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QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two yems of deilth, make any lrilnsfer of any malerial pml 01 his estate without receiYing
valuable and adequate consideralion? (Answer "Yes" or "No",) No
2. Did decedent, within two years of death, transfer property lrom himself! hersrlf to himsell/herself and anolher pmty
or parties (inclurling a spouse) in joint ownership? (Answer "Yes" or "No".) ...1l2-
3. If the answer to one or two above is "Yes" and the transters are clillmed to be nontaxilble, provide lhe following
information:
a. Age of decedent al time of Irilnsfer,
b. Copy of deillh cellificate.
c. AffidaYil hy the allending physician indicilting the stale 01 decedent's hcaltll at time of transfer.
d. All other information supporting nontaxability of transfer,
4. Did decedent, in his/her lifetime, make any transfer of pmperty without receiving a valuable or adequate consideration
therefor which was to take effecl in possession or enjoyment at or Mter his/her death? (Answer "Yes" or "No".) No
a. WilS there any possibility tlliIl the property Iransferred might return to lransferor or hiS/her estate or be subject
10 his/her power of disposition? (Answer "Yes" or "No".)
b. What was the Iransferee's age ilt time of decedent's deilth? --
5. Did decedent in his/her lifetime make any transfer without receiving a valuable and ildequate consideration therefor
under which transferor expressly or impliedly reserves for his/her life or any period whicll does in filct end before his/her
death:
a. The possession or enjoyment of or the righlto income from the property transferred? (Answer "Yes" or "No".) ~
b. The righlto designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".) No
6. If the answer to five b. illxlYe is "Yes," state whether the righl was reserved in decedent alone or others.
7. Did decedent in his/her lifetime milke illlilnsfer, the considerillion for which was transferee's promise to PilY income
to or for the ben6fit or careof transferor? (Answer "Yes" or "No",) No
8. Did decedent, at any time, transfer property, the bmeficial enjoyment of which WilS subject to chilnge, because of
a reserved power to illter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".) No
3, If the answer to eight aboye is "Yes," was the power to illler, amend or revoke the interest of the beneficiary reseryed
in the decedent alone or the decedent and others? (Answer "Yes" or "No".) No
REV'.453 EX~ (3.80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT OECEOENT
SCHEDULE "D"
BEN~FICIARI~S
'*
(Instmctlons on Reverse Side)
Estate of
John William Glass
BENEFICIARIES AND AODRESSES
RELATIONSHIP
SUlwtVED
DECEDENT
DATE OF
BIRTH
INTEREST OF BENEFICIARY
Martha L. Glass
9 Wyrick Avenue
Wife
Yes
shippensbur , Pa. 17257
Jerry L. Glass Son Yes 2/15 of Estate
Daughter Yes " " "
Glass Son " " "
Richard " " "
E. Glass Son Yes
Brenda K. Glass Daughter Yes. " " "
The above beneficiaries are living at this time except for the following:
NAME
DATE OF DEATH
REV.4~'4 EX. (3,80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
*
(lnstructlolls on Reverse Side)
P
TOTAL E VALUE OF DEPARTMENT
ITEM \
NO. DESCRIPTION MARKET DECEDENT'S VALUATION
VALUE INTEREST IOfficlal Use Ollly)
1
~
All tangible personal property was owned by
decedent and his surviving spouse, Martha L.
Glass, and no value is returned therefor
\
\
TOTAL THIS PAGE 0
Estate of
John William Glass
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File Number,
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
21-81-0076
REV-4114 EXt (&-80)
Date of Death
January 3, 1977
G Original
o Supplemental
o Remainder
Estate Name ___________ John ~,illiam 91~"s
Social Security Number
196-14-1220
REPORT OF INHERITANCE TAX APPRAISER
I, tho undersigned duly appointed Inheritance Tax Appraiser In and lor the County 01 Cumberland
Pennsylvania, do respectfully report that I nave appraised the real and personal property as reported in the foregoing
return at the values set forth opposite each item in the lost column to the right in Schedules flAir, ItB", "C", and flE"
Doted: April 1, 1981 1J1M!il/ .;rl~Ad,"I)
INHERITANCE TAX APPRAISER
INVENTORY
VALUE AS APPRAISED
ADJUSTMENTS
CODE (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE
Less Cebts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
I 9 000 00 00+
200 00 10+
none 21H
none 30+
9,20QQQ... .-----
40-
92+
Real Property (Schedule A)
Personal Property (Schedulo B)
Jolnt.Held Property (Schedule E)
Transfors (Schedule C)
TOT Al GROSS ASSETS
93-
OLlie Estate
o Annuity
RATE
FACTOR
PRINCIPLE
VALUE
CODE
FOR USE OF REGISTER ONL Y
Tax on $
~
COM PUT A TION OF TAX
$
I
$
S
6%
T ex on S
15%
T ox on $
Tax on $
Tax on S
s
Exemptions
Totul Estate
TOTAL TAX
INTEREST FROM
BALANCE
TO
s
S
I
Leu Crodih
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CIlEDIT
s
+ I
S
=
s
=
INTEREST FROM
BALANCE
TO
S
REV.SI8 FO (7.801
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COMMONWEALTH of PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
NOTICE OF FILING OF APPRAISEMENT
Martha L. Glass
9 Wyrick Avenue
Shippensburg, PA
17257
RE: Estate of
County of
File No.
John William Glass
Cumberland
21-81-0076
Dear Hrs. Glass:
You are hereby notified that the original
appraisement in the estate of John William Glass
has been filed in the office of the Register of Wills of cumberland
County an April 1 , 19 .m... Said appraisement reflects the following valuations:
---
Real Estate
Personal Property
Jointly Owned
Transfers
Total
$9,000.00
200.00
none
none
$9,200.00
As to such tax that is paid within three months from date of death, a five (S%) 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 obiect 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 April 1, 1981
Signed
. ~'J~,JJ /-/PfrfiHJ)
Title Chief Appraiser
NOTE: This is not a bill.
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GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxable estate.
In addition to debts incurred by the decedent or estate, other items arc 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.
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 52,000 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 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, The family exemption is
allowable only against assets wllich pass by a will or by the Pennsylvania Intestate Laws.
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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 column.
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.