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HomeMy WebLinkAbout81-00102 ~ ! ~ m . ~ >< CIl ~ I t!l ~ ~ 0 rI.l ~ . ~ N t::l . ; ..: ;:. ~ ~ ~ t) 0 ~ I-;l ..- CO ..... . 0 V- * C\I ~ ... . III .-I 0 - z all No. 21-81 102 PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY In the Estate of (Jl,f 1/ .<~c&/I~I'"I , deceased. To Register of Wills for the County of Cumberland, In the Commonwealth of Pennsylvania. Petitioner{f) is (_) the execut or named In the Last Will and Testament of O~ Z(, C-WiM4-t7V' dated ~<.I ..?o' / '1'1'7 Decedent was a citizen of the United States and a resident of 7'0~N-<M~ re' AOflijl (Borough), Cumberland County, Commonwealth of Pennsylvania, (/ Decedent died on ~ the;( S-YdaYOff/&,~1 A,D.19 f/ ,In the County of ~.rd' v , State of ;6~:'~ ,{;7 at the age of 39 years. Decedent has (has not) been married and has (has not) had children born to him (her) since the ex. ecution of the above described Will. !t/7oc/O DO Decedent was possessed of personal property to the value of (, ' and of real estate to the value of /VO(ll,: as near as can be ascertained; said real estate situated as follows /i/ /4 Therefore, your petitloner~) respectfully apply(ies) for the probate of the said Last Will and Testa. ment and for Letters Testamentary theron, Y;~l.d,'Z ~ / ?tj (/ Dated COMMONWEALTH OF PENNSYLVANIA l COUNTY OF CUMBERLAND / I J~J~ J/{)('1/ //o!) fctn) ~!JI- lelJ-l ;l.2~ l1ar.)'e f sf ' /J//ls6w'1, f!4 It/oj ~: g~~I/j~ JtbN~ (/ ;f-o<rT A-ryfj''''j ",.f./,e ss /~ f 1 ' 41rf III! I "7/ , "A v. I J7./'?VW..t' /, . /~0-<. , ,,' ,1 (/ C'rr&fl;P0r'n,r~/"ve named In above application, being duly ,J(//tf''''Y\ according to law say(s) that the statements set forth in this petition are true to the best of;k knowledge and belief. Name and address of Petitioner(s) sworn and subscribed before. me'7lf7T E'!~.:' 3'i~_19~~'__" . 4/ ,_, _ ~/.I_t..~~ . 't!tt.Y~ __-'.1*.:."'~ .AI .6- Register -/ . ~ -'I i, ,,, /'" Filed: February 12, 1981 Attorney ,/ /rt. r/;?,/ .~-tJ//'~ --;;;rI (/f/'/f'I'J", 1.1',( [5.fYlJ. ,.1,. ;1:<. ~ & L ' AI' //1 Il J]?~ ..lit: l /1/0 I - . B. My Grandnephew, William Kay, Jr., of Nokomis, Florida. C. D. My Grandnephew, Mark Umble, of Mason, Ohio. My Grandniece, Jan Umble, of Mason, Ohio. My Grandnephew, Paul Umble, of Mason, Ohio. E. However, any cash gifts given by me during my lifetime, after the date of this will, shall be considered advancements to the above bequests, and shall be deducted therefrom accordingly. 6. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, of which I shall die seized and possessed, or to which I shall be entitled at the time of my decease, to my sister, Helen U. Maffet, of Harrisburg, Dauphin County, Pennsylvania. In the event that my said sister, Helen U. Maffet should predecease me, then I give, devise and bequeath the entire residue of my estate in equal shares as follows: A. One-half thereof to my niece, Jeanne Umble Kay and William D. Kay, her husband, or their survivor, of Whitesboro, New York. In the event that both my niece and her husband should predecease me, then I direct that their share shall pass to their issue, per stirpes. B. One-half thereof to my nephew, Maurice L. Umble and Lois E. Umble, his wife, or their survivor, of Mason, Ohio. In the event that both my nephew and his wife should predecease me, then I direct that their share shall pass to their issue, per stirpes. The term "issue" as used in this wHI shall include those legally adopted. Il'< E-< ~ Z ... " ~ r::I 0 ,. " . z ~ ~ " E-< 0 E-< ~ < ~ " z Vl Vl . ~ p:: ..l " < E-< ~ ~ ~ . ~ Z ~ " p ,. p ~ <: Ul . ~ ~ 0 z r::I ~ ~ Z 0 o ~ ~ " . ....l ~ ~ II; . ci ....l . 0 0 . t-< ~ Z ~ z 0 :;: :> ~ < " . 0 . t-< " ;; E-< ....l ~ Vl 0 ~ -0: ~ = ....l ~ ~ OATH OF PERSONAl. REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 5S: COUNTY OF CUMBERLAND Defore me, the Register for the Probate of Wills and granting of Letters of Administration in and for the County of Cumberland, personally came ~"i?;/(.r ~,,-e e1 ;?;"J ~~I't-L.{. ",,./ ,;,Y:;~~ . ~r4 (/ ' ~ t who, being duly ~/O-n , do<"# _depose and say that as (J;~1J~.a~ O.ff4 ill L~~r, /fl-(!r,/ deceased of the last Will and Testument of will well and truly administer the goods and chattels, rights and credits of said deceased according to law. And also will diligently comply with the provisions of the law relating to Transf:r ~~eritances....1"",,,, ~ -?: A,D., 19 6>/ ;Jj6p,:tk- d.JJ . 'if . (). ? Register '''; .-l, ,., ~~ (Xl' 0> .., ...." '" ,., ,0 , L.L. 1/)' (Xl, 0 *, N ''-.: .;.: "I' 0 N' -I 0 ,...q 0 ~ 0: -I j:Q >l .-l' ~ I' - Iol' - .~ Ill' .-l, - \i,. : ~ :3: ,. (Xl' $ ,\. . c;: I, \\: Iol' !:: 8' .Q: T"'" ~ .-l: .~ ril, Q), "I, "Cl ~1 ~l ., "': 0 "Cl N' .... ~, z 0 .-l' ~j! " *' N .2l ., .... ~ "Cl 03 "Cl ., 0 ..., ~ - Ul !:: ,~ Z r<1 "' ~ DECREE Be it remembered that on the 12th day of February ,A.D.,19~, there was probated and recorded the last Will and Testament of Olive U. Anderson late of Mechanicsburg ,Cumberland County, Pennsylvania, Hamilton Bank Deceased. Letters Testamentary were granted '10 Witness my llaod.and official seal the day and year afor,esaid. Hi 21-81 102 Register of Wills of Cumberland County Pennsylvania i I I I I I I I I I Ren uncia tion In Re Estate of OLIVE U. ANDERSON, deceased. The undersigned Helen U. Maffet, Executrix of the last will and testament of Ihe above decedent, hereby renounce(s) the ,ight to administe, the eslale and respectfully ask(s) thai Letters Testamentary be issued to lIamil ton Bank (formerly National Central Bank). Harrisburg. Pennsylvania Witness her hand this 29th day of January ,19 81 (Signature) (Address) ./ '~f.tIT- \.ll.'bVI1~~ loG' ,4.,j d/4 ~d -?"4"L~, fJA /70'>5 It~ /d4// 1L {/ dl1 ~ c:1'w, -'ik~"7: ?4 17//1 (// ' REV-IS00 EX + (9.Ul) -t , BUR~AU OF EXAMINATION PENNSYLVANIA DEPARTMENT OF REVENUE P.O, BOX B327 HARRISBURG, PA 17105 INHERITANCE TAX RETURN RESIDENT DECEDENT FlloNumbor ~ \- <6\-DIOd... DECEASED Docodont's Nomo (Last, Firsl, and Middlo Initloll .D.d_q..r.5.Q~t \ i " Q.. U. Social SoclIrily Numbo, Dato 01 Doath CIIECK 1. D,iginal Roturn CXl Docodont's Add"" 1M (Y\DLAl'I1- AIIU\ ~f. \'f\lc..~a.l'\L(.~'Dl.tr~1 PA 110'55' 2, Supplomontol ROlurn D 3, Romoindo, Return 0 -~5-~\ APPRO. PRIATE 4. L1le Estate D 5. F.deral Esta'e To. 0 R.turn R.quired. 6. Decedent died tostate ), Docodent maintoined a living D B. Number 01 sale deposit 0 (Attach copy of Willi t,ust (Attach copy of Irusd boxes invento,ied All correspondence and confidential tax information should be directed to: BLOCKS CORRE. SPONOENT Nem Add,ess ,\- City Rocapitulation RECAPIT- ULATION 1. 2. 3. 4. 5. 6, ), B, 9. Real Estate (Schedule A) Stocks and Bonds (Schadule B) Closely Held Stock/Partnership InterestlSchedule C) Mortgages and Notes (Schedule 01 Cash & Miscellaneous Personal Property (Schedule EI Jointly Own.d P,operty (Sch.dule FI Translers (Schedule GI Total G,o" Assots (tot.1 lines H) Funeral Expenses Administrative Costs/Miscellaneous Exponses (Schedule H) Debts/Mortgages/Liens (Schedule f) Total Deductions (total lines 9 & 101 Net Value of Estate !line B minus line III Charit.ble Bequests (Schedule J) Net Valuesubjectlo tax liine 12 minus lin. 131 (111 (12) (13) (14) (ll ( 2) I 3) ( 4) ( 5)-lI.13l/1.~"l ( 6) ()) 'i~I'i"l'l'l./.. ( B) \ ;;}"\<6QO.'\C; . AND ( 9) (10) TAX 10. 11. 12. 13. 14. \ ~ \30,<11 \ \ I) ., LDO. O~ ':ll, /')00.00 \ls, ~I.g ~2.. \Oq, 1 110. O~ CALCU, LATION Computation on.. 15. Amount of line 14 t".blo at 6% ,ate (jnclude values from Schedule K) 16. Amount of line 14 taxable at 15% rate (jnclud. valuos from Schedule K) P,incipal tax due (add tax from line 15 plus tax from line 16) Total P,ior paym.nts: lal Amount Paid (bl Plus Discount Ic) Minus Interest 19. Bal.nce Du.lline 17 minus line lB) Make Check Payable to: Registe, of Wills, Agent *. * PLEASE RECHECK MATH * * * (15) x,06= 17. lB. l"'. ~.OO (17I_1J"'1 "4-10 If. oD (16)~ x.15= (1BI (191 Under penalties of perjury, I declare that I have examined this return, including occompanying schcdules .nd statements, and to the best of my knowledge and belief, it is true, c ct, and complete, Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ~ II? / !.;L ADDRESS I I DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE Zi REV-440 t 1'-80)" , COMMONWEAL TH OF PENNIY L VANIA DEPARTMENT OF RE~ENUE TRANIFER INHERITANCE TAX RESIDENT DECEDENT AFFIDAVIT OF FIDUCIARY (Instruc.llun\ on Reverse Side) -.- ,=-..====:.7';;.=c.:;::::.:.;c.=...~.':;::::,,;:::,-c:,,:,,::-.:-..=::;.;':"-,-::,;:.;:=::.:~..:~.=,==_===c __ Estate of OLIVE ~l.mSON_.___.___._____,_ Last Add,ess ~.o_.~~oun.!_J\!.~en~ri_~_.____ Mechanicsburg, PA 17055 Dole of Dea th~ANUARL2S._-19.81__,_______ Social Security No.___H!Ll!U~JL______,___. lei 1 VI tST A H:J (':IPI Bureau File No. ,______________, Counly Fi'" No. J / -J 1- /o..~Y _____ 1. Decedent died: ( ) Intestate (without a will) ( X) Testate (leaving a last will--capy ottached) 2. Is the filing of a Federal Estate Tax Return requi,ed fa, this eslate? Yes__ No X 3. ( X) Executor/Executrix ) Administ,alar/ Administ,atrix Name HAMILTON BANK Address 222 Market Street Harrisburg, (CITY) PA (STATE) 17108 (ZIP) 4. All correspondence should be mailed to ( Attorney ( X) Fiduci cry. '" 0; nf.;; ~ ;o~ 0::_ P1n :~~',( ';-10 ,';;::U r~r" ... ,l:> I:::=':. ~ r (} L": N I:? .,'..,.. '0 c '.'.,. -'< ,....;. , ., r..:~ 5. If an attorney is representing the estate, indicate: Name John A. Roe, Esquire Address 101 North Front Street H::Il'l'i ~hlll'g~ Ph 171n'{ (<:IT'(I l~TATEl (ZIP) List all safe deposit boxes registered in the decedent's individual name 0' jointly with, or as an agent or deputy of another, or in decedent's individual name with right of access by another as agent or deputy. Indude the nOme, and address of the bank or ather institution where the safe deposit box is located, the name (s) in which the box is registered and the relationship of the joint holders to the decedent. NAME AND ADDRESS OF BANK OR OTHER I~STITUTION IN WHICH DECEDENT MAINTAINED A SAFE DEPOSIT BOX NAME OR NAMES IN WHICH SAFE DEPOSIT BOX IS REGISTERED RELATIONSHIP OF JOINT HOLDERS TO DECEDENT Hamil ton Bank Olive U. Anderson Sister 222 Market Street with Helen U. Maffet, Harrisburg, PA 17108 Deputy Under penalties of perjury, I declare that I have examined this ,elurn, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct and complete. SIGNA TURE OF FIDUCIARY DATE RI!:V-ol'O 1'-&01 . COMMONW~AL TH O'F PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT DECEDENT SCHEDULE "A" REAL PROPERTY @.: ~:}. ~ ,~~~ ~&~~~A,fI~' "'l-"".':ir.:/.4.ff'r~;'I (Instructions on Reve,se Side) ESTATE OF OLIVE U. ANDERSON lEM ESTIMAlED DEPARTMENT DESeRI PTlON MARKET V ALUA TION ~O. VALUE (OfFICIAL USE ONLY) N 0 N E Mrs. Anderson was a resident of Messiah Village Nursing Home at the time of her death. TOTAL THIS PAGE -D- . <-e.. A,a ,/'1' :;.' ~Q@G5Y :'Jlm;I;"{12~~~~~[!!; '<,.-<i,;~j}\~~) Savings & lO1l1l ASSQCj/jllon . . '/ . 0' Horrfnbury March 17,1981 Marshall J. House Hamilton Bank Trust Department 222 Market St. Harrisburg, Pa. 17108 Dear Mr. House; This letter is in respons... to your recent requast for information concerning the estate of Olive Umble Anderson. ,Below is the only account held by the decedent as of the date of death' (January 25,1981). Account number: 01-01-020635 Account title: Olive Umble Anderson Balance as of date of daath. . . . .. . . Accrued unpaid earnings'. .- . . If . . . . . Total valua on the date of death . . . . . Opening data: January 17,1975 Type of account: Individual . . . . .$25,874.84 . . . 97.47 . . .S25,972.31 . . . . Should you have any questions concerning this data, please feel fres to contact our office. . Sincere~~, rd ./1. /J .. " '/ (/t'V, /~).;f(.. -' /J' . .'" /,/ ",,~'('.,;1-<..(J/,/\. (.../' c. 4.. 01'.( /,.(____ v" ~ Lorrains Dizdar L- Savings Servicing Department LMD:ld 234 NOR1H SECOND STREET, p,O, BOX 1111 ' HARRISBUnG, PA 17108 ' (717) 232.6661 '- -~r t8~-~~.~.- :~l .,.t 'J ri"l .fo: ,~fl ;1/ .'j/ ..,I' . ~" : .. ')1" . r , " ",.1 ,I' ..~ ., I ' .." ".' 'I :-~.,", " . ~""" J... _" \.) r ,.' I ,.~!,,,~~:" i':~" ,,'...<~ :'!~'h' ,,"' , I-I'~ t' " ".., ,/,"-, ""1)11 Y I' oj. I, ,J;''', 'd J1i"'~~';illt I;". Jil,t llii~liiit ',',....,..~ " ,. _:....'m" ,.r' "',' ......t,'.'. . Tlw Bryn Mmvr TIlI:,1 Cumpany BurN flll\\VH, I'LNN~YI \'/\NI/\ 1'1010 (21 :ilIA ;\.17UO March 18, 1981 Hamilton Bank Post Office Box 1071 Harrisburg, Pennsylvania 17108 ATIN: Marshall J. Ibuse, Trust Representative RE: Estate of Olive U. Anderson Checking Account n011-334-8 Dear Mr. fk:iuse: rn reply to your letter of March 10, 1981 regarding the above captioned decedent.. please be advised of the following: ' Checking Account nOll-334-8 Date of Death Balance - $1,404.93 (January 25, 1981) . Date Opened - 12/16/46 Title - Olive U.. Anderson No other account with The Bryn Mawr Trust Calpany As requested, enclosed is Treasurer's Check n43124 in the amount of $1,404.93 together with debit merro and closing statement. me. Should you require further infomation regarding this matter, please contact , Sincerely yours, /} "/' 'Q* /,,\/- , :'; \ 0 ~ \u..LL....p_..r.v 1'). _.,_ "'>1 (Ms.) Patricia R. Clifton Audit Departrrent Enclosures The Main Lim"s 011111 hank. Chm1er(?rl ill 1889 C7(,:r~ u. Al1rJeYJ'o>l - '(-o('I-??/,o 0 .- . . . ....-. .-- _,_.. _. u Ilk e oi"~~,,;lJ /:;7t-e oT !i-t.I1--' ;:';.,~.. .;.,,1 C:.-.r' f.S77 ~"ilJ' lie,,, rI )="".. c:I .lY""C;cJ )I..o,~ 7<>'.-,.... v.f. r:;",., hr.T J]>JI.LIY~~T 1?!'_,,-e~~---E:S'z.Pr' L ilo N 6<:;, <'>-q/ '-!(o/o"", <::::.?? .fIsc. /t;.rfr:.- Cc,..1. ",r-J'~..,r;.1 /PJ'.I' : It"f,- 4t!V"'''::'..rg 7/;' rOt 4-/'1?rt~,7$ f( ecorc!t""l/(ec f;:tj?f ~1(€ll?qJ' e /(aT Ej- -* Ie' ~)(4t1e. @ t% s-/:;. 71ft .'. ... .- . ~ :'-"0 1:1. I ai I z 7k. 00 c:>O I ---llr? "'~ "la/gC, -.JU:..(.'':> " Ii.. :.:ip /3t.,11 -___:LS,,~"" ,:/00 ~ ~ .1:',.1.. n-"y, <t'c.. e t")'I;lS. 0' L -------_.__..._----.~----_.-- - /' ! I -,~"7 , ) Si ~,lf.)~ p' ,(JJk'fJ,(?.!n I J-- ---.- - - --1--. --..-..---,------.. . REV-4ez ('-sot, COMMDNWE'AL TH' OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT DECEDENT ESTATE OF ..QLIVE U. ANDERSON SCHEDULE "C" TRANSFERS .~' ft, ~~ 4\ ~~~.,.\W ~ .,;,1. t ~~~\~\' ~~~,J INSTRUCTIONS: l. Answer the Questions on reverse side. !. If the answer to any of the Questions on the reverse side is "Yes," provide a description of the property transferred per Schedules "A," "B," or "E," its estimated market value at date of death, dates of transfer, to whom transferred and relationship of transferees to decedent. Attach a copy of any trust deed or instrl1meut relating to the tran~ferred property. ITEM NO. DESCRIPTION 1. Trust Under Agreement dated May 15, 1958, between 01vie Umble Anderson, Settlor, and Continental Bank (formerly Montgomery County Bank 'and Trust Company), Trustee, holding assets as of January 25, 1981, as folIo 2593 Units Bond Fund @ 4.69040108 $23,000 Trust for Short term U. S. Government Securities @ par 50 Shares West Penn Power Company $4.50% Pfd @ 34.125 20 Shares General Motors Corp. Common @ 45.09375 $156.00 Master Certificate of Deposit Principal Cash TOTAL TRUST ASSETS NOTE: As a result of the death of Olive U. Anderson, this trust now terminates in favor of Elizabeth A. Katzenbach, step-daughter of the decedent. 2. Security Deposit at Messiah Village transferred to Helen U. Maffet on April 3, 1980 TOTAL THIS PAGE ESTIMATED DEPT. VALUATION MARKET VALUE (OFFICIAL USE ONLY) s: $ 12,162.21 23,000.00 1,706.25 901.88 156.00 5.00 $ 37,931.34 $ 15,577.81 $ 53,509.15 ..1. ;)b 1. I ~ ~ QUESTIONS CONCERNING PROPERTY TRANSFERS 1. Did decedent, within two years of death, make any transfer of any malerial part of his estate wilhout recei~ing valuable and adequate consideration? (AnsvlOr "Yes" or "No".) No 2. Did decedenl, within two years of death, transfer property (rom himself/ herself to himself/herself and another party or parties (inCluding a spouse) in join I ownership? (Answer "Yes" or "No".) --NIL 3. If lhe answer 10 one or two above is "Yes" and UIC transfers are claimed to be oontaxable, provide the fOllOWing information: a. Age of decedent at time of transfer. b. Copy of death certificale. c. Affidavit by lhe allending physician indicating the slate of decedent's health at time o( transfer. d. All other information supporting nontaxabilily of transfer. 4. Did decedent, in his/her Ii(etime, ma!le any transfer of property without receiving a valuable or adequate consideration there(or which was to take effect in possession or enjoyment at or after his/her death? (Answer "Yes" or "No".) Yes a. Was there any possibility that the property transferred might return to transferor or hiS/her eslate or be subject to his/her power of disposilion? (Answer "Yes" or "No".) Yes b. What was the transferee's age at time of decedent's death? N/^. Transferee was Corporate Trustee 5. Did decedent in his/her li(etime make any tmnsfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves (or his/her life or any period which does in fact end before his/her death: a. The possession or enjoyment afar the right to income from the property transferred? (Answer "Yes" or "No".) ~ b. The right to designate the persons who shall possess or enjoy the properly transferred or income therefrom? (Answer "Yes" or "No".) Yes 6. If the answer to five b. above is "Yes," state whether the right was reserved in decedent alone or others. Right was reserved in decedent alone 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".) Yes 8. Did decedent, at any time, transfer property, the bElleficial enjoymenl of which was subject to change, because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation o( 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 the decedent and others? (-Answet~l'fes!'-tlF-l'Ne!!~) In the decedent alone. l'~ . tII... B. ~ly Grandnephew, \Villiam Kay, Jr., of Nokomis, Florida. C. My Grandnephew, Mark Umble, of Mason, Ohio. D. My Grandniece, Jan Umble, of Mason, Ohio. E. My Grandnephew, Paul Umble, of Mason, Ohio. However, any cash gifts given by me during my lifetime, after the date of this will, shall be considered advancements to the above bequests, and shall be deducted therefrom accordingly. 6. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, of which I shall die seized and possessed, or to which I shall be entitled at the time of my decease, to my sister, Helen U. Maffet, of Harrisburg, Dauphin County, Pennsylvania. In the event 'that my said sister, Helen U. Maffet should predecease me, then I give, devise and bequeath the entire residue of my estate in equal shares as follows: A. One-half thereof to my niece, Jeanne Umble Kay and William ,D. Kay, her husband, or their survivor, of Whitesboro, New York. In the event that both my niece and her husband should predecease me, then I direct that their share shall pass to their issue, per stirpes. B. One-half thereof to my nephew, Maurice L. Umble and Lois E. Umble, his wife, or their survivor, of Mason, Ohio. In the event that both my nephew and his \~ife should predecease me, then I direct that their share shall pass to their issue, per stirpes. The term "issue" as used in this wHl shall include those legally adopted. IlEV.453 0.80) COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "0" BENE F I CI AR I ES '*' (Instructions on Revers!! Side) Estate 0 f OLIVE U. ANDERSON SURVIVED DATE OF INTEREST OF BENEFICIARY BENEFICIARIES AND ADDRESSES RELATIONSHIP DECEDENT BIRTH St. Stephens Cathedral Cha:.i ty ~~s . N/A Bequest of $500.00 221 North Front Street Harrisbure. PA 17108 Church Farm School Charity yes N/A Benuest of $500.00 Box 8 Paoli , PA 19301 Holy Trinty School Charity yes N/A Bequest of $1000.00 Boite Posta1e 1309 Port-au-Prince Haiti - ---- "--- ----- --------- -_._-- . Barbara Ellen Kay Grandniece -xes of acre Benuest of $1000.00 33 G1enridcre RMrl Il'hitesboro N.Y. 13492 William Kay, Jr. .Gcrandnenbe\~ :ieA_ _o.Lag.~ .Jl.eque.s.LoL.$101lD...O.O- 33 G1enridge Road --.----.-.-.-.-- ----_._~._----_._---- .-- ------ Whitesboro. N.Y. 13492 Mark Umble Grandnephew ves of ann R nJ' _~lnnn nn 506 Walnut Lane Mason Ohio 45040 Paul Umble Grandne]lhe\~ ves of acre Benuest of $1000.00 506 Walnut Lane - Mason, Ohio 45040 (CONT'D ON PAGE #11- The above beneficiaries are Iivin9 at this time except for the followin9: NAME DATE OF DEATH ~EV.4S4 (1.80) . =OMMONWEAL TH Of' PENNSVL VANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT OECEDENT SCHEDULE "E" JOINTL Y OWNED PROPERTY (Instructions on (lflVCrSf1 Sic/oj Estate 0 f OLIVE U. ANDERSON - p TOTAL E VALUE OF DEPARn1r.NT rEM R DESCRIPTION MARKET C DECEDENT'S VALUAn~,r'J ~O. VALUE E INTE REST 10ffici,,/ u", :'nly) N T - - ._.~ N 0 N E -.J I - TOTAL THIS PAGE -0- ~~t.C. ".:4-& REV-484 EX+ i.&-ao) FII e Number Estate Name Date of Death Social Security Number INHERITANCE TAX SUMMARY SHEET (BUREAU USE ONLY) 21-81-0102 Olive U. Anderson Januar>y 25, 1981 181-01-6958 REPORT OF INHERITANCE TAX APPRAISER m Original o Supplemental o Remainder I, Ihe underslgn.d duly appalnled Inheritance Tax App,aiser in and lor the Counly 01 Cumberland Pennsylvania, do resp.ctfully report Ihat I have appraised the real and personal property as report.d in th. loregoing ,etum at Ihe valu.s set Iorth opposite each item in th.last column to}h. rlghlln S:~ules "AU, "8", "C", and "E" Dated, ,T.nll.Y'Y ?O, lQR? <:::::Z., ~ INH~fHTANCE TAX APP SER INVENTORY Rea! Property (Schedule A) Personal Property (Sch.dul. B) Jolnt.Hold Property (Schodulo E) Transfers (Schedule C) TOTAL GROSS ASSETS Leu D.bts and Deductions (SCHEDULE F) CLEAR VALUE OF ESTATE o Life Estote o Annuity FOR USE OF REGISTER ONLY Tax on $ Toxon$ - Tax on $ Tax on $ Tax on $ Exemptions Totol Estate Less Credits DATE OF PAYMENT ADJUSTMENTS I (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE VALUE AS APPRAISED CODE $ None 00+ 71 ,381 84 '0+ None l!ll+ 53 509 15 30+ 124 8 0 40. MIE FACTOR PRINCIPLE , 91M. 6% 15% -- TOTAL TAX INTEREST FROM BALANCE TO AMOUNT PAID S INTEREST FROM BALANCE DUE 92+ 93. VALUE CODE I COMPUT A TION OF TAX $ $ $ $- $ $ $ $ TAX CREDIT $ REV-4e7 EX+ (7-801 COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT INHERITANCE TAX APPRAISEMENT ~, ~~~2h~~ l,~:;~~~~ "".;"~~f.f,;":'-;-"" IIlORIGINAL o SUPPLEMENT AL File No. _.-21-:,s1-Q1..D? Estate of Olive U. Anderson County Cumberland Date of Death January 25, 1981 In the ovent that any future Interest In this estate Is Ifansfortod in possession or enjoyment to collataral heIrs of the decedent after tho expiration of any Cltate for IIfo or for years, the Commonwealth horeby expressly reserves the rIght to appraIse and asseSS transfer inheritance taxes ot tho lawful collateral rato on any such futuro Interost. PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH ASSET SUMMARY DEP ARTMENT' S APPRAISED VALUE 71.381.84 None 53,509.15 Unreported $ Unreported $ Unreported $ Unreported $ $ None $ 71,381.84 $ None $ 53,509.15 $ 1. Total Real Property - 5CH. "A". . . . .. $ 2. Total Personal Property - 5CH. "B". . . . $ 3. Total Jointly Owned P,operly - 5CH. "E" $ 4. Total Transfers - 5tH. "C". . .'. . . .. $ !\lr'lnA o LIFE ESTATE DANNUITY TOT AL GROSS ASSETS DREMAINDER TOTAL VALUE $ I do hereby certify that the above oppraisement is mode in conformity with Pennsylvania low and has been filed this day with the Register of Wills. d~ L _ ... . ,,J d:-~",~ J~nll""Y 20, '9R? , AP RAISER DATE Q) :> 'M ~ .. "" ::; ~ ~ <:: '" en 0 ~I '" <:: Z ~ !;: .. W 0 ;>< Q) .-I 'C .-I l:.I <:: 00: '" 00: 'C ;:l ..., <:: <:: ltl ...1 ::> ::l .-i <( 0 .. ~ Q) :a: Q) u Z :> .c ~ 'M 0 ~ 0 ~ 0 .-I 0 .-I 0 ~ ~ 0 .-I U .-i (\J .-I 0 ~ ~ ~ ~ 0 ~ fj; 0 '" 0 Z 0 ~ ~ '" ;>< f-< 0 Z f-< ~ f-< ~ Z Z ...1 0 ~ 0 ~ ~ Z ~ ~ ...1 Z ::E z 0 ;:l U ~ W ~ ~ '" ~ 0 0 0( Z :;: ~ W U 0 "" ....l REV.455 (l.BOI ,,\ COMMONWEAL TII 0F PEN,'4SVLVANIA D~PARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "F" STATEMENT OF DEBTS AND DEDUCTIONS ------_.:;-_.._----.~.--'=".-;:.:..-=,;..~.,"'.;,;... .... ,. -..... -..., ......--., ..- ..... -~- .._--+_..~-_._-- Estate of OLIVE U. ANDERSON Date of Death .JANUARY 25, 1!181 WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING: Claimant Relationship to Decedent Claimant's Address . - .0 - -. - ITEM DATE NAME OF PAYEE REMARKS AMOUNT NO. lo I~l? Cumberland ,County Rer.ister of Wi Is Letters Testamentarv t37.00 15 Short c",.t i fi ont". 1'; nil 1 Renunciation 1 00 ~';.oo 2. Mar 19, Cumberland Law Journal Publish Letters Testamentarv 18.00 3. Mar 20 Mess iah Vi llaee Balance due for room and bo"~d 1 or;';t;? 4. Mar 25. W. Orville Kimmel Funeral Home Funeral services 1 529.00 5. Aar 2, Internal Revenue Service 1980 Federal Income Tax 653.00 < I "^__o n^_+ ^" "^,,^_,,^ 1980 State Income Tax 168.85 7. Anr 16 West Shore Times Publish I,H^-O ']'" '0 ~R . ^_~ 77 !c"" '0+00 Tno ^, 0, ., on 9. Anr 30 W. Orville Kimmel F,meral Horn" R"i, ,,^- ' - at Washineton Memorial Chanel 100.00 10. May 7, Cumberland County Register Wills 8 Short Certificates 8.00 llo Hamil ton Bank Commission on sale of securities 40.95 12. Jun 4, Phoenixville Memorial Works, Inc Engraving on tombstone 126.00 13. ul 8, Dr. A. C. Edmundowicz Professional Services 25.00 14. Messiah Villape Final nolono" ~n" ORn ?? 15. Continental Bank Trustee Trust termino>ion fees F. exnenses 2 sn7.no 16. Middleton, Roe & Et zweiler Professional services 2,946.38 17. Hamil ton Bank Executor I s fee 3,446.38 18. Amount retained to file Inventor' Debts f, Deductions f, First F. Final Acronnt ,nn "" TOTAL THIS PAGE I 13 130.97 I hereby certify that to the best of my knowledge and belief the foregoing is a just ""d true statement of debts, funeral expenses and expenses of administration submitted to the est te as deductions for Inheritance Tax purposes, IWlIL N BANK ~. ;; B . "",,-. 11. 'Vf /~ IN S ( TURE OF ATT .r5ATE I OFFICI DEBTS AND DEDUCTIONS ARE ALLOWED II~ THE SUM OF S l~ / ~I?, 91 AT 12' PERCENT. I..~ /-,f~ DATE 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 claimable including the cost of administration, attorney fees, fiduciary fees, funeral and burial expenses including tile cost of a burial lot, tombstone or grave marker. All debts being claimed against an estate are subject to the approval of the Re~ister 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 $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. 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, t'" "" tJ n > rn > ~ z > 0 0 " 'Jl Z " Z Cl n C tJ .., '" t'" rn > 9 - 9 l'"' rn ~ Z ;:::I Z z z rn .., t"l ..., 9 9 .., -< 'Jl rn tii Z 0 'Jl 0 ..., 0 ":l ":l ;:::I > ~ 0 N .., ":l :,,1 6 ":l ~ ' 5: Z B " > c' 0' l'"' Ej2.i N ,"'- c:: (l. , (~:rr. 'Jl 01 c..:: '.~'L....: rn Q;,V~ c:: ' t:~~ oc:=, ::::::<0;- 0 U"J (..c:S Z ~o: ~ :](.;. co l'"' . u -< -< -< rn rn ~ > > ;:::I ;:::I 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 rcmarks 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 remc.rks column for each debt claimed. 6. Enter the amount of each debt being claimed, 7. The form must be si9ned by the pcrson who has assumed the responsibility for payin9 the debts. COMMONWEAl,TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLI,ECTIONS APPLlCA TION FOR AND CONSENT TO TRANSFER SECURITIES REGISTERED IN THE NAME OF A RESIDENT DECEDENT ~~'~~ ' ,&;; (\ ~.~~~ APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is he'eby made lor coosenl to Ihe I,ansler 01 Ihe lallawing securities 01 0 Ponnsylvanio Corporation or a Nalional Banking Association located in Pennsylvania: DATE 3/1.7/81 (a) 7 Shs. (b) Pe!.'n Dairie~Inc. (c) Class Il Common Stock @ 5.0 (NOTE: In describing securities enler in (a), ob O/e, eilher Ihe number 01 shares of slack or the lace amount 01 regislered bonds, in (b), the name 01 Ihe issuing company and in (c) thc class of slock or Ihe slaled inte,esl ,ole ond molurily date 01 registered bonds.) ISSUED ON July 15, 1954 , and hoving a TOTAL MARKET VALUE OF S 35.00 (Dot.) as 01 the dote of death of the decedenl, Olive U. Anderson , on January 25, 1981 (Name of Dl!ccdont) (Date of death) who was late of 100 Mt. Allen Drive, Mechanicsburg, Clunber1and County, Pennsylvania 17055 (Stleet and Number) (Post Office) (County) (Stote) The securities are registe,ed as follows: Oli ve Umble Anderson (Name or names in which certificates ore registered) ADMINISTRA TOR) Hamil ton Bank, 222 ~Iarket Street J.J!.arrisburg. Pennsy~ia 17108 EXECUTOR) (Name) (Add,a,,) Haml1 ton Bank, Executor NAME OF APPLICANT Peter A. Sc1l1~iers COUNTY FILE NUMBER ,:;f !-j/-ltJ.2., ADDRESS OF APPLICANT 222 ~~~e~l Harrisb~r~. BUREAU FILE NUMBER SIGNATURE OF APPLICANT By~~~;{~J".'LJ..Lz:t'--3:i NOrICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NOT BE CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION. Pa. COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE CONSENT TO TRANSFER SECURITIES DAT~C'j)Jt /ff/ I hereby consent to the transfer of the above securilies now regislered jn the name of the a oresaid Decedenl and waive the filing of a cerlificate cerlifying to the poyment of Ihe tronsfer inherilonce tax 10 which Ihe p'operty of said Decedent is made subject pu,suant to Ihe provisions of the Acl of June 20, 1919, P.L. 521, ~s amended and the Act of June IS, 1961, P.L. 373, os amended. This is also in acco,dance wilh Ihe p,ovisions of the Act of April9, 1929, P.L. 343. This Consent to Transfer Ihe herein described property operates only in ,efe,ence 10 the eslole of Ihe above-named Decedenl. ~~~'" 'f I"'. ~y IJ /' [lEJ,; . ~:\ '''r~''':;!:;j} the Secrelory of Reve ue ii COMMONWEAL TH OF PENNSYLVANIA DEPARTME~T OF REVENUE BUREAU OF COUNTY COLI.ECTIONS APPLICATION FOR AND CONSENT TO TRANSFER SECURITIES REGISTERED IN THE NAME OF A RESIDENT DECEDENT ~~,:~~ " '. I''''. '" '~~II' ~, ~ ii.&~~ DATE3/17/81 APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby made (a, C(XlSent to the t,ans(e, o( the following securities of c Pennsylvania Corporation or 0 Notional Bonking Association located in Pennsylvonia: (a) 28 SbL--(bL~lm Dairie~lnc. . (c) Class A Common Stock @ 5.0 (NOTE: In describing securities enter in (a), ab Ole, either the number of shares of stock 0' the face amount of r~gistered bands, in (0), the name of the issuing company and in (c) the class of stack or the stated interest rate and ,!,aturity date of ,egisteted bonds.) ISSUED ON July 15, 1954 ,and having 0 TOTAL MARKET VALUE OF S 140.00 (Do'.) as of the date of death of the decedent, Olive Unble Anderson (Name of Deceden:) on January 25, 1981 , (Dole of death) who was late of 100 Mt. Allen Drive, Mechanicsburg, Cumberland County, Pennsylvania 17055 (Street and Number) (POG' Office) (County) (Slate) The securities a,e registered os follows: Olive Umble Anderson (Nome or names in which certificates ore registered) ADMINISTRA TOR) EXECUTOR ) Hamilton Bank , 222 Market Street , llarrisburg, pennsylvania 17108 (Nomo) (Add,,,,) Hamil ton Bank, Executor NAME OF APPLlCAtH _~_teT A. Scl1l'ieTs COUNTY FILE NUMBER d{/-t/-/t!;:!, ADDRESS OF APPLlCANL2.2LHar~~traeJ:.,Jlarilibll"g, Po. BUREAU FILE NUMBER SIGNATURE OF APPLICANT ~:::~I../}<,-/../J)'!f.j.,j....... ~~:::&.im: NOTiCE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, iT WILL NOT BE CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION. COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE CONSENT TO TRANSFER SECURITIES DAT~U11AJ/~ /f// I he,eby consent to the transfer of the above securities now ,egistered in the name of the foresaid Decedent and waive the filing of a certificate ce'tHying to the payment of the t,ansfe, inheritance tax to which the property of said Decedent is mode subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521, os amended and the Act of June 15, 1961, P.L. 373, os amended. This is also in accordance with the provisions . of the Act of April 9, 1929, P.L. 343. This Consent to Transfer the he,ein described property operates only in ,efe,ence to the estate of the . obove.nomed Decedent. ~. ~" '1''''';::'''. .~ {.:....,. ~ :'f'>' .... rlfi;;,"'~'" ~-"i;JJl'~}~ Signed fo.s,!he Secretory a; Re~e . /)' . It! J By cd. .; ,~,,/l.4/ ,/) (i.gnol.r;2l ~ .', / _ .6:~":;::, ~ """..L..~j.i-j2LWd-.tJYf- 7-fny (County) I RCC-7Z (9-(,81 COMMONWEAL TH OF PENNSYLVANIA DEPARTM!:~T O~ REVENUE BUREAU OF COUNTY COLLECTIONS APPLICATION FOR AND CONSENT TO TRANSFER SECURITIES REGISTERED IN THE NAME OF A RESIDENT DECEDENT (;,a,~~ ' ~~ -z;..' ~.~iI'.1' . t\ ". ,~....I , . APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is he,eby made far cmsent to the I,onsfer of the following securities of a Pennsylvania Corporation 0' 0 National Bcnking Associolion lacoted in Pennsylvania: DATE 3/13/1981 (a) 30 Shs. (b) Belmont Industries, Inc. (c) Commen (NOTE: In desc,ibing securities enter in (a), ob Ole, eithe, the number of sha,es of stock or the face amount of registe,ed bonds, in (b), the nome of the issuing campany and in (c) the class of stock or the staled inte,est rate and maturity date af registered bonds.) ISSUED ON various dates , and having a TOTAL MARKET V AtUE OF $ (Data) as of the date of death af the decedent, Olive U. Anderson (Name of Decedent) $105.00 an .January 25, 1981 , (Date of death) who was late of 100 ~It. Allen Drive, ~Iechanicsburg, Cwnberland County, Pcnnsyl vania 17055 (Street and Number) (Post OHice) (County) (StaIO) The securities are registered as follows: Olive U. Anderson (Nomo or names in which certificates arc rC9i~tcred) (Nama) Market Street, Harrisburg, Pennsylvania 17108 (Add,...) Hamil ton Bank, Peter A. Sclwiers Executor ADMINISTRA TOR) EXECUTOR ) lIamil ton Bank - 222 NAME OF APPliCANT COUNTY FilE NUMBER v?/-,?/-/t';{ADDRESS OF APPLiCAlH222 Marl,et Street, lIarrisbu,g, Pa. BUREAU FILE NUMBER SIGNATURE OF APPLlCANT/~" : '?'.{;:Li'z:L/~ HOTlCE: IF YOU FAIL TO PROPERLY FILL 11'1 AHY PORTlOt~ OF THIS APP JCAi1b~~ ILL HOT BE COHSIDERED COMPLETE AHD WILL BE RETURHED TO YOU FOR COMPLETION. COMMONWEALTH OF PENNSYL VANIA - DEPARTMENT OF REVENUE CONSENT TO TRANSFER SECURITIES DATE~W./JJf/ffl I he,eby cansent ta the transfer af the abave securities naw registered in the name af the a o,esaid Decedent and waive the filing of a certificate certifying ta the payment af Ihe transfer inheritance tax ta which the property of said Decedent is made subject pursuant ta the p,ovisians af the Act af June 20, 1919, P.L 521, a.s amended and the Act of June 15, 1961, P.L. 373, as amended. This is alsa in accardance with the provisians of the Act af April 9, 1929, P.L. 343. This Cansent ta Transfer the he,ein described p,aperty aperates anly in reference ta the estate af the , above-named Decedent. 'A ~~ ~ e'~ ~ '~;j;;i' '~A Tj ..-,' ~t\~:" j~' ..." ~-. "" ,''''' ~ Signed fa, the Secreta,y of Revenue / ~i v: Bye... .' , . ;?d..~.(_tk?i!&:... Rccon (9061\1 COMMONWEAL TH OF PENNSYLVANIA DEPARTM"NT OF REVENUE BUREAU OF COUNTY COLLECTIONS APPLICATION FOR AND CONSENT TO TRANSFER SECURITIES REGISTERED IN THE NAME OF A RESIDENT DECEDENT APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby mode for cCl1sent to the ',ansfe, of the following secu,ities of 0 Pennsylvania Corporation or 0 Notional Bonking Association located in Pennsylvania: (0) 7 Shs. (b) Conestoga Transportation Company (c) Common (NOTE: In describing securities enter in (0). ab Ole, either the numbe, of shores of stock or the face amount of registered bonds, in (b), the Ilome of the issuing company nnd in (c) the closs of stock 0' the stated inte,est ,ate and l)1aturity dote or ,egiste',ed bonds.) DATE 3/17/81 ISSUED ON 10/24/1958 ,and having 0 TOTAL MARKET VAUJE OF S 35.00 (DOlO) os of the dote of death of the decedent, Dli ve S. U. Anderson (Name of Decedent) , on January 25, 1981 (Dotc of dcath) who was late of 100 ~It. A11cn Drive. Mcchanicsburg, Cumberland County, Pennsyl vania 17055 (Streot and Number) (Post Office) (County) (Slate) The securities ore registe,ed as follows: Olive S. U. Anderson (Namo or names in which certificates are reglsterod) ADMINISTRA TOR) EXECUTOR ) Hamil ton Bank- 222 (Name) Market Street, Harrisburg, Pennsylvania 17108 (Add,...) Hamil ton Bank, Peter A. Sch\~iers J:;xe cutor NAME OF APPLICANT COUNTY FILE NUMBER c1/-.r/-/Cl.2. ADDRESS OF APPLlCAtH 222 Market HarrisbUJ;,g, Pa. BUREAU FILE NUMBER SIGNATURE OF APPLlCANTBy' . ~-1r NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLI '~'TiO;11 'LIJ: NOT BE CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION. COMMONWEALTH OF PENNSYLVANIA - DEP ARTMENT OF REVENUE CONSENT TO TRANSFER SECURITIES DAT~/t/f'P I hereby cOllsent to ,he transfe, of the above secu,ities now registered in th" nome of the foresoid Decedent and waive the fi ling of 0 certificate certifying to the payment of the transfer inheritance tax to which the property of said Decedent is mode subject pursuant to the p,ovisions of the Act of June 20, 1919, P.L. 521, as amended and the Act of June 15, 1961, P.L. 373, os amended. This is also in accordance with the p,ovisions of the Act of April 9, 1929, P.L. 343. This Consent to Transfe, the he,ein described p,operty operates only in ,efe,ence to the estate of the above-named Decedent. ~~ ~. .H'! Ih ~.;.....,' ~J ~"L"" ." .;;'(~V~~;~..! .."~ Signed fa, the Secretory of Rev.enue , . / B' A {j /r "tAl j Y h" -, --/.- /~) (Signa 1') 11" 'I 1 ,../., 6(, ,..-? '/ -J~tf1'- ';'.'t! j '/, M;?i!-/'e-L-dt..;h'Z Y (County) !. COMMONWEAL TH OF PENNSYLVANiA DEPARTM:;NT OF REVENUE BUREAU OF COUNTY COLLECTIONS APPLICATION FOR AND CONSENT TO TRANSFER SECURITIES REGISTERED IN THE NAME OF A RESIDENT DECEDENT ~ '~~ .,:'.;ilo,.t ~:r.----:'r ~ I'fQ'l;Jc>" . (\ ~ I "-i:i~ DATE 3/1,7/81 APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is he,eby made far Coosent to the t,ansfe, of the following securities of a Pennsylvania Corporation or a National Banking Associo1ion located in Pennsylvania: (a) 28 Shs. (b) Notional Central Financial Corporation (c) Common (NOTE: In desc,ibing secu,ities enter in (0), ab Ole, either the number of shores of stock 0' the lace amount of registered bonds, in (b), the nome of the issuing company and in (c) the closs of stock or the stated inte,est rate and maturity date of registe,ed bonds.) ISSUED ON various dates ,and having 0 TOTAL MARKET VALUE OF S 437.50 (Date) as of the dote 01 death 01 the decedent, 011 ve U. Anderson (Nome of Decedent) on January 25, 1981 , (Date of dcolh) who was late of 100 Mt. Allen Drive, Mechanicsburg, Cumberland County, pennsylvania 17055 (Street and Number) (Post Office) (County) (Stote) The securities ore registered os lollows: 011 ve U. Anderson (Noml.l or nomes in which certificates ore registered) ADMINISTRATOR) EXECUTOR ) r.larket Street, Harrisburg, rennsyl vania 17108 (Add,...) Hamil ton NAME OF APPLlCAIH _ Peter ^. Schwiers COUNTY FILE NUMBER 2/-%1- /tI~ ADDRESS OF APPUCArH 222 ~Iarkct Str~eet Harrisbur,g. Pa. 7f-:) "Jt; iI"./.. BUREAU FILE NUMBER SIGNATURE OF APPLICANT Bvd~.-K_t~,c7'CL(U.'-iL,#- vH':C PTe~.l.del1"L NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTIOtl OF THIS APPLICATION, IT WILL NOT BE CONSIOERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION. Hamilton Bank, 222 (Name) Bank, Executor: COMMONWEALTH OF PENNSYLVANIA -, DEP ARTMENT OF REVENUE CONSENT TO TRANSFER SECURITIES DAT{~f/A,/lAJ/.f /11/ I hereby consent to the transfer 01 the above securities now registered in the ,nome of the afo,esaid Decedent and waive the filing of 0 certilicate certilying to the payment of the t,ansler inheritance tax to which the property 01 said Dccedent is mode subject pu,suant to the p,avisians of the Act 01 June 20, 1919, P.L. 521, a.s amended and the Act 01 June 15, 1961, P.L. 373, os amended. This is also in accordance with the provisions 01 tho. Act 01 April 9, 1929, P.L. 343. This Consent to Transle, the herein desc,ibed property operates only in reference to the estate of the above-named Decedent. ~t~ ~- .~~~ ,,~_..l '.. -..;r;....,1 ~ Il ."-'!,<:,;: l\ ",~~J""'! .......'<.J:,~,i;;" Signed for the Secretory of Revenue ,(/ 'J By l COMMONWEALTH Of PENNSYLVANIA COUNTY Of CUMBERLAND \ j 55: I. Suzanne ~ight .~~r.usCJl.Qllres~.Ilta,lY.Q...ofJlillnil ton BanK, ----- being duly sworn _ according 10 law, deposes and says Ihal he - thoy- !iamil ton ~an.k .Exe.c.utnr .__.---" 01 Ihe Es",le 01 OJ i vc_Umllle ^nrlersnn late of Borough of Mechanicsburg , Cumberland Counly, Pa., deceased and Ihat the wilhin is an invenlo'y made by ____.. !iamil.ton Bank .__ ._,-'-' Ihe said Executor ollhe enli,e eslate 01 said deGedenl, Gonsisling of alllhe personal prop.rly and real eslale, eXGept real eslale outside the Commonweallh 01 Pennsylvania, and that the ligures opposite each item 01 the Inventory represent it's lair value as 01 the date of decedont's death. !iAMILTON BANK - Executor Estate l + ~Oliv.e Umble Anderson and subscribed before me, )/11 / J.- .B _~-'>J (II, ^" / Executor.' . lratOT 222 Market Street }j/J~~~'" ./ (Q(7~(<l vi / (~ 19 ,pI ~if;'~A(~!o~~' ;Z~~~~/~:bnf7MJ HARRISGIJRG, DI,UPHIl1 COUNTY MY COMMISSIOI1 EXi'iH,S el!'i 11. 1985 Member. Pennsyl'Jani1 Ar,sr.ciarion oj :;~t~[i~5 !iarrisburg, PA 17108 -------- Addreu Day January Month 1981 Date of Death 25th Year n I. An inventory must be filed within three months alte, appointment of personal representative.g;:; 2. A supplement inventory must be filed within thirty days of disGovery of additional assets. &~~ f'I',-, 3. Additional sheets may be altached as to personalty or ,ealty i" ~~ J~' _:: 4. See Article IV, FiduGiaries Act of 1949. :: . CJ:~.. C-' : INSTRUCTIONS cP ~ ",,'" r.,~ ~o r,.,:;O ''::~ .,? ::::l .:,~~ N .0 :' 1 'I .'" " v ~~ ~. >- I .,; z w I- W 0 ~ ~ '" ~ '" I- tIl ~ W <( '" ~ I 0.. I- '" I:Y' u 0 '" ~ w \, 0 w w '" ". c '" >- -- :r: '" ~ ~ ~ I- 0.. ..J U. p.. ~ 0.. C I- ~ Z 0 0 0 U. ..J <( "" 0.. :l: W 0 <( w ""I :c ,,:. ,\ > z '" ~\ '" . <( Z 0 ::> c II '" 0 . .; II '" z '" 0 '" , U Z w <( 5\ 0 .... 0.. '" "tl C ~ I' 0: - -.: 1\ 0 ~ -" ""- ~ E "tl II - ~ 0 ~ . 0 ..J U u: '" 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Inventory of the real and personal estate 01 OLIVE UMllLE ANDERS9N ducoosed. 1. 2. 3. 4. Pfd @ 39.6251 @ 23.3125 @ 3.50 @ 9.09375 shareholders 2,337. 88 1,981. 56 105. 00 10,925. 89 59 Shs. American Sto'res Company $5.51 85 Shs. American Stores Company Cm 30 Shs. Belmont Industries, Inc. Cm 1201.463 Shs. CNA Income Shares, Inc. Cm Dividend on Item #4 payable 1/13/81 to 12/30/80 - check uncashed at death Shs. Conestoga Transportation Co. Cm @ 5.0 \ Shs. National Central Financial Corp Cm@ 15.625 Shs. Peerless Turbine Corp Cm @ none ,I Shs. Penn Dairies, Inc. Class A Cm @ 5.0 I! Shs. Penn Dairies, Inc. Class B Cm @ 4.5 II Shs. State Mutual Securities Cm @ 8.34375 Ii Dividend on Item #10 payable 12/31/80 to shareholders of record 1\ 11/28/80 - check uncashed at death II Farmers I Trust Company of Lancaster, Depositors Participation Certificate IIA~~ (See Attached) @ none i First Federal Savings & Loan Association Passbook Savings Account #1 1 02063 Accrued Interest to date of death on Item 12 Bryn Mawr Trust Company Checking Account #011 334 8 Continental Bank, Trustee, unpaid accrued trust income as of date of death Equitable Life Assurance Society - Death benefits on policy #00238073 payable to estate $2.50 U. S. Gold Coin Gold Wedding Band Reimbursement from Coltnnbia Health Insurance Company Refund from Columbia Health Insurance Company - cancellation of contract Reimbursement from Massachusetts Indemnity Life Insurance Company Heal th Contract Reimbursement from Massachusetts Indemnity Life Insurance Company Medical Expenses of record 468. 57 35. 00 437. 50 O. 00 140. 00 31.150 10,846.. 88 ! 494.! 00 I I O.i 00 25,874'1 84 97.\47 1,404'193 1,299. 32 11,742.160 165'1 00 39. 60 121. 32 59. 58 7 28 15 28 7 1300 16. 17. 18. 19. 20. Ii II li 'I I' il II Ii i! I, i I 323.\ 40 :~ i$71,381.1~ \1 I! I " II i I' I 11 , \ I i I I I' I 21. Thl. .action will ba comp'latad by Buraou Haodquo,ta" only whan tha ap'p'lication fa, axamption ho. baan daniad. Dole: Tha oppllcolion fa, examption contolnad on Ihe face of this fo,m has baan danlod bacouse Hal.: Any po,ty in inta,a.I, including Ih. Commonw.alth, ogg,iavad by this oclion may within sixty (60) days olt.r tho dole of Ihl. nolic. .xareis.lhoi, ,ighh of P,ote>I, Holica, 0' Appaol in acco,donce with Ihe p,ovislons of opplicobl. Pann.ylvonio Inhe,ilonce and Eslol. Tax Acls. ~, 00 nr ",'" ~~,~~ N j-"lTl :3~~ .." 17!g .." "._,:;.1 ~. ,. TJ -P::J . -'I'l1 ;1. ,(~ -. -.J " j.O " , ,', 'v 'V RCC~ J I I. nO) APPLICATION FOR CHARITABLE EXEMP'rrON FROM PENNSYLVANIA TRANSFER INHERITANCC: TAX (Ac' of May 28, 1956, P,L, 1757, and Ac' of Juno IS, 1961. P,L. 373, as amended) .~ ~ COMMONWEAL TH OF PENNSYL VANIA OEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Appllcallan i, haraby lilad la, tha app,aval of an exemption from Pennsylvania Transfer Inharltanca To, an the t,an,fe, al tha properly da,cribad balaw: J. Bu,eau File II 21-81-102 2. Date 01 Dealh JanUal::y_2.5_,._l98J._____ 3. ,...., '....., -jl~--,L'?- /'?f.;:J, 4. Nama 01 Decadenl OL1..llR~~~.o.f\l i I I I I I I I 5. Tha Cammanwaalth's app,ai,ad va'ua 01 tha praparly la, which an a,amptian is c'aimad is $ 500 00 (Hale: Where Ih. prapa'ly is alhe, Ihan a 'p.ci/led amaunl al cash, Iha a,emptian cannal be appTav.d unlil Ihe Vo'ue of Ihe prape'ty has b.en estab'ishad by appraisa' by Iha Cammanwaallh, e,c.pl In Ihase cases whe,. Ihe amounl 01 Ihe gift a, bequesl ,ep,es,"ts a slatad f,acliana' a, porcenlaga pa,lian 01 Ihe enliro eslala or Ih. enliro ,esidue. In Ihase cas.. enter such fractional or percentage amount above), 6. Check Ihe manna, in which tha I,ansler was effecled and submil a copy of 'n" dacumenl aUlharizing Ihe Iransle" unless such male,ial has b.en proviausly Ii/ad. WILL iJ{; 1 (1/ alher, a'plain) I DEED 0; TRUST INDENTURE 0; SURVIVORSHIP 0; OTHER 0; 7, Correcl Buslna.. Name and Add,e.. 01 Charitable Organizalian ,acaiving p,apa,ly: HAME ST. STEPHEN'S EPISCOPAL CATHEDRAL ADDRESS 221 North Front Street, Harrisburg, Pa. 17101 8. I certify Ihal Iha inlarmatian canlained he,ein is, 10 Ihe basi 01 my knawledga and beliel, Irue and carract. Signalu,a of ApP'ica~~ 4~ K~~.4.r" lrusl: Ofhcer HAMILTON ikNK Add,a" 01 Applicanl Official Tille ;In MarkF>t StrF>H Harrisburg, Pa. 17108 Trust Officer Dala February , 1982 Thl. lorm mu.t bo complotod In hlpllcoto and 011 throe Copla. dollvo,.d to 'ho Rogl.to, 01 Wills 10' tho County In which tho docodont ,..'dod, 0' In whl~h lo"ors wo,o I..uod fa. 0 non.'esidant decedont's estoto. II tho docodont was 0 non.,o.ldont of Ponn.ylvonlo and lo"ors woro nOllssu.d by 0 Pennsylvania Reglsto, 01 Wills, dollvor all th,oo caples to tho Ol,octor, Bu,oou of County Collocllon., Penna. Department of Revenue, 26 S. 4th Street, Harrisburg, Pa. Do nal wrile balow Ihis lina, Far Officio' Usa Onl Referred to Bureau Headquarters Approved 0 For Secretary of Revenue Denied' 0 (Initials 01 ReglSle, of Wills) (AUlho'ized Signa lure) (Counly) (Tille) (Dale of Relarral) (Dol. 01 Action) * See relverse side for reasons MUST BE FILED IN TRIPLICA TE This ..ction will be completed by Bu,eau tteadquarte" only when the application 10, exemption has been denied. Date: The application lor exemption contained an the lace 01 this lo,m has been denied because Nate: Any pa,ly in Inte,..t. Including the Commonwealth. agg,leyed by this action may within sixty (60) days after the date 01 this notice exercise their ,Ights 01 Prat..t. Notice. a' Appeal in accardance with the p,aYlsians 01 applicable Pennsylvania Inheritance and Estate Tax Acts. r> 05 C2~ "0'" ~;:;:") N r"~ -,.....~. ~o l'ij..: .." ;:J~~' ,.." '~,"J ;.0 .", ".0 -f" J;. '" :~~: -..J " ," u " .'-': '-. .1C:C..1tl.n'}) APPLICATION FOR CHARITABLE EXEMPTION FROM PENNSYLVANIA TRANSFER INHERITANCE TAX (Act of May 28, 1956, P,L. 1757, and Act of June 15, 1961, P,L, 373, os amended) t+- ~~ COMMONWEALTlI OF FENNSYLVAN'A DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Application I. horoby fllod fo, tho app,oval of an exemption from Pennsylvania Transfer Inho,lIonco Tox on tho I,an.lo, 01 tho p,apa,ty d..c,lbod bolow: 1, Buroau Filo//21-81-102 2. Dato of Doath _January-25., ~98L 3. Dato of App,aval ~~ /'1Jlf< 4. Nomo 01 Docodonl 01i.ve~ Anderson S, The Commonwoolth's opp,oisod voluo 01 tho p,opo,ty 10, which an oxomption is c1oimod is $1. ODD DO (Note: Where the proporty is other than a specified amount of cash, the exemption cannot be approved until the value of the p,ope,ty hos boon ostablishod by oppraisol by tho Commonwoalth, oxcopt in tho so casos who,o tho amount 01 tho gilt or bequest represents a stated fractional or percentage portion of the entire estato or the entire residue. In those coses enter such fractional or percentage amount above). 6, Check the manner in which the transfer was effected ond submit Q copy of IIlU document authorizing the transfer, unless such material has been previously filed. WILL l/l; DEED 0; TRUST INDENTURE 0; SURVIVORSHIP 0; OTHER 0; (II otho" oxploin) 7. Correct Business Name and Address of Charitable Organization receiving property: NAME HOLY TUINITY SCHOOL ADDRESS Port au Prince. Haiti 8. I certify that the informution contained herein is, to the best of my knowledge and belief, true and correct. Signotu,o 01 Applicont /Lc..G Zu 'aV'-- ,/ Sue ~h1l ' Trust Officer l'.AMILTON BANK Add,o.. 01 Applicant 222 Harket Street Harrisburg, Fa, 17108 Olliciol Titlo Trust Qfficer Doto February . 1982 Thll form must be completed in triplicate and all three copies delivered to the Register of Wills for the County in which the decedent rOllded, or In which letters were issued for a non_resident decedent1s estate. If the decedent was a non~resident of Pennsylvania and letters were not luued by a Pennsylvania Register of Wills, deliver all three copies to the Director, Bureau of County Collections, Penna. Department of Revenue, 26 S. 4th Street, Horrisburg, Pa. Do not w,ito bolow this line, Fo, Official Use Only For the Secretary of Revenue Referred to Bureau Headquarters App,ovod 0 For Secretary of Revenue j Deniod* 0 (lnitiols 01 Rogiste, 01 Wills) (Authorized Signoture) (County) (Title) (Dato 01 Rolerral) (Dote 01 Action) * See reverse side for reasons MUST BE FILED IN TRIPLICATE This section will be campi eted by 8u,eau Headqua,te" only when the application for exemption has been denied. Dote: The application for exemption contained on the face of this fa,m has been denied because Note: Any pa,ty in interest, Including the Commonwealth, agg,ieved by this action may within sixty (60) days after the dote of this notice exercise their rights of Protest, Notice, 0' Appeal in acca,dance with the p,ovislons of applicable Pennsylvania Inheritance and Estate Tax Acts. n cD ::o~ n~1 N S"::',I roC') _:.. ;;;~ ...., ~'? to I . 'I~O ~~'~~'; ...., _\C"J -n ,rr, ~ j:"? t'.., -..I .' ,. '0 '., " ,.,; REV, 1547EX (, -82) BUREAU OF EXAMINATION I NOTICE OF INHERITANCE TAX ASSESSMENT PENNSYLVANIA DEPARTMENT OF REVENUE, APPRAISEMENT ALLOWANCE OR OISALLOWANCE CONTROL NO. 101 P,O, eox B327 I ' HARRISBURG, PA 17105 I OF OEOUCTIONS, ANO ASSESSMENT OF TAX 10ATE J..... 06"Q3-62 ESTATE OF ANDERSON OLIVE U FILE NO, 21 81-0102 OATE OF OEATH 01-25-81 COUNTY CUMBEIl.LAND NOTE: TO INSURE PROPER CREOIT TO YOUR ACCOUNT SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS OF THE ABOVE COUNTY, MAKE CHECKS PAYABLE TO "REGISTER OF WILLS. AGENT," IF TAX PAYMENTS ARE MAOE WITHIN 3 MONTHS OF THE OECEOENT'S OATE OF OEATH. A DISCOUNT OF 5% OF THE TAX PAlO MAY BE DEOUCTEO. SUZANNE M KNIGHT HAMILTON BANK 222 MARKET ST HBG PA 17108 PLEASE RETURN THIS PORTION TO REGISTER OF WILLS IF PAYMENT DUE ~1:11:: _A_L9~C:; _ ~HJ~ J-!fI!.E_ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - - - - - - - - - - - - - - - .. - - - - - - - - - - - - . NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR OISALLOWANCE OF DEOUCTIONS ANO ASSESSMENT OF TAX ACN 101 DATE 08-03-82 ESTATE OF ANDERSON OLIVE U FILE NO,21 81-0102 I CHANGED TAX RETURN WAS: 1 X I ACCEPTED AS FILED APPRAISEO VALUE OF ESTATE: ,. Real Estate (Schedule Al 2, Slocks aod Bonds (Schedule BI 3. Closely Held Stock/Partnership Interest {Schedule Cl 4. Mortgages and Notes (Schedule D) 5. Cash & Miscellaneous Personal Properly (Schedule E) 6, Jointly Owned Property (Schedule Fl 7. Transfers (Schedule Gl 8, Total Gross Assets APPROVED OEDUCTIONS AND EXEMPTIONS: 9, Funeral Expenses/Administrative Costs/Miscellaneous Expenses (Schedule Hl 10, Debts/Mortgages/Liens (Schedule II 11. Total Deductions 12. Net Value of Estate 13. Charitable Bequests (Schedule J) 14. Net Value Subject to Tax ASSESSMENT OF TAX: 15, Amount of line 14 taxable at 6% rate 16. Amount of line 14 taxable at 15% rate 17. Principal Tax Due TAX CREOITS: PAYMENT . i DATE 10-19-81 05-12-82 RECEIPT # DISCOUNT 1+1 INTEREST H 069764 010719 .00 277.96- THIS ASSESSMENT IS BASED ON: 1 SUPPLEMENTAL RETURN NO INTEREST IS DUE IF PAlO BY 05-12-82 IF PAID AFTER DATE INDICATED SEE REVERSE FOR INSTRUCTIONS, 111 I 2l 131 ( 4l 151 1 5) 1 7l .00 .00 .00 .00 .00 .00 .00 181 .00 191 (101 .00 13 ,130.97 (111 ( 121 (13l 1141 13,130.97 13,130.97- . .00 109,760.02 (15l 1181 .00 109,760.02 .00 16,464.00 16,464.00 X,05= X,15= (171 AMOUNT PAID 8,000.00 8,464.00 TOTAL TAX CREDIT BALANCE OF TAX OUE 16,186.04 277.96 RETAIN THIS PORTION FOR YOUR RECORDS (If Balance Due is less than $1.00 no payment is required) " cxi N I, ,:- ::t~ r ""'(~J 'lu . :~ ;~.? " .~ C> INFORMATION This document is the Notice required to be given under Section 709 of the Inheritance and Estate Tax Act 01 1961 172 P,S, section 24851, If the tax is paid withIn three (3) months after the decedent's death, a discount of 5% of the tax paid is allowed. Inheritance Tax becomes delinquent nine (9) months after the decedent's death. Interest is charged at the rate of six (6) percent per annum on the amount of unpaid lax. (SEE EXAMPLE BELOW) EXAMPLE: If a balance of lax due of $2,000,00 is in a delinquent status from 3-3-80. and payment is made on 5-23-80, the interest is calculated as Indicated below: STEP 1 Determine the rate of interest from the table below. STEP 2 Multiply the balancE' of tax due by the rate of Interest. STEP 3 Add the interest to the balance of tax due. Inte,es\ from 3-03-80 to 5-23-80 Results in: 2 Months 20 Davs . Rate of interest = ,010 + ,00335 ,01335 Balance of tax due Rate of interest INTEREST $2,000,00 x ,01335 $ 26,70 Balance of tax due $2.000.00 Plus Interest to Date of Payment (+) $ 26,70 TOTAL tax and interest to Date of Pavment $2.026,70 ~ - -- --- -- - - - - - - - - - - - - ~ - - - - - - - - - -- - - - - - - - - - - - -- - - - - - - - - - - -- - -- - - - - - --- 1 month ,005 4 months ,020 7 months ,035 1 0 months ,050 2 months ,010 5 months ,025 8 months ,040 11 months ,055 3 months .0 \5 6 months ,030 9 months ,045 12 months .06~ 1 dav ,00017 11 days ,00186 21 days ,00352 2 davs ,00034 12 days ,00203 22 davs ,00369 3 davs ,00051 13 davs ,00220 23 davs ,00386 4 days ,00068 14 davs ,00237 24 days ,00403 5 days ,00085 15 days ,00250 25 davs ,00420 6 days ,00101 16 days ,00267 26 davs ,00437 7 days ,00118 17 days ,00284 27 davs ,00454 8 davs ,00\35 18 days ,00301 28 davs ,00471 9 davs .00152 1 9 days ,00318 29 davs ,00488 10 davs ,00169 20 days ,00335 30 davs ,00500 --------------------------------------------------------------------- Any party in interest, including the Commonwealth and the personal representative, not satisfied with the appraisement and assessment may object within sixty (60) days after receipt of this Notice as prOVided by Section 1001 of the Inheritance and Estate Tax Act of 1961 (72 P,S, sec, 2485 - 1001), MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT" DETACH THE TOP PORTION OF THIS FORM AND SU8MIT WITH YOUR PAYMENT TO THE REGISTER OF WILLS FOR THE COUNTY SHOWN ON THE REVERSE, SEE THE INHERITANCE TAX INSTRUCTION 800K FOR ADDRESS, J REV, 15B3EX (3-B2) PENNSYLVANIA DEPARTMENT OF REVENUE ':;UREAU OF ACCOUNTS SETTLEMENT P,O, BOX 2055 HARRISBURG, FA 17105 ESTATE OF ANDERSON OLIVE U DATE OF DEATH 01-25-61 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT PAYMENT TO THE REGISTER OF WILLS OF THE WILLS, AGENT," INHERITANCE TA~ASSESSMENT 101 CONTROL NO. RECORD ADJUSTMENT __ DATE 10-07-6j! FILE NO, 21 81-0102 CO~NTY CUM~ER~ND SUBMIT THE UPPER PORTION DF THIS FORM WITH YOUR TAX ABOVE COUNTY. MAKE CHECKS PAYABLE TO "REGISTER OF SUZANNE M KNIGHT HAMILTON BANK 222 MARKET ST HBG FA 17108 PLEASE RETURN THIS PORTION TO REGISTER OF WILLS IF PAYMENT DUE CUT ALONG THIS LINE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . "INHERITANCE TAX RECORD ADJUSTMENT" ESTATE OF ANDERSON OLIVE U FILE NO,21 81-0102 DATE 10-07-82 ACN 101 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION VALUE OF ESTATE: 1, Real Estate (Schedule A) 2. Stocks and Bonds (Schedule 8) 3, Closely Held Stock/Partnership Inlerest (Schedule Cl 4, Mortgages and Notes (Schedule 0) 5. Cash & Miscellaneous Personal Property (Schedule E) 6, Jointly Owned Property (Schedule F) 7, Transfers (Schedule Gl 8. Tolal Gross Assets ( 1) ( 21 ( 3) I 41 I 51 ( 61 ( 71 .00 .00 .00 .00 71,381.84 .00 53,509.15 ( B) 124,890.99 DEDUCTIONS AND EXEMPTIONS: 9, Funeral Expenses/Administrative Costs/Miscellaneous Expenses (Schedule HI 10. Debts/Mortgages/liens (Schedule Il 11. Total Deductions 12, Net Value of Estate 13, Charitable Bequests (Schedule J) 14. Net Value Subject to Tax I 91 (101 .00 13,130.97 (11) (121 (13) (14) 13,130.97 1l1,760.02 2,000.00 109,760.02 TAX: 15, Amount of line 14 taxable at 6% rate 16. Amount of line 14 taxable al 15% rate '7, Principal Tax Due TAX CREDITS: (151 ( 161 35,424.34 74,335.68 X,06= X,15= ( 17) 2,125.46 1l,150.35 13,275.81 PAYMENT DATE 10-19-81 05-12-82 RECEIPT # DISCOUNT (+) INTEREST (-I AMOUNT PAID 069764 010719 .00 173.26- 8,000.00 8,464.00 1-- NO INTEREST IS DUE IF PAID BY 05-12-82 IF PAID AFTER DATE INDICATED SEE REVERSE FOR INSTRUCTIONS, TOTAL TAX CREDIT BALANCE OF TAX DUE 16,290.74 3,014.93CR (If Balance Due is less than $1.00 no payment is reqUired) RET AIN THIS PORTION FOR YOUR RECORDS INFORMATION '. If the tax is paid within three (3) months after the decedent's death, a discount of 5% of the tax paid IS allowed. Inheritance Tax becomes delinquent nine (91 months after the decedent's death, Interest is charged at the rate of six (6l percent per annum on the amount of unpaid tax. (SEE EXAMPLE BELOW) EXAMPLE: If a balance of tax due of $2.000,00 IS In a delinquent status from ~~. and payment is made on 5-23-80, the interest 15 calculated as indicated below: STEP 1 Determine the rate of interest Irom the lable below. STEP 2 Multlpl~' the balance of lax due b~' the rate of interest. SHP 3 Add the interest to the balance of tax due, Interest from 3-03-80 to 5-23-80 Results in: Balance of tax due B_aJ~_._9JjDJ!,!JQ:;1 INTEREST 2 Months = 20 Days = Rate of interest = ,010 + ,00335 ----:51" 3 :15 - - - - - - - - - - - - - ~ - - - - - - - - - - . -- - ,020 ,025 ,030 1 month ,005 2 months ,010 3 months ,015 1 day ,00017 2 days ,00034 3 days ,00051 4 davs ,00068 5 days ,00085 6 days ,00101 7 days ,00118 8 days ,00135 9 days ,00152 10 ,days ,00169 4 mo"lhS 5 months 6 months 11 daiS , 2 da\,s 13 daY$ 14 day!; i 5 days 16 days 17 dal's 18 days '9 davs 20 days . - - - - - - - - - - - - - - - - - - - - - - - - - . $2.000,00 x ,0Illi_ S 26,70 Balance of tax due S2,000,OO Plus Interest to Date of Payment (+l $ 26,70 TOT AL tax and Interest to Date of Payment $2,026,70 - - - - - - ~ - - - - - - - - - - - - 7 months 8 months 9 monlhS ,035 ,040 ,045 10 monlhs ,050 11 months ,055 12 months ,060 21 days .00352 22 days ,00369 23 days ,00386 24 days ,00403 25 days ,00420 26 days ,00437 27 daYs ,00454 28 days ,00471 29 days ,00488 30 days ,00500 ,00186 ,00203 ,00220 ,00237 ,00250 ,00267 ,00284 ,0030 I ,00318 ,00335 --...------- .-------------------- MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT" DETACH THE TOP PORTION OF THIS FORI~ AND SU81~IT WITH YOUR PAYMENT TO THE REGISTER OF WILLS FOR THE COUNTY SHOWN ON THE REVERSE, SEE THE INHERITANCE TAX INSTRUCTION BOOK FOR ADDRESS