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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
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DATE
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FILE NO,
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COUNTY FILE NO:
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COUNTY
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DATE OF DEATH
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Appraised Value of Estate:
Real Estate
Personal Property
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Jointly Held Property/Transfers
Total Gross Estate
Total Approved Deductions
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Clear Value of Estate
less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
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Amount Taxable @ 6% Rate
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tax due
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Amount Taxable @ '5% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
$-, ,,,,///,7
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'" '* ,.. '" .. '* A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
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Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritanco Tax from
to date of payment. Interest due if paid by
is
BALANCE OF PENNSVLVANIA INHERITANCE TAX DUE
$
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See Information on Reverse Side
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Assessed by: / " / --: {.I iv'
Agl,I;nl for 1M CommQl'lweelth
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RrV.451 EX+ (3.s01
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*'
(Instructions on Reverse Side)
Estate of LAVERN HENRY DEIBLER
ESTIMATED DEPARTMENT
ITEM DESCRIPTION UNIT MARKET VALUATION
NO, VALUE VALUE (OFFICIAL USE ONL Yi
1- 1966 Chevrolet Truck $ 125.00
2. 1975 Ford Pinto, sedan 250.00
3. Commonwealth NatiDna1 Bank Checkin9 Acct. #162-
292155-7 397.88
4. Defense Activities Federal Credit Union Checking
Acct. #0041071366-44 1,069.13
5. Interest check from Defense Activities Federal
Credit UniDn 75.00
6. CSA Annuity from the United States Treasury 627 .79
7. Harris Savings Association Certificates of
Deposit, including interest as of d/o/d,
as follows:
a. No. 9-16-003833, issued 3/12/80 503.85
b. No. 9-16-006527, issued 5/13/80 Q ,079.10 Jot. <J, S' ("
C. ND. 9-13-802699, issued 8/7/80 20,855.99
8. Harris Savings Association Certificates, reg.
Lavern H. Deibler, Trustee for:
a. JDshua Danner, No. 9-16-011554, issued
12/2/80 500.00
b. LDri Koons, No. 9-16-011555, issued
12/2/80 500.00
c. Karen KODns, ND. 9-16-011556, issued
12/2/80 500.00
d. Kathy Danner, ND. 9-16-011557, issued
12/2/80 500.00
e. Keith Deibler, No. 9-16-011558, issued
12/2/80 500.00
f. Kim Deibler, ND. 9-16-011559, issued
12/2/80 500.00
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TOTAL THIS PAGE $ (27,983.74
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QUESTIONS CONCERNING PROPERTY TRANSfERS
....
l- ,Did decedenl, within I'^o ye~rs 01 dealh, lII<1ke any transler 01 any lIIalmi<ll part 01 his esl"le w;lIlo,,: :ocw;;:.,
valuable and adequate CDnsidP.l"1i007 (Answer "Yes" or "No",)-1!<<L-
2. Did decedent, within Iwo ye<lls 01 de<lth, tr<lnsler property lrolll himsel II herse! I to hilllsel! '1Ief:;"I' ci;r: ':' r,," :,: to'
or parties (Including a :,prlilse) io loint ownmship? (Answer "Yes" or "No".1 _tiQ__
3. II the answer to one 01 two "bove is "Yes" <lnd the tr<lnslels ilre cl<lillled to be nont<lx<lblc, pro'lIct.! 'If !,oI1il"'''lQ
information:
a. Age 01 decedent "I time oltf<Jnsler. N/A
b. Copy 01 de~th certilic:1tr:,
c, Affid<lvil hy Ihe <lltending physici",l indic<lting the st<lle of decedent's he'lllh ill time of Ir,l,lslcl.
d. All othe! Inlorl1l<lI'\1n S!IPPoll,ng lionl<lx<lllilily of tWl1sler.
4. Did decedent, in his.'her iifetime, lII<1ke any tr<lnsfer of property without receiving <I Vil!u,lhle cor ,ldo,:1I1(', '~."':::r" ,:!')"
therelDr which W<lS to lilke effect in possession or euioymenl ill or :lfler his/her de"lh7 I Ans\':';1 "Yi"." I,' ::"'. ..N.Q_
a. Was there <lny pnssihillly Ihat the properfy transferred might retllflllo tr<lnsleror 01 hislhel esl:Jl~ Of i,,~ "''''!!d
to his lief power 01 disposition? (Answer "Yes" or "No",) J!..ll- '
b. Wh<lt'ln;, (lie tl,m-;Ieree's <lgi! ilt time 01 decedent's deilt!!? _JiLL..
5. Did deceded In his 'hor liletime IIwke any tmnsfer without receiving il v"lu<1hle ,wi iHlen:l.ltr. CCJlISi(\~r,tI'.1': ",,,:.'1,'
under wl1ir.I1'ranslerOI flxpll.lssiy or impliedly reserves for his/her life or !1I1'1 period Wh:r.;l doeo in 1-,,';::1\, D":,)' 'I" "'i
de<lth:
a. The W,:;ossion or enjoyment of or the light to income Irom the propelty Iriln5lelled; (Ans';e. ""'t',.. u,':i:,",' __.NQ,_
b, Tile right \0 desiRni;\n the n01:;ons who Shilll possess or enjoy the propmtv Ilanslerred or li:C[1i"'~ \I,p..,"I.Y:,'
(Ans'llGr 'Yes" 0' "No",)-1:!9_
6. 11 the :Jn~i'li" 10 five I', ,1bove if; "Yes," stilte whether the right WilS reserved in decedent alone 01 [.!lIt' !, _.lI/-A_-
---..-.-------
7. Did der:r,dr.'ll in hi~;III!' lifetime make iltmnsfer, the consideration lor which W<lS tmnsferee's plo:l\lse tv p,,'.' 1.1<:(',,:',
to Dr fe: 'iI" benefll 01 C<lfC of Ir<lnsleror1 (Answer "Yes" or "No".) No
8. Did decedont, at <lny tillie, tr<lnsler propeily, the bmeficial enjoyment of which was slllljl!c: IQ ch<ln,"'\ IlC'c,'.!se oj
a reserved power 10 alter, amend, or levoke, or which could revmt to decedelltunder terll:S 01 tr<lnsiel 01 Dy IWr;I.1I!>!II!)f
law? (An"NOI "Yes" or "No".1 No
9, If the <lnswer to eight above is "Yes," was the power to aller, <llIIelld or revoke the interest of the bend,ci.w If:se:'.ed
in the decedent alone or the decedellt alld others'l (Answer "Yes" Dr "No".) .....lIlL..._
RPA'4!f4 EX'" (3.801
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
'*
{Instructions on Reverse Sidel
I Estate of LAVERN HENRY DEIBLER
DESCRIPTION
TOTAL
MARKET
VALUE
P
E
R
C
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N
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DEPARTMENT
VALUATION
{Officie! Use Onlyl
VALUE OF
DECEDENT'S
INTEREST
1.
Defense Activities Federal Credit Union Saving
Acct., reg. L. H. Deibler or Catherine
Deibler, value as of d/D/d $ 2,899.94 50% $ 1,449.97
United States Series E Bond ND. Q6340458990,
in the amt. of $25, issued 8/4/79, reg. Mr. f7, "'I-:
Lavern H. Deibler or Mrs. Catherine I. (1 0 . 05)
Deibler, value as of d/o/d (20.10) 50% 1.'11
United States Series E Bond No. L2174731, in
the amt. Df $50, issued 8/4/79, reg. Mr.
Lavern H. Deibler or Mrs. Catherine I. .J'l, R J' (20.1q)
Deibler, value as of d/o/d (40.20) 50% !1. '/t
Defense Activities Federal Credit Union Promis
sory Cert. No. 60073, issued 10/14/76, reg.
Lavern H. Deibler or Catherine I. Deibler,
value as of d/o/d 1,000.00 50% 500.00
Defense Activities Federal Credit Union Promis
sory Cert.. ND. 63515, issued 1/8/79, reg.
Lavern H. Deibler or Catherine I. Deibler, )~
value as of d/o/d 1,000.00 50% 500.00
2.
3.
4.
5.
6. HarrisSllvings Account It9 16 009430 in nQrnec of
decedent, Lance Barthel or Sherry Barthel
established 8-7-80 1,039.56 100 I 1,039.56
1,039.56
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TOTA!.. THIS PAGE $(2,480.12)
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INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and persDnal, owned by the decedent jointly with "~,other
party or parties as joint tenants with right 01 survivorship, Both tangible <Inri "Hannibl" property ,lfe to be
included, List real estate first.
1. Describe all real property as indicated in the instructions IDr Schedule "A", Descrihe all personal property
as indicated in the instructions lor Schedule "[3". Include the name. "ddres~ and reliltionshitl to the
decedent of the co-owner (s) and the dale the joint O\.Jnership was established,
2. Indicate the total market value Df the jointly owned property,
3. Indicate the percentage of the decedent's interest.
4. Indicate the market value 01 the decedent's interest.
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMEIH OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
INHERITANCE TAX
APPRAISEMENT
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REV.4~7 EX+ (7-801
I!J ORIGIN AL
o SUPPLEMENT AL
File No. 21-8J,::.QQItL_
Estate 01 Lavern H!LIIJ:'y_PeJQ1er
County Cllmherland___,__,__
Oale 01 Doath J~.!W!ber ;:>g. 1980
In the event that any futuro inter!J~t in this estole is transferred In possession or anjoyment to collatera\ heirs of the decedent after the
expiration of any ostate for life or for years, the Commonwealth hereby expressly teSCIVt.lS the right to appraise and assess tronsfer
Inheritance taxes at the lawful collotero\ role on on such futuro interost.
PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH
Totel Real Property _ SCH. "A". . .. .. $ --'2.5?O.OO
Total Personal Property _ SCH. "B". . . . $ 28,001. 32
Total Jointly Owned Property _ SCH. "E" $ 3,51g.44
Total Trensfers _ SCH. "C". . .'. . . .. $ None
Unreported $
Unreported $
Unreported $
Unreperted $
DEPARTMENT'S
APPRAISED VALUE
$
$
$
$ N ne
$ 39,040.76
ASSET SUMMARY
DUFE ESTATE
DANNUITY
TOT AL GROSS ASSETS
DREMAINDER
TOTAL VALUE
$
I do hereby certily that the above oppraisement is made in conlormity with Pennsylvania low and has been Iiled this
day with the Register 01 Wills.
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APPR.6..ISER
06/11/81
DATE
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F'lIe No. o?/-??I- J/f 19 81
RECORoCOOrWi"-
REG"T" '
'81 FER 19 All :~2
REGISTER OF WILLS
CLERX-OiU'HAN'?, co!!'
CUMBERLAND C:J , ! '
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF NORTHUMBERLAND
I ss.
INVENTORY
KAREN M. KOONS
m~l(<<--
Administrat.!:.iL of the Estate Df LAVERN HENRY DEIBLER
deceased, being duly sworn according to law, depose-S-and say~that the Items appearing .In the
following Inventory Include all of the personal assets wherever situate and all of the real estate In
the Commonwealth of Pennsylvania of said decedent, that the valuation placed opposite each Item of
said inventory represents Its fair value as of the date Df the decedent's death, and that decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a mem-
orandum at the end of this InventDry.
Sworn to and subscribed before me this
)(atth m ~.o
Ka ren M. Koon s Personal Representative
12th
day of
.._JE.br.uary A. D. 19&
_-'1ilm t. 1r1wrlvh;
NOTARY j'UBLTC - My Commissi::>n Expires: 1/18/82
Attorney - (Name) ,1""""y Apf"l hallm, F<q
(Address) ~SfS6~~~mFi~~he~~~~~t~ ~3~~3ry, PA
Persenal Representative
17801
ITEM
NO.
VALUE BET BY
PERSONAL
REPRESENTATIVE
NAME OF ARTICLE
REAL ESTATE
1. ALL THAT CERTAIN tract of ground in Martinis Addition to West Fairview,
Cumberland County, Pennsylvania, known and designated No. 310 Third
Street. $ 7,520 00
PERSONAL PROPERTY
2. See Schedule "B" attached hereto and made a part hereof.
27,983 74
TRANSFERS
None
JOINTLY OWNED PROPERTY
3. See Schedu1 e "E" attached heretD and made a part hereof.
2,480 12
TOTAL ASSETS------------------------------------------------------------ S 37,983 86
NOTE: The Memorandum of real estate outsIde the Commonwealth of Pennsylvania may, at the electien of the
persenal representative Include the value of each Item, but such figures ahould not be extended Int~ the total of the
Inventory, (See Section 401 (b) of FiducIaries Act 01 1949.1
NOTE: !1lis form to be used only In estates of pel'lIons dying on or after ~'ebruary 23, 1956,
Additional Pages may be attached.
~~ .81
:H
PETITION FOR LETTERS OF ADMINISTRATION
IN nm ESTATE OF ,..tdl:I.,f.!.I.\L,...l.flt:./d,(I:,....tJ,<J~,f',U~()ECEASlm.
1'0 ,..,.,..."... t:(df.!::<.,..,'~,,:,.," 1-,-, ,s~~i: '::1"",."'..""""'.,.""""'."'....."""."'...,.,.,."."
Rcgislcl' of Will,; fol' the COllllt)' of Cllmherlalld. ill the Commonll'ealth of l'enn,;yil'ania,
The l'clition of "",.,/(?!(i,i,'>1J.", ,., !.f,~" .,..6:e,~:,A.J. :\~., ".", .""..." "" ,.,., "...",.",.""" ,.",....."", ".,., ".,.", ".... .."....
........................,..........,.."..,.....,......,.. I'e,;pcclfllll~' ,;holl'e' h I hat .., !.~,!:I.":;::~{.~:.....dt:;"'("/,....,i.k:,(,$.uf.,{.S-..
'd t f t ){S- F,111< v/{"-" TOII'II,;)'i"
was a rest en 0 ".~...;..,.~...........,........,.........,......,....."Bol'ough
. Cllmherland Counl,\', State of Penn..yJ-
vania, and a Citizen of United State,;, and elepal'leelthi,; life inte"tate in the County of ...................,........
.~~ ~r!.~~~!:""XF.-!? f: .~;:!.!?.. and S tHt e () f .,..........." l i:..~. 7~ :~::(,~.. ~((:~ .~~:.. ~~\......................,..................... .....................
th ),,'1. I f I7E(~,"i'1d.1.. ,',
on ....,..........,....................., e ....,..,..,.(..,............,..,...... , ay 0 .............;,..0..,..................,..,........ A, D" 19.."..'.~..,
at the age of ....rg,...... yeal'",
That the saiel ..,..-?,l.U!.c-.':':.,:./....,H..f!:'::.',~'.'........?::.,~,i!.(f,~"",...... deeea,;ed, left ,;ul'viving the following
named widow 01' husband, heil's and next to kin, to lI'it:
Name
Relalion,;hi"
Residence
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jp LIN(.'l..tV,\T. NfJf'.-7'S.'iUt PI/-
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vt.: I (II TFIt"'lJ:-./~ j-I v.~ ,:t 0"1-'<:5'.'10' f1+
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.'1!d..... C.f.l!t!,~~'!!:.[!.?.... .t.!':f.:r" :!,~,':.~:!~ (I/<.\ V1+
,oj'" .1.....,,t,!,,,..2 ,~!.!.....?'.f.:)' ;;'.';'N~.~:!?i, ?4-
1<.fJ.!.!.I:f.......!:,:...".!.yl.~!.::/~....,.,.".,.
F7.!~.,..,"'..,...,.D..~!.B~.~,&..".......".,.,'
K.6.,l,[tf...../.i:/...",.M,!.!l.?:.O'S......,..."""
K,t.lIS.~!:\....,..tL".,K~~dS..",......"..."...,
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That those above named include all of the next of kin, so far as known,
The ,;aid decedent was po",essed of' personal pl'opel't;- to the e,;limated value of $...tl'?".?!,'?<?,'..,/!.:-:?......
and of Real li~gtale, ICRS incumbrance, to the estimated value of $...~j..~~.9.~?~..~~.~?....... ap. near as can be
ascertained.
That the said Real ,",;tate in ,;0 far '" is knoll'n i,;,localed in ...-?/.':?....,..!.!:(!.(!.ii!..,....'5.I.!.?.i..(i".~.........
........ ...0.. ?;, ~ :C,..,.. f (),!.~~; ':!.!, t~);/,..,..., $;..~! !:!,I'HR ,k.1~ /,i.',),..,., ~;9.~c: i:-: .l.~~" ~...,..,~ f;\-;"..,..,.."",....,...,.".",.,..,...,..,..
Therefol'e, youl' petitionel'(s) respeclfully appl)'(ie,;) for Letters of Administration in the above
named estate.
Dated ,..):';)J::l,U..I1,~,!:,.....2J..,...... A. IJ" l!I,~L
Signature and Addl'e"
of PetitioJ\cr(~)
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COMMONWEALTH OF I'EN:-:SYLV ANIA 1
COUNTY OF CUMBERLAND l HH;
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""....",..,....,....",......"..",......,..,..,...... named
in the above applkatioll heing duly ".":~,V;-:~.'..l,~.~....".,.............,,..., Ht'col'c1ing to law, say that. the fllctH Bet
forlh in the aho\'e application arl' trlle to the heHI "r.j,l~rs... koo\\'ledKe and helief.
'b"e"f'~r'~"'m"'e","'"'' .......... ...., ..........' '..'..' and HlIhHcrihed] ,,""""" ,." ';4/:"~'" .".".'1 ;.;"" '.1:<';...'."".. ""......""".
."""'.,.",,.., ,),"- {", ,(, 7. ,l,.,. ,/.,;,." ,I... (.::,:. ),:L ;),.,.....",.....",."
......,~iY;,...........1)....~..,.......: ~' D., J!l.......... .."""..",..,.."..,........,.."......"....................."......,..,........,
.,.,..,/.l.l~/..c:;.""vl't.(C.4/... ,.'.."R~~'i'~;~'~..., ",."., '" ,..", '" .....",., .."" ,...".., ,."" ...."........""..'................
Filed: . .;,l.(;l,~:-::f!,f.:\......?,?,j../l.r!...,..................,....
AHorne,\' ;
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OATH OF PERSONAL REPRESENTATIVE
COUNTY OF CUMBERLAND
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....." ..../", /:I.oS............, ,I...".".,....",.,...",...."",...,."..,............,.."...",......."...."""".",..,....,.........".......". pe ......,ner "" J"
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being duly .......f.U,.,..'........................................, according 10 law do ~..L.... depose and ',say that. aH the'
'.... .- . .
administra T;1,lit....... of the estate of ....b,tl.y.,~~.........':!,~~,~.:1..........~,~:J.I.~.'::,4:~...........;::.;;;;........;!.............~;
} ss;
COMMONWEALTH OF PENNSYLVANIA
-,
........................................................................................................................................................................................
deeeased ...,:i..i!,L.......... will well and truly administer the goods and chattels, rights and credits of said
deeeased, aecording to law. And also will diligently comply with the provisions of the law relating
to Transfer Inheritances.
S'(lJ"Iit>J " d b 'b I
.......Co.............(.".....................,......,... an su scn el
before me.
'T~? A cl
..................y.R.-D......ff.......................... . D., 19~.........
R~~4<.T...e.:':..,?ft&~,.....,.,",.....
.....",..;::.",/d:l,.\i:,J.l..../.?: .7. ,,/.;i.,I?:!.7...L2.........,...........
.................................................................................".........
DECREE
. 23r-d January 81
Be It remembered lhat on lhe ,........................,...... day of ................................................ A. D., 19..........
Lelters of Administration in the estate of ,............... ................,........Ji.~Y,\H;.t:\..!.\!?X!,;::y...p..~.P?~:},~:,.............
\vest ro.irview
.....,...",.......,.."".,.......,..,..,......".......,......,...".........,.. lale of ,..........,...,......,..,....",......"...,.......................,......,.....,..,.
. Kare11 r:l. Koons
Cumberland Counly, Pennsylvallla. deceased, were gran led to ......................................................................
........................................................................................................................................................................................
Witness my hand and official seal the day and year aforeRaid, ~?
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