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HomeMy WebLinkAbout81-00090 t%~ ..:l rn H 0 ~ 0) jl., co: 0 tl ,.. ex> -- - ,.. 0 C\I tal .... . 10 0 .... Z lit UJ COMMONWEALTH OF PENNSYLVANIA .;COUNTY OF CUMBERLAND I. J 55: ____V:Lr_ginia B. _ Hatte~___._____ ________ being duly sworn .______ according to law, doposes and says that she is the surviviIill__ he:Lr______________________ 01 tho Estate 01 Opal B. McCu] 10Up:h late 01 Carlisle Borough , Cumberland County, Pa., deceased and that tho within is an inventory made by ____.Yir:g.:!J1:La__!l... Hatj;'"n____, the said surviving heir 01 the entire estate 01 said decedent, consisting 01 all the personal property and real estate, except real estate outside the Commonwealth 01 Pennsylvania, and that the ligures opposite each item 01 the Inventory represent it's fair value as 01 the date of decedent's death. Fd-u-, 0'~ //~ J) ( -' "3 ()?SL<- . Ii ,~: r. f1 f 'I' ... "',I :' . .., ..." I; ~ ' : . i ' " "'_ ",.... .'<....,/ '_d,\!'. CARI.IJLr. tiC';',:), Cr.I":,'.>,:,',:} C_,:'.;TY MY CUM:f\I~SiOi; [X;::i~::J OGL 3, j8q4.J. 19l:L_ 2 (. " /-1 1k J~ . ! M11'.NvtUv , ut. I Executor. I'.dmlnl.lroto1f Surv i ving 251 South Hanover Street Sworn and subscribed belore me, Carl:Lsle, Pennsylvania 17013___ Address Date 01 Death 18th October Month 1980 Year Ooy INSTRUCTIONS I. An inventory must be filed within three months alter appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional e"ets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. .c bD -d c >- .c ;j " 'n ~ ... w bD 0 ~ :;: ~ '" ... ;j >< ~ w -< " >< I>.. ... 0 0 " H I 0 0 Vl ,-j P'l " " ~ w w ,-j 0 '" >- J: '" ~ "" " l- I>.. U. ;j OJ ~ I>.. c ... -' ~ I Z -< 0 ~I ,-j c 0 ..... u. -' "' I>.. ~ W 0 -< w ~I ,,:. 'n :l: > '" 'n :;:-< I z ,-j + Z 0 c >< 0 >< " H .0 Ii Vl z P'l, ro 0 '" U 'z w -< ,-jl 0 .... hi " - I>.. ." C - " c u a ~'!:~: ro, ~ 'n I O"i - -;: :;: ", ~~ 0' 0 lL,I'.. " >< QC 0 : .Ll 2...t " E ." .... H c.;.1~. - + ..! 0 L~ll.l. ! a:nl ~ " 0 0'- ao -' U i.i: "' \Xc..': u.J 0,,, 0- ..... 'w u'" "'..- w'" "'- a:'" ~ ..."" ~ -,u u RCC.33 (4.731 ~ -/(I-J'/ COMMONII'EM,TII OF PENNSYLVANIA DEP,\RTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS . ,;J 1-- ,{; '<Ie RESIDENT DECEDENT COUNTY OF_Cumberland - ~ --- IMPORTANT, This fctUrII II1USI be complelcd ill dClailumJ filed lJl duplicllte, with ull atlllclH'd, with the Regisler of Wills of lhc ('Ullllty \\'Iu'rc decedclIt rcs itlcd; Return is duc wilhin uinc 1Il1l/lllls ufter LillIe of llClIth, unlcss 1111 cxtcnsiun is granted h)' Ihe Sccrelar}' of Ih~\lCllIlC, (Sl'ctiOlI 70.1 uf the Inhcrit:luce illlll EstatL' Tax Acl Ilf JlMl') , I I , I i I J opa~N ~/~" ;':':'~:';~~,~:/~: EST,\TF (IF } IST^TE FUL.I_ N^ME OF nl~CF.lJENTI La'a.f Cumberland _u_____._ -ca.", ' ) 55' :::J ,\FFIIMVIT OF " '~ :i.J cO ~ :0::0 Pl~ ~o ~.,~o -;0 :~rT'l :)0 -;~~ ~ -'1 .'~.~ , " :~.:) Rii&lllclt lrnltXOCMOC Surviv:Lng l@)lO(llfrolWl'>>K heir' ." "'1 ':.J Pennsy 1 vani~_ Slale of County of Ctlmber1 and VirgtJLia.Ji._IIatten.. surviving heir of the cstate or tho obove.nomod decadent being duty sworn, deposeS and sayS X<Klx>iI>~w*w Dccedenl died Dc tober (MONTHl Nomo and address of allorncy or } other authorized represontative ta wl1oll1 all correspondence should bo mailed. 18 (DAY) II)~{IOSIOIC leaving 0 lost will, copy of whir.h is herelo attachOd..} (YEAR) MtX*Mc Irwin. Irwin & Irwin 44 South HrlnOVAl" Stl"eet, Carlisle. Pennsvlvan:La J7013 That as such surviving heirdepol1el1t is familiar with the affairs of said estate and the property constituting (EXECUTO R-AOMINIST RA TO Rl the assels thereof and their fair market valm:. That at the time oj' dcath there was no safe deposit hox registered in deccdcnt's individual nllme, or jointly with, or as agcnt or deputy of another, or in decedellt's individualnamc, with right of access hy another as agent or deputy, with the exception of the following; _ NAME AND ^ODRESS OF BANK OR OTHER INSTllUTION IN WHl'CH DECEDENT RENTED A S....FE DEPOSIT BOX THIS SAFE DEPOSIT BOX RENTED IN NAME OR NAMES OF REL.ATlONSHIP OF JOINT HOLDERS TO DECEDENT That the contenls of said safe deposit box or boxes are itemized under Schedules with the exception-of the following, for the reasons hereinafter set forth: of this return, That Schedule A aUaehcd herelo and made part hereof sels forth fully and in detail all the real property in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof as of date of death of dccedcnl. That Schedule B aUached hereto and made part hereof sels forth fully and in detail all personal property whercsovcr situated owned by Ihe dccederll at the time of death: all moneys left by the decedent at the time of dealh, whether in decedent's immediatc possession, standing to decedent's credit in banks of deposit, savings hanks, trust companies, or other instilutions. whether individually, or in trust for any other person or persons giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's death in the case of savings banks, and to the date of decedent's dealh in all other cases; all bonds, postal savings, treasury certificates or notes and olher evidence of indebtedness of the United States to Ihe de~ cedent; all obligations, whether by statute or agreemcnt they arc dcsignated as tax frec, of the United Stales, or any state, or polilicill subdivision thereof, or of an)' foreign counlry, which .Ire owned at the time of death; all wearing apparel, jewelry. silverware, pictures, books, works of an, household furniture, horses, carriages, automobil(~s, boats, and any ilud all nllu:r personal chattels of whatsoever.\kind or nature, left by decedcnt, together wit,h the fairly estimated m.lrket value thereof; ,all bonds and morlgages held by decedent and of all claims due ilnd owing deccdent al the timc uf t.lcillh. and all promissory notcs or other'instrulllcntli in writing for the paymcJlt of money of which decedent died possessed, of whatsocver nature, with intcrest thereon, if any, giving the face \'allle and l'stinlilted fair market value therenf, and if such estimalcd fair market value be Icss than the fuce value, il sels [orth briefly Ihe reasons for such depreciation as to each item; all moneys payabl~ to the estate from life insurance policies carried by decedent; all annuity a'nd endowment contracts the proceeds of which were payable upon lhe death of the decedcnt; all and the corporate slocks and dividends due thcrcon and unpaid as of lhe date of dcath, honds and accrued inlert"st thereon to the date of decedent's death and other inveSlment securities owncd by the decedcnt al Ihelime of death, with the marker value Ihere- of al such time. ......~L..t,~/-, "-'. eX 1-1-'1-:1'0 A {\ ~ 0Y-y /'/.1.'/ In tilt' (~IlSl~ of sl:clIrltlcs nl' elosl~ or I'llllllly (~OrIHII'lIl.lo'IS. t.tJ1~ vllllll~S l'I!IHlrt,f~rl Ill'f! us f'ur IlS possihle suhsIHnltnt.t'll hy f'IIIHIH:lnl sLIlt.eml'lIt.s 01' ltw c:OI'llIll'IlI.I'II1S. SIIlIWIIll!; 1.I11! HssI.'l.S IIIlII 1lHhtlltl~s th~'rcol' IH; 0(' the f1IIU' of dellth. TIll! seheclulf! IIlso S(!!s forl.h I,II'! 11I1YI'1!sl. 01' rll'f:l!dl'nl. Ill. the t.lmH uf' df'nt.h In /lilY l'n-p'lrt.rmrsltlp or hl1!'> I IWS!'> , lIllIl In sllpport of' Ull' V/llw! or <;111"11 Int.prl'!'ll. tllI.'I'" Is IIIl1Jexl!d t.o sltld SChf'flllll', 1'I11111u'Inl st.ntl'nlmll.s shl)wll1~ ..hf'IlSS'!t.s /tlld IllllJ111111!s 01' sllle! r.o-plll'uwrsltlp or hll!';lness. AC'{lr~' of' Uu' en-purt.OI!rship /lp;rf'f!lnl'llt, (If' nrlll, II sl.lltt'l11....nl. sl'ltll1~~ f'ol'lh UtI' Iwl.llrf' of' t.Ilf~ n,gr('I'lm~nt) togl.t.JH:!r wlt.h It stntt'mlml'. se1.t.in)!; I'orth llll! Chlll'llcll!r 01' t.11I! hl1S1l11'SS, II.H IOI~Ilt.llll1, and SllCh other ('nets pertntntn,g to the bus1ness liS lIU1Y he pert.lnent. 10 /I f'lIlr IITle! .Inst Ilpprlllslll of t.he dl~c:erlelll'.ls Inl,l!rest. tlmrHln must. he slIhmtttf'fl. It. slumlfi nlsn 5f!t forth In It.nrnl',.I!(1 f'orm, t.o)!;t'Uwr with t.he f'ntr mnrkl~t vnlue t.hereof, Iln~' ot.her propert,y owned or bCqllf111thl!ll hy t.1t/' dpcpdf:!lIt. lit t 11(' 1. I 111!,' of' dl'lll.llt TI1l! Schedulf' C Ilt.tllcherl heret.o IInl! mildI:' Jllll'" !lPI'col' Ht'ls l'ort.1! II t.rue nnswer t.o l!flCh in1lutry contnined t.l1nrt~ln ullllin tlH! ellSI' of' I.rnnst'f!rs (JfprOpiH't,\', 1'1'111 "r p..rsmwl, wtl.llin two yellrs of de{:mtent's death, in contemplation or deCf!lhmt.' S Ih'?elth, or lnt.enrh!d t.o t nkt' pf'l'pc!. III possesslon or cn.1oymlmt. ell or after death, Sllill sehl'dllle ~wts forth t.he nelt,lIrf~ Ilnd vlIlllP. of' sHeh pro!'('!'I,y, 1,0 whom trltnsferred, the relationship of t.he trans t'ereeS to the rleceden t, UU! propor t.I Otlll t.e Shn~l! I'oee i veil h~' ench t,rullsf'eree and all other fnets of a pertinent nature reJ!;nrrlinl!; sHtll t.rnn!'lf'er~. In t.he cusp. of trllnsfers intenrlerl to take effect in llossesslon or enjoyment. ltt or lifter rlnHth, t.here Is ell so Ilt.t.lldH'rl to the schedule n cony of the {teed, trust agreement or other instrument crenUng the l'.I'USl.. Tltnrl~ Is also set forth Lo said schedule n list, of 1111 property, real nnel pcrsonn1, with it.!'; \'111 lie, widell JlIl:'iSCS nt decedent's dent.h by virtue of the exercise hy dec~~dent, l!ither individuldly, or.1ointl~' with Ilnother, or any powl!r of' appoint.- ment vested in decedent, oltllor inrtivilluully or ,1ointly, hy thp wUl, lteed, or nt.her inst1'ument of' anot.her1 with 1\ eopy of the instrument. crenttng such power nt.tHelletl t,o thp schedule. That Schedule 0 fl.ttnchecl hereto nnd mmle part, 11(!rl'of seLs fort.h the Hilmes nnrI addresses of 1I11 persons benef"icially interested in this est/lte nt. t.h(~ time of' d'?cedp.nt.' s Itenth, the nature of' their res- pective int.erests, their relatIonship, if' any, to tIlf~ cleccdellt, t.oget.her wit.h the ngp.s Ilt the time of decedent's death of III I minors, annuitnnts and hcnef'tciltrtes I'or lif'e lIIHler fleccdellt's WLll. It also contains n stn.t.ement showing whIch of' tile llcnef'icillrtes nlUn+}d in the r1f'(:p.dcnl'.'s will, II' any, dted prior to decedent, the dntes of their dellt~h, t.hel,r Issue, Imll t.he i"f1lnt.lonsll'-JI of" stich Issue to the hcncf'iclnry. That S.:hedule E nttllched hereto nno mnde fl pHrt hereof' scts forth all propert~t, renl liIlcl per- sonal, owned by the decedent ,10intly with nnotller or ot.hers, IncllJ11lnl; intnngihle, standing in the flume of the decedent and others, plus the dat.e nnd pInce of' recorrt of Instl'uments eff'ecting the vcsti ture of real estate Hnrl the date of acquls1t1.on of llersonnlty, plus the nfllne, Illtrlress Hnl! relntionship, if' nny, of co-owners to the deceden t. That Sc/1edule F nttllched hereto and mfHte fl pllrt, hereof' gets forth flllly Imd in detedl fl.11 rlebts and deductions claimed for nnn on behalf of this clf.!eedent's estute, lncllutlnp'; rllllerlll expenses paid; family exemption, where nppl ienll10; costs of IIdminlstrlltlon of' this estllt.e; conosel fees nod f'ndicinry' 5 commissions patd or t.o he IHlid; cost. expenlled for huried t.rust.s, t.omhstones or grllvemllrkers, and reli- gious services, io coosequence of the de,1I;h of the dece,l.ut.; deht.s "ud cl "ims owing nOli unpnld Ilt. t.ime of death; taxes accrucrl chargeable f'or periofl prior to flecedent's Ilenth (except those nllowed under Section 65101' the Inheritance lInd Ii:stnte Tux Act); together with (t statement. of' eollaterlll vtcflgert f'ol" obliga- tions, if any. It is agreed thn.t t.he fiduciary wlll present proof of' sfdd elnirned Olllt.J;/ltions upon re- quest, that if the nmonnt. nctllI11l~' plltcl in settlement of' /lny fee, eOllJluission or debt is less than the estimateri nmount cl1dmlng fUld 1l110werl, that tlH! slime will he report-en to the Hl'glster of Wills, and that the amount of tax I\sse'~sed cnn he renssessed in IlceorrlHn{',e t.herewl tho That the totnls of' the npproprlntc COll1ll1T15 in Schedules "A", "Il", "e", "E", /lud "F" ns directell therein, have heen cllrrJell f'orwnro nnri properl~' re~lst.er('d In t.he SUlTunnry. Subscribed and sworn to before me this e ;:it .......,...............~.: " day of '" "".' ~.'U,:'~ ......--......~LGC)"- '-3, ~ ( I. 0" , ".19,..,.8,1 "',1~~i:c;~d~~jk~....,.,......_,.. " ,,2, 51[$~;llthJ:!.a.,l}gY.~r....$.tr.~-~..t..............._" (Street Number) Carl i,sl~J y'"D.D.:'lyl.,Yi3,nta,UQl3...., , (City In" Town and State) sorE: Bef'or'c sip;u1np; uff'ldll\'lt m!lI,I~ ~lIrP 1111 blank HIHlPes ill tlll'? 1l1'l'ilill\'11. Ulllt schelhlles annexed lire filled In wit.h det.nils or the \liord "Sone", and 111 r.llS(~ t.he /lHspls inellHle r/lrc Itlllt unlisted sccuritll'!s, securities of clnse or 1'/lm11y corporlltinns or 1m lllt.f'rt~st tn an~' eo-pllrlTH'rship or hIlSlll'~SS, thut the rlutfl. nnd stR.t~01ents rC'luirl'd mutcr the pllrfl~rapl1 /llJflv~ rl']ilUng; tu Scl1l'rhltl.' "Il" llJ"P nttncltecl. ,\]so mllke cert.aJn thnt column #1 in t.lll' "SuTlvnnry" hilS hel'T1 prn\lf'rly t'nmplt"tPcl liS I\bovp-.tlr.'c1..~d. !',:'il,:'" REV"453 (8"781 pI. '~ ;';"~ <!'J"~I ~ 'f(.JJA,.' 'F?(,~.itJ;J,~, S1:'~':I:tyQ..~ COMMONII'EALTII OF PENNSYLVANIA TRANSFER INIIERITANCE TAX RESIDENT DECEDENT SClIEUUl.lc "U" BENEI'I('I,\RIES .__________4._..______..__.______ -.--.------- --.-------- llENEFIClARIES AND AllDRFSSES (Suite full namcs uml addrcsscs of all who huve an interest, vcstcd. contingent or othl..'t~ wise, in cstl1tc) I 1l1\'11'1 1l11~~:"1 y" -=- - - t- 'llio," ===t-_J .t--~ ==t=~~ ~-- ~ .~ RELATIONSIIII' (Ii NICp.dliltlren or illc!o!oitillllltl~ chihlren IIrc invulved. st't forth tltis facl,) SUR\'!VI:\) DECEDENT STATE YE~ OR NO 11'0'1'1'10'"'' OF IlENEI-1C1AII Y IN ESTATE Virginia B. ~atten 251 South Hanover Street, Carlisle, Pennsylvania 17 Dau hter 13 ~ _m_________ ______,,__,__---1. _ ._.~_4.________.__"_________ "--------- Deponent further says that all the above-named beneficiaries ore living at this time except be~ow: NAME DATE OF DEA1i4__. RESIDENCE - '::rJl:= ~~ It. ~. C .- ~ ~ C - 3 'E~ - _0.0 v E U '10" :;U:t, - - ~ o ~ - U 0 - ~ e g, Yo U :;! " SU.\I~I"ln' (I) (As Reported) - 0 - 1.776.06 - 0 - Ij,b90.tJb ROlli l''''l,erty Personnl Propert)' Tra{ISfcrs JOlntlL.Ql:illed (Sl:h. "A") (Seh. HU") (Sell, "e") $ $ ,$ $ $ $ -li,J!6.6.., 92 Gruss Taxahle Estate --'__. n_._..._._ ~ fo- "0 ~ Z ~ " W ~ " :::;: " ;:.. ~ W u .c: '" " .J - .c:Q bO <t ..: :; VI co:: u.. bO 0 .~ :i c.. 0 :; H '0 '" c.. 0 0 C ~ 0.. " ..: " w ri p:j (1j 0.. .:: W '::fo- ri ri ;;, <t 0 fo- fo-..: :; QJ H ~ :I: c 0 Z c ....fo- e) ri OJ c '- fo- 0", C) Ul .0 ~ Z u.. W :E: ',-i E c.. <t 0 ri :; .... I- " 0 '" .51 H u - co:: p:j (1j -5 0 '" W u -;; 0.. ~ f0- ri u W - .... '" '" fo- <1J c " '" ..: p. .... c - "S :::;: c t, 0 0 u c E :::"'0 ;; 0 E ;::~ c 0 .J U U (2) (As Delermioed) $ $ $ $ $- $ . . RCC.Jtl cO' ,I;. U~~' 'l\!1 (fi!;;" 0.' ~Thi' "(.1u,} COMMONWEALTII 01' I'ENNSYLV,\NI,\ Tll,\NSFER INIIF.I(IT;\NCE T,\X SCIIEDlII_E "F" .Ill"" fLY Il\V~EIlI'IWI'I'I(TY IlESIllENT IJECEIJENT INJ;T\(lIITltlNS, T101' ,,,1..,",,1,' ",,,,I. "1",1",", "II 1'rol','rl)'. ".."I a",' 1",,,,",,,,01, -",:!~hY 110" """""..,,1. .Iol"Uy .1110 1",,,tI..,,' ,,,. """'1':" ,,,,,11,,'1,," ''''"oglhl''', ,I"""l",,, I" u,.. ,,,,,,,,, "I' II,.. "..,.,.".."' ..,,01 "th''''s. Lht r,.a1 .."..1" I'II'sl. '"' ",,111,..11"" "" ,\01'" "'''''''''. I',lvl'.., 101""1' 01"""'11"1"0. ,", 1"011",,,,,,, """.." S"",,,oI,,I,' ',I'. I'I"s th" 01..,"' ,,,,,I 1'1'"", or r,'..orol or lo,tr"","o' ..1'1'","10", v.."1 """', h'" 01" "ot. ,,,..I,,,;,, ,'"L1,,"u.." '''' ",,' or ,ta'" I,.'a' ",I.,,'" ,,01"" ,,, ",;[..,.. "01110,'1",, ""I,,,,,,,. \"".,,,,,,,01 l,r"I,,'rl,y ,ho"I" 10.. 11'1.,.01 0" ,,, Srh,'oI"I,' 'II", \,1"s ,Ia,"' ,,1' ""'1"lsl'I"", ,,,.., 'h" """,". ,,,I"r'''.., """ r..'a,I"",hll' (1l' a"y) or "o-ow"..r" to thl' 1II'I,..dl'lll.. - - -=--===--:----- IJEIIAlrl't,tEN'f VI\I.UA1'10~ (;,\111'ION-Do lint. WI'1I.l! I II Tht:=; ( '\Cl~. \'11(1 PI~rl'l'Il'Hg'~ l,:~tllt,t' Vn 1 Ill' Still"" VIlI\1lLt.loll Vnluo of' Entl rl! Pl'ope r ty ,Ill lie ur IlI'cel\l!l1L'S 11ltl~ I'CSt Commonwealth National Bank: Savings account #18-0010313-4 Reg. Opal B. McCullough and Virginia B. Hatten Opened 1/24/58 Closed 10/3/80 50% 6,190.86 Commonwealth National Bank: Evergreen Savings #18-0011214-4 Reg. Opal B. McCullough and Virginia B. Hatten Opened 7/21/75 Closed 10/3/80 50% 7,500.00 - ]I\sert. this totH] opposite ".lo\ntly OWlled Propel'l~,II, Sclledul,-~ "E" .in the "As l\l!llOrt,edll colmlll on t1i.~ lust PH;;!;.! or thts return. 13,690.86 I~"?CIN~ _$f{ V REIJ~48" \8..78) SUMMARY Estate Name Cumberland 21-81-0090 October 18, 1980 r~cCullOuf!h OpRl (LAST NA.ME) {FIRST NA.MEI ~ II REPORi OF INHERli ANCE i AX APPRAISER B. COMMONWEAL TH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIOEtlT DECEDENT County, NumbCH and Harne File Number Date of Dealh l\NIT1ALl I, the undersigned duly appainled Inheritance iax Appraiser in and for tho County of Cumberland Penn.ylvania, do respectfully reparl thai I have appraised the real and personal property o. reported in Ihe foregoing relurn at the values set forth opposite each item in the la.t column to the right in Schadule. "A", "B", "C", and "E". Dated: MArch I? 1 g8l llI'M/17 )-/!'/"/lIlkJ) INHERITANCE TAX. APPi<At5ER I, Ihe undersigned duly elected Register of Wills in and for cumberland County, Pennsylvania, do respect- fully report that I hove allowed deductions in the amounts claimed by deponent, except oS \0 tho.e items where a greater or lesser amount is set forth in tho last column to tho right in Schedule "F", which grootor or lesser amount reprosents the sum allowed as a deduction. REPORi OF iHE REGISiER OF WILLS INVENTORY VALUE AS APPRAISED ~ REG15Tl::H OF WILL~ \ AOJUSTMENTS ODE (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE 92+ Doled: Real Property (Schedule Al Personal Proportv (Schedule B1 Joint.Held Property (Schedule E) Transfers (Schedule CI TOTAL GROSS ASSETS Less Debts and Deductions {SCHEDULE FI CLEAR VALUE OF ESTATE S 00+ 06 tOt 86 20t 30t 2 g3- 4Q. PRINCIPL.E fACTOR +==. VA\...UE E.Q.~ - annuitIes............ .........- $ Valuation of life estates or \= F= E5TATE TAX A55ESSMENT5 _5 COMPUTAiIOI"- OF TAX FOR USE OF REGISTER ONI..Y Tax on $ Tax on $ Tax on $ Tax on $ T ax on $ Exemptions Toto\ Estate cooe: 5 $ 5 $ $ ('1 As lJvidenccd by Charltablo EX(lmpllon CortUlc~tes Issued by the Secretory ot Revenue. 2% G% 1!i'~ $ TOTAL TAX LosS tGJI: previOUSly paid BA LANCE LesS 5% of talt if paid within 3 months after death $ :~ t= BALANCE OF INHERITANCE TAX DUE Add intcrost al rote of 6% from to AMOUNT OF ESTATE TAX ASSESSED Este'e to.IC pold BALANCE DUE Add interest ot rote of 6% from to $ I 1= s r- s 5 L- $ \-= S S I TOT AL T AX BALANCE PAID Supplemental Codes: (FOR USE IN HARRISBURG ONL Yl 48_Adju.tment 49+Adjustment 56_Annuity 6O_Life Estate 92+Remainder Appraisal 93_Remainder Deduction 9 3C-Cha.i1y 94_Rcmoinder RCiidue 96_5uccessive Life Eslolo FOR USE OF REGI5iER ONLY NOiE: Where subsequent adjustments are made 10 the above computation of lax by the Register 01 Wills lor proper reason same should be noted below, with short explanation. " ADJUSTMEIUS ~ f- ....l Z '" .. t1J . -r. " ::; " CIl " " - ;.. t1J . -r. u CIl u .<:: 0:: :< Q 0. 0:: ;::s " 0. 0. Ll.. .<:: 0 '2 -r. 0. 0 bD H 'd " Q tll < '" ;::s 0 >: ;- z '" :c t1J 0 (J:I (1j - < f-o t1J f-o f- M ;., M on 0 ~ ;l:: '" < M l1> H c f- Z f- 0 f- ;::s M l1> c 0:: Ll.. CIl u "' .0 " 0 0 t1J " 'M " 0. 0. r-'? ~ M ;::s ~ iJJ 0:: H 0 0:: u ,:l t1J . (1j ~ - - f- (J:I u ";;j " .. f- - " on ...: M ~ i< 0 '" 2 (1j ~ c 0. c ;., ~ ::::'5 - 0 ;J C '-"0 " " ""< " 0 0 ....l U U ".... ~ ~ t3 ~ ~ 'lR ~ ~ ~ \D >- >- ::> ~ '6 'g '" :>: ;:l Q) I1l ..l . M M :!l t'l III s.. '... Q) >-'I M 1 M c-. r<'I ~ Z ~ Ii! M '" ~ 0 M .. 0 0 0 ~ ~ 0 ~ ~ ~ 0 1;; 0 rfl Z 0 .. ~ '" >- f-< 0 ~ ~ \:l f-< ~ Z z ::l 0 0 z ~ ~ ~ z Z f-< c:l ;:l u ~ ~ ~ 8 0 z Ii '" - ~ c:l "'" ..l .:? ! - It' I. ~/;~ HEV.455 EX" tJ.IiO' COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "F" STATEMENT OF DEBTS AND DEDUCTIONS ._~=.~=.'.;",;:,,'..o.;;':~".;."'. ....:.:,___..:.........."'.-=,'-_.____.._.____... Estate of OPAL B. McCULLOUGH Datf!orD"athOct..18,198Cl'ileNo, WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING: '" ~~.,::~ ~';].) ~;..~ r:~() i~' ::~ Claimant Claimant's Address ITEM NO. DATE NAME OF PAYEE Benny Rowe Auct:Loneer Ewin Bros.Funeral Home Belvedere Medical Corp. Carl:Lsle Rad:Lolo Assoc. Presbyter:Lan Homes Inc. Roger B. Irw:Ln Wolf Trash Serv:Lces MGM Pharmac Un:L ted 'l'ele hone Co. PP&L Company UGI Wagner Haulin Reg:Lster of' Wills Register of' Wills Roger B. Irwin Irwin, Irwin & Irwin arold Kretzin arlisle Hos :Ltal 00 ~ .,,'" i,,"" I;~g __).'_J ,n ~l :.J .; ~:l Relationship to Decedent_. 'I .." :xl REMARKS -.~~--. ~ "" ~ AMOUNT ...... Public sale expense EllJler'al seY'vicF's edical services _. -rFl v ser oom and board egal fee Power of' Attorne rash collection edicat:Lon lectric bill as bill D&D ~otar fee ttorne f'ee ~edical serv:Lces os :Ltal services TOTAL THIS PAGE $ 5,613.61 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 submilted to the est"te as deductions for Inherita 'celt; purposes, ~ I J j J. '! . <,. , (, ~ 1 ,2. & If? I SIGNAT RE or~ ATTOHNf:V/FtrJUCIARY GATE I OFFICIAL W E ONLY DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S I~- /'!:3. L, I J t, PERCENT, AT ) .. '_C~{,::.!/' ,J~/~-rYl DAT[ 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 are claimubie including the cost of administration, attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone or gruve marker. All debts being claimed against an estate are subject to the approval of the Register of Wills with whom the Inheritance Tsx 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 $2,000 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. I n the event there is no such spouse or chiid, 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 which pass by a will or by the Pennsylvania I ntestate Laws. c '" 0 (") > t'1 :> :a > 0 0 0 (Jl 1::1 - Z Cl (") c:: 0 .., z 3: z t"" t"'1 t"'1 ~ 9 9 t"" ~ Z ;;l - z Z t"'1 .., t"'1 Z 9 9 .., -< (Jl t"'1 - '" z 0 (Jl 0 .., 9 ." ;;l ." ~ ~ 0 ~ - ~ 0 - z (") - > t"" c: (Jl t"I 0 Z ><: ><: !( t'1 t'1 ..... ~ ~ INSTRUCTIONS FOR COMPLETING SCHEDULE "e 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,