HomeMy WebLinkAbout81-00042
,.......
"
INSTRUCTIONS
ASSETS _ Describe 011 Reel Estate located in Pennsylvania and held solely by decedent or held jointly with another party
ar parties as tenants in camnan ar as joint tenonts with right of survivorship. Include the decedent's percentage of ownership
and the estimated market value. List all tangible and intangible personal property owned individually by the decedent ar
jaintly with anather party or parties as joint tenants with right of survivorship at the time of death. Include intangible
personal property titled in tho name of the decedent, but payable at death to anather party or porties including but nat limited
to P.C.D. U.S. Savings Bonds and tentative trust accounts. List any property transferred by the decedent, within two years
of death for which he/she did not receive valuable and adequate consideration.
DEBTS & DEDUCTIONS - Unsatisfied liabilities incurred by the decedent prior to his/her death ore deductible against
his/her ta,)(able estate. In addition to debts incurred by the decedent, other items are claimable including the cost of
administration, attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone or
grave marker.
Evidence to support the dacedent's or the Estate's liability /ar the debts being claimed should be attached to this return,
A family exemption of $2,000.00 moy be claimed by 0 spouse of 0 decedent who died domiciled in Pennsylvania. If there
is no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is member of the same household
can claim the exemption. In the event, there is no such spouse or child, the exemption can be claimed by a parent or parents
who are members of the same household as the decedent.
r "ll 0 n :t>- m :t>- :!l
:t>- O 0 0 VI 0 r
z C'l n c: 0 ool Z 3: Z
m m ^ z ;0 :t>- P P r
z m ool m ool z
p Z ool -< VI m VI
0 VI 0 ool
Z 0 ;0
P "T1 "T1 :t>-
ool 0
'T1
0 'T1
-. Z
, I{' '-" Q
\.; ~ co :t-
o. -=:I: ~.' ; . r
i<. . .~~ c:
L..... 0 oc'(::2 1Il
c,:,
N ~j:<( -< -< 111
Cj.: !.l. .J
u.rl.' Z ":':i:r.: m m 0
Of'" ~ (:)L~ :t>- :t>- z
0:::":' 'w ;0 ;0 r
OL:.i ~:E ::$
'-'w "':::>
.~oc ~ w'-'
CO ...J
\.. . t..l
INFORMA TION
PLACE FOR FILING _ The return is to be filed in duplicate with the Register of Wills of the county wherein the decedent
resi ded.
TIME FOR FILING - The raturn is due nine months after tre decedent's death, unless on extension for filing has been
applied for and granted by the Secretary of Revenue withiri the nine-month period.
FAILURE TO FILE RETURN - Section 791 of the 1961 Statute provides that", . .any person who willfully foils to file
a return or other report required of him shall be personally liable. . .fo a penalty of 25% of the tax ultimately found
to be due or $1,000 whichever is the less to be recovered by the Deportment of Revenue as debts of like amount are
recoverable by low."
Rc'C,12. 1~,'6E\l
COMMONWEAL TH OF PENNSYLVANIA
DEP,ARTMENT OF REVENUE
QUREAU OF COUNTY COLLECTIONS
I
I
,._,..,_ l.
APPLICATION FOR AND CONSENT
TO TRAt~SFER SECURITIES
REGISTERED IN THE NAME
OF ^ I~E~"DENT OECEDENT
*'
[).~T~anu~ry"I6;' 1981
APPLICATION (MUST BE FILED IN lRIPLlCATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby mode for coosen! to tho t,onsfer of the following securities of 0 Pennsylvania
Corporation or 0 Notional Bonking Association locotod 11\ Pennsylvania:
(0)95 SHARES (bLl'J'llNSYLYl.\N,l:i\ J'QWER, & LIGHT ".cOM1.'ANL.__ (c} CO~10~!TOCK
(NOTE: In describing securities enter ill (0), o~ ""e, eithel the number of shores of stock or the face amount of
registered bonds, in (b), the nome of the issuing company and in (c) the closs of stock or the stated interest rote
and maturity dote of registered bonds.)
ISSUED ON _~.2.!Y~~.n_..'-' ond having n TOTAL MARKET VALUE OF S .!:~~?~._38
(Date\
oS of the dote of death of the decedent, ~C:~~~ w ._.~.li::?~_---___. , on 10/1_6/80
(Namu of Decodent) (Dale of death)
704 Coolidge street
who was lole of___....._.,____._,.,._._
(Street und Number)
New Cumberland
Cumberland
PA
17070
.. ..--..--..-.----.-.-------..---.-------
(P05t Office)
(County)
(Stote)
The securities ore registered os follows: ...___~.~t:'_~~._!.<!_IN9~~._._._._ ",,-,---
(Nome or nomes In which ccrlificOlc!> ora rcgistered)
ADMINISTRA TOR) NONE
EXECUTOR )"-..--,- (No~;')--" - .--" ---..--.---(Add,;;-;-)-----.
NAME OF APPLICANT _:L~~,,-C8_~~.:... Arn-%~ Esquire
P. O. Box I
COUNTY FILE NUMBEL;;LL-=-2{-~l{.d. ADDRESS OF APPLlCANL~.aL~p_ilil1-'-Pennsy1vania 17011
BUREAU FILE NUMBER n ...._SIGNATURE OF APPLICANT.. ()~(.. ~e..I?~
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPC;Z;-TIOH, IT WILL NOT BE
COHSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
I h.re" "."",,, .h. "."';.~:;~,~.I,:~:;:,::~,:::::~.:~:;,~d ,. .h. ""m~:,T.iit;,;.
__ .__4___ .._+._ .~_.,.__ .-.-. - --.-"-.--' ----.--------------..-..-.----. -
_.________ _____.._.__.__ .__ __ _. _n...'.___'._.'_"'.____._._'___'
i
19 fI( I
I
I
I
I
I
I
I
I
I
Decedent nnd woive the filing of a certificate certitying to the payment of the tronsfer inheritance tex to which
th,~ property of said Decodent is mode subject pursuant to the ~rovisions of the Act of June 20, 1919, P.L. 521,
os omended and the Act of June 15, 1961, P.L. 373,05 amended. This is also in accordance with the provisions
0/ the Act of April 9, 1929, P.L. 343,
This Cono.nl to Tronsfer the herein ".:scribed property operotes only in reference to the estate 01 the
obove.named Decedent.
SiL~ned for the Secretar:;;,f Re'(enue
By ~).(:._22fL\"~~~
(S;g'/Jrl ' C f~ ~J A ~_. \
(:rh~rp1~ML.L.~_, ,n.' ,~'" &v' .\.
...:/l (..'i (Tltle~ (County) ,