnt need not be described by metes and bounds. See Section 3301(a). 4. Real Estate situate outside of the Commonwealth shall be sehednled but not appraised. Section 3301(b). 5. Additional sheets may be inserted where space is fOllnd insllfficient. 'Tl :!! r '" '" 0 .. '" t-< 0- H -l <: :I: t'J ~m z z" P ::0 cm- .~ . ::a::az m(ll< ::;:: ~om 0 ....z~ \ c::: m~O ~ () (Il....::a ~ -l..,o( I ~::ao ~ mO'Tl p ~ 0;1\ 'Tl::a ~ -l '" 0( ~ ~ o :; '" '< . ~" "-' L. (Y' C .' ~_. 0.. l/.~ . ':"')":'. t.....: ft~~ C;::' ~ C'~'. ..... LJ J~~; 0"" ~~ 0:::(,," ;;;: 08 I~ <'>UJ ~::t: ~a: - t,l.,::J 1'" ....Joe> u HEV-4GO (lI.'JU) COMMONWeALTH OF P~NN5VLVI\NIA DI!I'J\flTMENT OF REVENUE. OURr~J\U OF FieLD OPERATIONS APPLICATION FOR CHARITABLE EXEMPTION FROM PENNSYLVAtHA TRANSFER INHERITANCE TAX (Ac' of May 28,1956, P.L. 1757, and Ac' of Ju", 15,1961. P.L. 373, os omended) ~~. ~ -L Application is hereby filed for the approvnl o( on oxemption from Pennsylvania Transfer Inhcritnncc Tax on the transfer of the property dcscri~od b"low: 1. Bureau Fi Ie /1_ 21-81,-_3L___ : :::.::,:::::,~S;;f;/- S. Tllo Commonwealth's appraiscd vaJue of the property for which on exemption is claimed is S 5,000.00 (Note: Wherc the property is other than a specified amount of cash, the exemption cannot be approved until tho value of the property has beon established by appraisal by tho Commonwealth, except in those cases where the amount of the gift or bequest represents a stated fractional or percentage portion of the entire estate or the entire residue. In those cases enter such fractional or percentage amount above). 6. Check the manner in which the transfer was effected and submit a copy of the document authorizing the transfer, unless such material has been previously filed. WILL Olf DEED 0; TRUST INDENTURE LX; SURVIVORSHIP 0; OTHER 0; (If ather, explain) 7. Correct Business Name and Address of Charitable Organization receiving property: NAME Bethany Village 325 Wesley Drive, Mechanicsburg, PA ADDR ESS 0' See listing on reverse side for additf' nal charitable organizations covered. 8. I certily that the information contained ~ei is, to the b~st of my knowledge and belief, true and correct. ,,") I , Signature of Applicant - '^^^" I ~ \ ~ _1'------. ,\ ~. Address of Applicant Official Title 35 South Duke Street, York, PA 17401 Attornoy for Es-t-ate Date fl. z.-<, t4 r--( , . This form must be completed in triplicate and all three copies delivered to the Register of Wills for the County in which the decedent resided, or in which letters were issued for i:I non.resident decedent's estate. If the decedent was a non-resident of Pennsylvania and letters were not issued by a Pennsylvania Register of Wills, deliver all three copies to the Director, Bureau of Field Operations, Penna. Department of Revenue, P.O. Box 2970, Harrisburg, Pa. 17105. Do not write below this line. Far Official Use Only REFERRED to Bureau Headquarters I A*~ Far the s~etarY of Revenue !--L-~~~gna,a: of Regist~r Wills) !-L:i~4.J~<<X - I (Cau~) I _ Lh1A/ q~ /ftf/ Approved 0 For Secretary of Revenue Denied* 0 (Initials of Register of Wills) (Authari.ed Signature) (County) (Title) (Date of Relerral) (Date of Action) * See reverse ,ide for reasons MUST BE FILED IN TRIPLICATE This section will be comel eted by' Bureau Headquarters only when the apylication for exemption hus bCt'll doniod. Date: ____.___..___ Tho application for exemption contained on the face of this form has been doniad because / Note: Any party in interest, i:lcluding the Commonwealth, aggrieved by this action may within sixty (60) days after the dote of this notice exercise their rights of Pfctest, Notice, or Appeal in accordance with the provisions of applicable Pennsylvania Inheritance and Estate Tax Acts. ):: C' c_ r-" f..) 0 II ; "~- :' .~_. - ~';c~ .", ~':;(-: C);" "" ~~..r,.. ':....-1 ~ll" ,.- 'Y.r~ e.l.' ~ l?w c:......J '.., at=] .~..- Ul.>.1 u:: .l,~ ~n: ~ llJ=> 1'" -'W '-' This soction will bo compl otod by' Bureuu Headquarters only whon the tlp"p'lic!!..!ion for exemption !Ius becm donled. Dafe:._ .____.,___.__"___.._.___ Tho application for exemption contained on the face af this farm has bocn denied because O__P__ Note: Any party in Interest, i:lc:luding tho Cnmmonwoalth, aggrieved by this action may within sixty (60) days after the date of this notice exorcise their rights of P,ctest, Notice, or Appeal in accordance with the pro'dsil)ns of applicable Pennsylvania Inheritance and Estate Tax Acts. .~, ..,. I'; r" - , a.. ~...J .:..:' ,. ~.-: r;-' L_! , , ~ ~2 Ci'" "" ll...!; 5 Co.' ,w a::Vi "'" ";:::.~ cc:s ;uw y;,.l'_ ~a:: ~ ,.,::> 1'" ...JU u .... REV.45' EX+ (3.80) COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "F" STATEMENT OF DEBTS AND DEDUCTIONS Estate of OLIVE R. MaUCK Date of Deathll/14/80 WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING: File No. 21-81-31 Claimant Relationship to Decedent Claimant's Address at lime of Decedent's Death ITEM DATE NO. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. NAME OF PAYEE REMARKS AMOUNT Account owing, supplies Anesthesiologists Rad. Assoc., account owing Account O\.,ing Account owing, surgical servo Account owing Reimbursement Account owing, drugs $1,123.00 917.00 2,500.00 1,500.00 16.00 18.00 43.69 5.00 6.00 1,440.00 391.14 91.60 99.62 67.17 12.00 30.18 39.75 51.00 5.00 142.58 4.00 5.00 15.13 Huff Cha el, Inc. Hetrick Funeral Home Fred C. l1ason Stock and Leader Register of wills Cumberland Law Journal The Patriot News Co. Register of Wills Notary fees Bethany Vi llage I1rs. Mason Mrs. Bruner, LPN Harriet Cam bell LPN Dickson Pharmacy William A. Sullivan, I1.D. Bethany Village FHN Associates Hol S irit Hos Mechanicsbur Prac. D. K. Sanderson, 11.0. MDS Laboratories Edna C. Munson Dixon Pharmacy Mortuary services Mortuar services Executor's commission Attorneys' fees Letters Testamentary Advt. Executor's Notice Advt. Executor's Notice Filing Inventory Account owing for rent Account owing Account owing for services Account owing for services Account owing for drugs Consultation SUBJOTAL $8,522.86 I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral expenses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes. .k. S;:l'-' ()...~ ~~.. ..-...... SIGNATURE OF FIDUCIARY G..~ /.(. .1C1r;., o E OFFICIAL USE ONLY DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S ~ / q q,ll AT 9?7r4.:$rER~F~fl,~d /,?,- t;./ % TAX RATE ;0 .5.7/ DATE .' GENERAL INHERITANCE TAX INFORMATION Unsatisfied liabilities incurred by the decedent prior to his/her death ore deductible ogainst 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, funerol and burial expenses including the cost of 0 burial lot, tombstone or grave marker and other related burial expenses. All debts being claimed against an estate o,e sublect 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 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 0 member of the same household con claim the exemption. In the event there is no such spouse or child, the exemption con be claimed by a parent or parents who ore members of the same household as the decedent. The family exemption is al/owoble only against assets which pass by a will or by the Pennsylvania Intestate Laws. NOTE: Compensation paid to an estate representative; namely, a~ executor or administrator, for services performed in administering on estate is reportable for Pennsylvanio Income Tax purposes. This taxable income item should be reported on form PA.40.lndividuallncome Tax Return. t"' ~ CI Ii ~ tTl ;.. :5 z 0 0 [fJ tl C') Ii c:: CI '-l Z s: Z t"' tTl tTl r: Z ;.:I ;.. p z 0 t"' Z Z tTl ...; m ...; ,', p ...; ><: [fJ tTl - P [fJ ~: .> ~ . Z 0 [fJ 0 .., , rv' ~."l 0 'T1 'T1 ;.:I <:l._ !:..(~, >- ". ~.;.. --. .., lJI. ~"';: .,": 0 (:." Cr": "" ~':_~i Z w~+ c~. ~. ~E:~ = 0:::<.0; "'" "," ~~ u'" l):S .....w ",'" ~ ~u 1'" u -< >< tTl tTl >- >- ;.:I ;.:I INSTRUCTIONS FOR COMPLETING SCHEDULE "F" 1. If the family exemption is being claimed, indicate the claimant's nome, oddress and his/her relationship to the decedent. Enter "family exemption" in the remarks column ond the amount claimed in the amount column. 2. Assign consecutive numbers to each item listed. 3. Enter the dote on which each debt was incurred and/or paid. 4. Enter the names of each payee. 5. Provide a brief explanation in the ren,arks culumn for each debt claimed. 6. Enter the amount of eoch debt being claimed. 7. The form must be signed by the person who has assumed the responsibility for paying the debts. IF ADDITIONAL SPACE IS NECESSARY USE BlS" x 11" SHEETS. ~ GENERAL INHERITANCE TAX INFORMATION Unsatisfied liabilities incurred by the decedent prior to his/her deoth are deductible ogainst his/her taxable estate. In addition to debts incurred by the decedent or estate, other items ore claimable including the cost of odministrotian, attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tambstane or grove marker and other related burial expenses. All debts being claimed against an estate Ole 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 may be claimed by 0 spouse of 0 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 0 member of the same household con claim the exemption. In the event there is no such spouse or child, the exemption con be claimed by a parent or parents who are members of the same household os the decedent. The family exemption is allowoble only against assets which pass by a will or by the Pennsylvanio Intestate Laws. NOTE: Compensation paid to on estote representative; namely, an executor or administrator, lor services performed in administering an estate is reportable for Pennsylvania Income Tax purposes. This taxable income item should be reported on form PA_40_lndividuallncome Tax Return. t'" '" 0 Ii ~ tTl ~ ~ - >- 0 0 [fJ Z Cl Ii ~ 0 ...; z :::: z ~ tTl tTl r: ;.:I >- p - 0 Z Z tTl ...; tTl ...., Z P ...., ><: tTl - P [fJ [fJ Z 0 [fJ 0 ...; 9 ." "=1 ::ll ~ '- ~- ',..l - c ~. 0 " '.> Z , ." "';:.;' q( C") 5;:5 I.J..JU~ S:f, o~. ........ cr;.v', ;0;: ~~ CJ~ ...~= u"" ,::"- li!'" - ~B iP _J '-' ><: -<: tTl tTl ~ >- ;.:I INSTRUCTIONS FOR COMPLETING SCHEDULE "F" 1. If the family exemption is being claimed, indicate the c1oimont's name, address and his/her relotionship 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 an which eoch debt was incurred and/or poid. 4. Enter the names of each payee. 5. Provide 0 brief explonotion in the ren,arks column for each debt claimed. 6. Enter the omount of eoch debt being claimed. 7. The form must be signed by the person who has assumed the responsibility for paying the debts. IF ADDITIONAL SPACE IS NECESSARY USE B'l," x 11" SHEETS.