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Home My WebLink About81-00095 ie ~ till lo:l . 0 ~.g roi ~ I, Ii .:J: -0 In E-l .(f) . - o ~. ... .CD ... If) U.I ~' t 14 ..J () gj ~ . .iit 0 riI ~ ~ H ~ '" ; " .' , .' " , , . ~ . . . . OATH OF SUIISCRIIIING WITNESS COMMONWEALTH,~FPENN~YL~.~.NIA I ss: COUNTY or CUMBERLAND I.. "J' ~ "t'.,' ,"I This 6th day of February A.D.,19 81 before me, Register for the Probate of Wills and granting lellers of Administration in and for said County of Cumberland, in the Commonwealth of Pennsylvania, personally eame Tom H. Bietsch and Janice E. Hertzler the subscribing witnesses to the foregoing instrument of wrilir,g purporting to be the last Will and Testament of Miriam E. Heck Dated May 20, 1980 late of North Middleton Township Cumberland County Pa., deceased w,ho being duly sworn according to law, depose and say, that. they were present, and saw and heard.the testa trix Miriam E. Heck sign, seal, publish, pronounce and declare the said . - instrument ~f writing as and for h-1:L-Testament and Last Will, and at the time of so doing . she their was of sound and disposing mind memory and understanding, to the best of knowledge, observation and belief. Sworn to and subscribed before ~\1~ \J~l.N~,~ ?J;;/'7 (!. ;;<,,~;,) Register AFFIDA VIT OF DEA I'll COMMONWEALTH or PENNSYLVANIA t ss: COUNTY or CUMBERLAND \ ",' Robert K. Reitzel; Trust Manager. The Carrnonwealth National Bank, being duly sworn says that as aearly as can be ascertained the said decedent__ Miriam E. Heck died on Friday the 30th day of at or about 5:qO o'clock, ~M. Sworn to and subscribed this 6th day of February January A.D.,19 81 , "'~O" ~ ~7 ~#/- {? '~/r~/ Register 10?;1 ---- - - --.- ----- ....-.... __ r-" __ .."'" .~ REV.1162EX '~I COMMONWEALTH OF PENNSYLVANIA 4 NoK 29467 DEPARTMENT OF REVENUE . ., OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX If '" ; II = ow II ~ --- -..~-~~...~.... - lAX Al (j";, lAXAl15% I ' RECEIVED . FROM Commonwealth Net. Bank fAXA1_l),j " ADDRESS 1 N. Hanover at. ESlATElAX Carlisle. fA 17013 .--ESTATEWFOAMAT~N:-------------------------- DAlE OF DEATH .Tanuary ;lO-llBJ.. 10TAL TAX CREDIT ~'. tnn,nn FILE NUMBER 21-81-95 DATE OF PAYMENT Aril 29 1981 NAME OF DECEDENT Miriam 1':. Heck i COUNTY Cumber land POSTMARK DATE REMARKS ill ill LESS DISCOUNT PLUS % INTEREST (FROM 10_1 105.00 r--------------------____________________.__ TOTAL AMOUNT PAID $1.995.00 "PAID ON ACCOUNT" SEAL IIECEIVED BY / / ! '. \ ., / ,- .-,:..---/ SIGNATURE.. . I Hf (il:-,!l Il Of \\'IU S ....- .-,-.. ..~ .-.. ....- ----- -- -- - - -- "---~ ..-- -- -.-- -- -- Commonwealth J~ National Bank ~ April 30, 1981 Oauphin Oeposit Trust Company 2 West High Street Carlisle, Pennsylvania 17013 We, The Commonliealth National Bank, as the Executor/Administrator of the Estate of Miriam E. Heck , a resident of North Middleton Township , Social Security # 160-16-434/ , request the below information as of the decedent's date of death, Januarv 30. 1981 . Your cOl'!pletion of the following report \~ill be sincerely appreciated. IF THE ANSHER TO ANY ITEI1 IS "NOttE," PLEASE SO STATE. Kindly mail it in the enclosed stamped, addressed envelope. Thank you. /) J, /1 ./ /j{jW: r . d-' "- THE CONr.l0NHEAL TH NAT,ONA 8ANK I I Report from (Bank) Oauphin Deposit Bank & Trust Co. NOTE - If the space provided is inadequate, please attach a statement giving full details in the format 9iven below. 1. At the close of business 011 January 30, 1981 our l'ecords showed the following balance(s) to the credit of the above-named decedent. In the event that we could readily ascertain whether there vlere any balances to the credit of the customer not desig- nated in this request, the appropriate information is given below. Registered Owner(s) Accrued *Interest Taxable Account Number Type of Account And Date Amount Interest On Decedent I s Account Established Final Return 16327 Cert. of Dep. Miriam E. Heck dated 5.000.00 85.29 85.29 7-1/4% due 8/7 /78 8/7/82 6088 Cert. of Dep. Miriam E. Heck dated 5.000.00 28.27 28.27 maturity date 7/2/74 7/2/78 Heck dated 6D89 Cert. of Dep. Miriam E. 5.000.00 28.27 28.27 dated 7/2/78 7/2/74 001929 Cert. of Dep. Miriam E. Heck dated 5.000.00 35.90 35.90 10.15% 1/8/80 *The amount of interest paid to the decedent or credited to the account from January 1 to (and inclUding) date of death. The amount accrued at date of death would not be included in this figure. " The Commonwealth National Bank. 10 South Market Square, Harrisburg, Pa. 17108 (717) 564.9500 1. Did decedent, within two years of death, make any transfer of any material part of his estate without receiving valuable and adequate consideration? (Answer "Yes" or "No".) NO 2. Did decedent, within two years of death, transfer propClty from himself! herself to himself/herself and another party or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) -1ill- 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. Nt A b. Copy of death certificate. c. Affidavit by the attending physician indicating the state of decedent's health at time of transfer. d. All other information supporting nontaxabilily of transfer. 4, Did decedent, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consideration therefor which was to take effect in possession or enjoyment at or after his/her death? (Answer "Yes" or "No".) 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".) NO b. What was the transferee's age at time of decedent's death? NIA 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".) lID- b. The right to 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. above is "Yes," was the right reserved in decedent alone ( ) or decedent and olhers (). N/A 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 al ter, amend, or revoke, or which could revert to decedent under terms of iransfer or by operation of law? (Answer "Yes" or "No".) YES 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 decedent and others (). Decedent alone QUESTIONS CONCERNING PROPERTY TRANSFERS Commonwealth National Bank [J,11;' ...:\ :..\ .......'....:'..y.'.:- \~,:.., C Ca~h AfllCJlJ1l1 S 41. 581. 82 ..19097011........ . Tlus~ Apr(!crnunl Nc" Th!~ TRUST I~ ~S:(dll:~h.;\~ !;i'lWt'l;l" TI1': COlT1mOIlWt~ijllh N.ltlollal BanI-. <15 TrlJ~lee and tIle undersigned a~ ~~tt!OI. ThL' st.!lllOl h']Il~b\' W.Wl~, Eo' CC)[1','{:\'5 to the Trustee i1ll fight, l!tie and interest III the ciI!.h amount Indicated ab(\vt: .1nd to JIlV OUlPI assets or l.l!lil:tles set fOlth on Schedule "A", which may be altJchceJ to fllld macje a part oi lhl~ dprecJnr.nt In 111,111,10"1\1 these <lnd all\, o:her a~S'!I~, ::.ubsequcntl\' translt?IH!(j to tillS TRUST, the TllJstet' 15 charged with IIH,' follOWing dutH!s: kf!er th!' il~Se!~ safely, usp \Iw cme and attenlion whIch il reasonably prudent man would devote 10 tlw management 01 his own fmandal afj<i1r~. considering the economic conditions of the tlm!:: adVISe the settlor monthly of tile past month's transactions and the valuation of asseTS held at month end, and annually of any neces. sary Information for the preparation of the scttlol's tax returns; transfer the net incomr each month to the prinCipal of the TRUST for reinvestment, to or for the use of the settlor,.to the settlor's checkmg account as mdicated below, or to other persons in amounts described in a separate letter delivered to the Trustee. In addition to those powers granted by law, the Trustee may exercise the following powers in order to perform the above duties: receive proceeds from the sale, maturity, call or conversion of TRUST assets; invt!st in and buy or sell assets (including real or personal property, common funds managed by the Trustee, and obligations. deposit C:lccounts, or slock of the bank or its affiliatesl subject to the settlor's guidelines indicated below; borrow money at reasonable rates and pledge TRUST assets as collateral, should it be prudent to do so; pay any necessary expenses. including reasonable Trustee's compensation; allocate transactions between income and principal as the Trustee deems best; and handle routine matters according to the Trustee's -best judgment, including but not limIted to making timelv exchange of temporary issues for permanent, executing proxies or voting shares, buying or selling fractional shares, and exercising, holding, Of selling warrants representing rights received in corporate recapitalizations or rcorg~nizat ions. The settlor may alter or amend thiS TRUST in any way provided that such change does not result in making the TRUST irrevocable or creating dispositive provisions to take effect at or after the settlor's death. The settlor may add to or withdraw from the TRUST'S income or principal at any time, subject only to providing reasonable notice, and may provide for automatic funding by indicating below. The TRUST shall terminate upon the settlor's death with principal and undistl ib~,ted income being paid into the settlor's estate. The Trustee may expend TRUST income or principal in behalf of thE.! settlor at his direction 01 in behalf of any named beneficiary to the extent of his beneficial int~rest. Only the settlol shall have the power to assign or encumber his interest in the TRUST or other. wise cause its assets to become liable for the payment of a beneficiary's personal obligation or debt. The Trustee is responsible for losses caused by its gross negligence but not for other losses such as, but not limited to, those created by fluctuation in market valuations. The Trustee is not required to account to anyone, except as described above, unlf.!ss expressly directed in writing by the settlor or his personalrcpresentative. Either party may terminate this TR UST at any time. subject only to providing reasonable notice. This agreement is not binding upon the bank until such time as it has been accepted by an administrative officer, who will be assigned to the TRUST; this officer will be in contact with the settlor and may be called upon by him at any time. INVESTMENT GUIDELINES ........... Commercial paper I ........... Treasury bills ....X..... Taxable bonds ..... ...... Tax exempt bonds ........... Common stocks .... ....... Trustee's discretion AUTOMATIC FUNDING ( ) The Trustee is to charge my checking 'jji.Ll..'---;:\ ..i,... \~.~- ..;.,.(. ............s.l!jriiiiijic............................. account S ...... ......................... on the ......................... of each .................. and add it to this TRUST for investment Hiriam E. Heck ............~j,.lriiea.ii.1me......................... INCOME TRANSFER ....X..... For reinvestment . .......... To checking AIC ........... To address shown . .Church.. of.. r.od..llome.............. Sheet aCl!flc~s ..249,-,5322........ ..16n_.l "-4-34.1. Phone No. Soc. ~ec."'r~o. 4.......fu.tJO,Jftlq ....Retired....... ~JlIl 01 ~ r1h 'OccupalHlI 801 lIarrisburg Pike ............ C.(IY: 'si.1ic':Z"(p .friil.c'............... Carlisle, PA 17013 . ......... '.C'tlc.ckin'g 'ACCO'lin't' NO:-......... -.. ONL Y YOUR ATTORNEY CAN PROVIDE LEGAL ADVICE FORM 197 JKG REV-453 E)(+ (10.110) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "0" BENEFICIARIES ~.. ~~W r~l~~.~ '.0i~I/%ti (Instructions on Reverse Skin) Estate of Miriam E. Heck BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY DECEDENT BIRTH Florence A. Thompson Daughter Yes Legal Bequest of $100.00 R.O. #2 Pill mvra Pa. 17078 John L. Bell Grandson Yes Legal Bequest of $100.00 R.O. #1. Box 109 Clavton Del. 19938 Marv Louise Swartz Granddauqhter Yes Leqal 8eouest of $100.00 30 . Rovalton, Pa. 17057 Linda A. Wilt Granddaughter Yes Legal Bequest of $100.00 708 N. Harrisburg St. Steelton Pa. 17113 _r.il,.nl " Sinnn,. r,randdaughtp,. Yp< I pnill 1Rpnuest nf ~lon ~_ P.O. Box 126 Lander, Wyoming 82520 ~. Gordean A. Yohe Son Yes Legal Residue of estate 1504 Thompson St. Harrisburg, Pa. 17104 . The above beneficiaries were living at the time of the decedent's death except for the following: NAME DATE OF DEATH If additional space is necessary, USe 8Y2" x "., sheets. REV.454 EX. (3.801 COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY * (Instructlons on ReveNw Sicle) Estate of Miriam E. Heck . \<i r I ITEM TOTAL VALUE OF DEPARTMENT NO. DESCRIPTION MARKET DECEDENT'S VALUATION VALUE N INTEREST (Official U.a Only) = T 1 Savings Certificate No. 132883 with Harris Savings Association, at 7l.%, dated 3-6-78. Regi stered in names of Mi ri am E. fleck and Gordean A. Yohe. 5,000.00 50% 2,500,00 2 Interest accrued to date of death on item no.2 30.30 50% 15.15 3 Checking Account No. 1921072359 with The Commonwealth National Bank. Registered in names of Miriam E. Heck and Gordean A. Yohe. 2,032.30 50% 1,016.15 4 Statement Savings Account No. 1900020155 with The Commonwealth National Bank 34.77 50% 17.39 . TOTAL THIS PAGE 3,548.69 .:f:$~j'.6f At:> 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 right of survivor~hip. Botl1 tangible and inton\Jible property arc to be 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 lor Schedule "B". Include the name, address and relationship to the decedent of the co.owner (s) and the date the joint ownership wos estabiished. 2. Indicate the total market value of the jointly owned propertv. 3. Indicate the percentage of the decedent's interest. 4. Indicate the market value of the decedent's interest. C ." v n :>- rT1 :>- .... ;<. 0 Ul "" Z 0 U t:I - C1 n e u -l Z "" Z t'" rT1 t'1 ~ Z - >- 9 - 9 t'" Z ,. -l - Z rT1 -l 1'"J ~ P P -l ~ Ul rT1 Ul Z 0 'J1 0 -l ? ." ." ;::l ~ ~ 0 "'l - ." 0 c::; Z - :>- t'" c:: Ul rT1 0 Z ~ ~ :( ~ r'1 '" :>- ;,. ;::l ::c f' . ,. Commonweal th Jt\. NadonalBank ~ February 20, 1981 Mr. John Ha rt Commonl'lealth National Bank 10 South Market Square Harrisburg, Pennsylvania 17108 . He, The Commom,ealth National Bank, as the Executor/AdministratDr of the Estate of Miriam E. Heck , a resident of North Middleton TownshiD , Social Security #..liQ:li.-4347 ,request the below information as of the decedent's date aT death, January 30. 19B1 Your COl'lp 1 et i on of the fo 11 OI./i ng report wi 11 be sincere ly appreci ated. IF TH E ANS\oIER TO ANY ITEH IS "NOllE," PLEASE SO STATE. Kindly mail it in the enclose stamped, addressed envelope. Thank you. Report from (Bank) Coml'lonl'/ealth National Bank NOTE - If the space provided is inadequate, please attach a statement giving full details in the format given below. 1. At the close of business on Januarv 30. 19..ID..., our records showed the following balance(s) to the credit of the above-named decedent. In the event that we could readily ascertain whether there ~/ere any balances to the credit of the customer not desig- . nated in this request, the appropriate information is given below. Registered Owner(s) Accrued *Interest Taxable Account Number Type of Account And Oate Amount Interest On Oecedent's Account Established Fi na 1 Return 1921072359 Checking Account Miriam E. Heck and Gordean A. Yohe ;}ON.:3O , 1900020155 Statement Saving. Miriam E. Heck and :Ji.f. ?? ,IS- Gordean A. Yohe *The amount of interest paid to the decedent or credited to the account from January 1 to (and including) date of death. The amount accrued at date of death would not be included in this figure. The Common.....ealth National Bank, 10 South Market Square. Harri!lburg, Pa. 17108 17171564.9500 t"' ~ ~ (~ ~ t'1 ~ :5 z 0 0 '" C'l () c: ~ ~ z E: z I:"" t'1 t%l ~ z 1:l 9 - 9 I:"" Z Z t'1 .., ..; z 9 .., t'1 - P >< '" ~ z 0 '" 0 9 "Ij "Ij ~ ~ 0 ..~) ." ~ - c.~ '-. 0 "Ij - ~.' ' ", r.:' Z () L, IS: t,,:' ;; l:... ~~ ~ 0:: I:"" 6'. I c:: ul.:i c~ , '" C'-" ~ (!;!i: t'1 O:V~ c..o f-,~ 0(3 c::; '",-, 0( 0( 0 '-'w ~.~- t'1 t%l Z ",.- l:t'" ~ -:;, )- ~ :< SO ~u ~ t.> ..... REY-4U EX+ (&-80) INHERITANCE TAX SUMMARY SHEET (BUREAU USE ONLY) File Number 21-81-0095 Estate Nome i~i.riam E. Heck Dote of Death January 30, 1981 Social Security Number 160-16-4347 REPORT OF INHERITANCE TAX APPRAISER ILl Ori ginal o Supplemental o Remainder I, the undersigned duly appointed Inheritonce Tox Approiser in and for the County of Cumberland Pennsylvanio, do respectfully report that I have appraised the real ond personal property as reported in the laregoing return at the values sot forth opposite each item in thelo~. to the right in Sc~le5 "A", liB", "C", and "E" Dated: November 16 , 1981 _ L tf.t~""x4-" INHE TANCE TAX APPR ER ADJUSTMENTS REMAINDER APPRAISEMENT CODE YALUE AS APPRAISED CODE (HARRISBURG USE ONLY) $ NONE 00+ 92+ 113,584 91 '0+ 3,548 69 2lH NONE 30+ $4"( ,133 60 40- 93- COMPUTATION OF TAX $ $ $ $- $ INVENTORY R.al Property (Sch.dul. A) Personal Proparty (Schedul. B) Joint_Held Property (Schedule E) Transfer. (Schedule C) TOTAL GROSS ASSETS Leu D.bt. and Deduction. (SCHEDULE F) CLEAR VALUE OF ESTATE o Life Estate o Annuity RATE FACTOR PRINCI PLE FOR USE OF REGISTER ONLY Tax on $ CODE 6% Tax on $ 15% Tax all $ Tax on $ T ax on $ Exemptions Total Estate $ $ $ TOTAL TAX INTEREST FROM BALANCE TO Less Credits DATE OF PAYMENT AMOUNT PAID TAX CREDIT $ $ INTEREST FROM BALANCE DUE VALUE CODE GJORIGINAL INHERITANCE TAX APPRAISEMENT o SUPPLEMENTAL File No. ~:i3.1_:~g~~. ~~: ~ "." t r:;':.:.~\i, ~I, ,~\~1i~ .~;;",~~~r.,.,.~.. '." "ti.'!2.~':"'.".':":' REV-487 EXt 17-80) COMMONWEAL TII OF PENNSYL'IMlI^ DEPAlHMENT OF f,EVeNU[ TRANSFER INHERITANCE TAX RESIDENT DECEDENT Estote of -1:!iriamJ;.,_J!9s:_k Co un ty Cumber 1allcL. Date of Deoth _____~_anuary 30, 1981 In the event that any future interast in 'his l!Istola is tronsfencd In po:.;session or nnj(jyment to o::ollatcral heirs of the decedent after the expiration 01 ony estate for life or for ynars, tho Commonwr.olth hereby expressly reserves the right to approlse and assess transfer Inheritance t?XttS at the lawful collateral role on CIf'.Y such future inlewst. PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH . - ASSET SUMMARY DEPARTMENT'S APPRAISED VALUE 1. Totol Reol Property _ SCH. "A". . . . ...$ None 2. Total Personal Property _ SCH. "B". . . . $ 43,584.91 3. Total Jointly Owned Property _ SCH. "E" $ 3,548.69 , $ None 4. Totol Tronsfers - SCH. "C' . . ... . . . . Unreported $ Unreported $ Unreported $ Unreported S $ None $ 43,584.91 $ 3,548.69 $ $ None DANNUITY TOT AL GROSS ASSETS OREMAINDER 47,133.60 TOTAL VALUE $ I do hereby certify that the above appraisement is mode in conformit with Pennsylvania law and hos been filed this' day with the Register of Wills. :/ LA') *~ APPR. ER November 16, 1981 DATE r- "" 0 8 ~ t'1 ~ == - ;I- 0 V1 - Z Cl n c: I:l .., Z ::: z r- t'1 t'1 ;-: Z ;.l ~ 0 - 0 r- Z Z t'1 .., t'1 Z 9 .., -:: t'1 - 9 V1 V1 Z 0 V1 0 .., 9 '-=l '-=l :e ~ ~ 0 "rj - "rj W f-' f-' Z ooen 0 ..:;.. 0 - <D f-' 0 C !ll 0 ::r .... z n en " S"lf-' fi " \ - ... o'f-' .... ;I- ::r (I) I-'.:J:: n ~ r" :;: "l rn!ll ::r c: f-'f-''' .... !ll ro" 0 t'l V1 0. tl~ .... H) . t'1 0. 0. rn f-' "'0' <:1 :I: -:: -:: 0 ro "c 0 ro t'1 t'1 Z ct " 0. n ;;> ~ :( 0 :<' tl f-' :I: ;.l --.1'" 0 ~ >-l 0.... S 0 f-':<' ro 1:1 w rn ::r .... '0 '"' -- 0- Inventory of the reol ond personol .stote of Mi ri"111 F Heck.. Real Estate None Intanqible Personal Property 1. Miriam E. Heck Trust under Agreement #19097-01-3 with Commonwealth National Bank consisting of: $10,000 Certificate of Deposit with Dauphin Deposit Bank@ 7.25% due 7-2-82 Accrued interest on above $5,000 Certificate of Deposit with Dauphin Deposit Bank @ 7.25% due 8-7-82 Accrued interest on above $5,000 Certificate of Deposit with Dauphin Deposit Bank @ 10.15% due 7-8-82 Accrued interest on above 22.598 units Commonwealth National Bank. Common Fund A-I Accrued earnings on above Principal Cash 2. Claim payments from Columbia Accident and Health Insurance Company 3. Refund from Internal Revenue Service of 1980 Individual Income Tax 4. Refund of premi urn from Co 1 umbi a Acc i dent and Hea lth Insurance Company Total Personalty CB/7071 "() ~:'1 ':' '1~J38J..Jn:J 'c;.:; 'i ~J.~ HO .,~H3 01:J '.If: (,id ~- I~U lB. J.t S103~ . Ie. ;:.1 (J:;-J~033~ deceased. 10,000.00 56.54 5,000.00 85.29 5/000.00 35.90 22.598.00 288. 40 .64 43,064 177 421 72 81 00 17 42 43,5B4 91 COMMONWEALTH OF PENNSYLVANIA I COUNTY OF CUMBERLAND J The Commonwealth National Bank by Ann V. Alexander, Trust Officer 55: ..---.--------.-------- being duly sworn __ according to law, deposes and says that he executor ______ of the Estate of _M.id.illlLLtleclL- late of Rnrnllgh of Carl i s 1 e , Cumberland County, Pa., doceased and that the within is an inventory made by __.Ihe.-C.ommonweaJj;lL))IatJonaLBank , the saidExecutor of the cntirc estate of said decedent, consisting of all the personal proparly and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the ligures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. Sworn and subscribed before me, _-8 .;? S 19 81 ."" ~, rf:::L 1 North Hanover Street a.IIE M. lIIHNER, lIotary Puulic PE~N 'WP., CUMBERLAND COUNTY MY CIli,';.II~ION DPmS ~IOV. 12. 1932 Mt1Tiher, P~nn~tl'/Jnia A~:;CC!i~OI1 01 N{-~afie~ Carlisle, Pennsylvania 17013 Addnn Date of Death 30 January Month 1981 Day Yeer INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. <1J ~ Vl .~ k ~ s- -ti >- '" u ~ li2 w ~ ~ I- 4- . w ~ . D- o U 0 0 VI . ~ I W W .<: C '" ... "- :c '" ~ ~ I- D- D- C ~ Z I- ..J LL :0 . ~ LL ..J <( 0 si e, D- o W <( w :t \ > 0 0< :g 0 ,;. <( Z OJ - -- Z 0 c c "6~ I <1J ~ II VI Z 0 '" ~I .<: () LlJ ..; ;-> ... D- ." c . , - 0:: ! 0 .' .., ." -" . E - ~ .2 0 . 0 -' () u: '" Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxable (;state. In additian to debts incurred by the decedent ar estate, other items are claimable including the cast 01 administration, attorney lees, fiduciary fees, luneral and burial expenses including the cost of a burial lot, tombstone or grave marker and other related burial expenses. GENERAL INHERITANCE TAX INFORMATION All debts being c10imed against on estate are subject to ti,e approval 01 the Register 01 Wills with whom the Inheritonce Tax Return is filed. Evidence .to support the decedent's or the estate's liability lor the debts being claimed should be atteched to this schedule. A family exemption moy be claimed by a spouse 01 0 decedent who died domiciled in Pennsylvania. If there is no spouse, or il the spouse has larfeited his/her rights, then any child of the decedent who is 0 member 01 the some household con claim the exemption. In the event there is no such spouse or child, the exemption con be claimed by o parent or parents who ore members 01 the some household os the decedent. The lamily exemption is allowable only against assets which pass by a will or by the Pennsylvenia Intestate Lows. NOTE: Compensation paid to on estate representative; namely, an executor or administrator, for services perlormed in administering on estate is reportable lor Pennsylvania Income Tax purposes. This taxable income item should be reported on lorm PA.40.lndividuallncome Tax Return. t"' 'to C' (') :> rr1 ~ ;g - :> 0 0 " <fl Z ~ (') c:: " -l Z ~ Z ~ rr1 rr1 ~ Z ;;:l ~ 9 9 z Z rr1 -l rr1 Z 9 -l -< <fl rr1 - 9 <fl Z 0 <fl 0 -l 9 'Tl 'Tl :xl ',1. ~ ~'~l .- - r-.. 0 5~ Z ,. ~ .. - .:' I . ..,." 5:-: C...::' :_::~ -.::" c :ll:i W ;~-;5 '" ~ ~ ,u W -< -< rr1 rr1 ~ :> :xl \ 1. If the lamily exemption is being claimed, indicate the claimant's nome, address and his/her relationship to the decedent. Enter "lamily 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 01 eoch payee. 5. Provide a brief explanation in the remarks column lor each debt c1oimed. 6. Enter the amount 01 each debt being c1oimed. 7. The lorm must be signed by the person who hos assumed the responsibility lor paying the debts. INSTRUCTIONS FOR COMPLETING SCHEDULE "F" IF ADDITIONAL SPACE IS NECESSARY USE Bh" x 11" SHEETS. COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF EXAMINATION OFFICIAL NOTICE OF INHERITANCE TAX ASSESSMENT *' COUNTY FILE NO: /. < f , /; I , DATE " i',-- , , " 1/:--/ . TO: r"" ,//,' ~" , '_4 .'1 /; -J./' /'/" I.. <: / ~ ,/' .<1' ESTATE /' ! . ,! -' I' . ~ I ( ,: ,. . , /1(' ./,. .'.... I' J;;..... '7. _ " ;;./ " C./ I , ,i , l ,,,,1 /l I" 1j, -" /) "'",' .~. I Ii FILE NO. ../ r- 10 - . -./1 - '//. " ., / , COUNTY . l /: ( ~ / 1./, . .(" .t. /,11 ,'.- ~/'" ' i ....1 I / ( / -/ I DATE OF DEATH --; i~' r:,. . .~ / Appraised Value of Estato: Real Estate $ .--------- Personal ProperlY + :/ ':, / -..:,/ ! I Jointly Held PropertylTransfers + '1 ,/-J/',,'--' ;;.. '/ . / S ,./ / /;;.,; /~.) Total Gross Estate Total Approved Deductions ,//" //.1. ) , Clear Value of Estate S ..--;:-- ;:-"1" I /...;....7 ,...'..-( . -.-.-....---- Less: Approved Charitable Exemptions Clear Value of Estate Subject to Tax $ ~;; " J"/ ).':" Amount Taxable @ 15% Rate tax due s ").1 I. '17 .I s " II r ;(7 / Amount Texable @ 6% Rate $ ...~ ,:~ I ';,j,--- 7rf lax due TOTAL PENNSYLVANIA INHERITANCE TAX DUE .. '* ... .. ... .. A five percent discount totaling $ will be granted if the Inheritance Tax is paid by Less Credits: DATE OF PAYMENT 1,)_ .~'._:t' I . AMOUNT PAID DISCOUNT INTEREST TAX CREDIT $ - + - .;(' ;' //-;/ " (I'}/; ('J $ 'i! f, S = S (I,t! , - , ; II. '7 + = -:) II ,. -; " + = 'I. -) 'J <. .? _./, v .../ / Interest accrues 8t the rate of six (6) percent per annum on the unpaid balance of Inheritance Tax from to date of payment. Interest due if paid by is BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE $ /1 . . I , ~ /1// "e.~~ .' ,../ i, /1..1 Assessed by: ,.... 1,1 1,r / ~. See Informal ion on Reverse Side Ag.nl'or~~~~~mo7.'i:-:- ,I }._I_J} ,.,,::,;,'~".' '-'~ . 'j ,;..,t., I /1 I' ." /......(' J-./ / nt,ll: