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HomeMy WebLinkAbout81-00111 I ~ . ..:l . ~ ~ l1.l ~ H ~ ~ \"'1 I'i/ \"'~ ..... co .1 ". ,... ..... (\' 0 ~ .. J9 0 Z " LLI nEV-!I19 E)(+ (7-80) COMMONWEAL TH OF PENNSYLVANIA . OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT OECEDENT INHERITANCE TAX RETURN FOR INSOLVENT ESTATES (Instructions on Reverse Side) COUNTY NO, J / - ~'I - II I STATE NO, E,tate of flfiliJf.L ~. ;1/., / Ii' II /'// I .; i ' Last address V /~;,/(", (STREET) I- el i,,1c ~. >- z ., 0: w I'll) I ' ~ Q U w (CITYI (STATl;'! (Z.IP) ::l U w tlllI !{D Q Q u: Dote of Death I ' ( ) Exec. ( ) Adm, Other Name ; II t II I.', II,.,! Social Security No. : I . I II ! /'.(~ Addro.. I, f\ Social Security No. /:;~--()I - '112.0 (STREETl I f. j'e', ) '')^ " ')1. i, '." f ; i I _ _ _L. - ICITY) (STATl~1 Cl.IPI Under penalties of perjury, 1 declare that I have examined this return and to the best 01 tv knowledge end belief it is truo,correct and compl~te. /1'vlJ112 7f).0 g ~ -t( / 1-\1 " II; I Signature 01 FiducIary Date TYPE OF ASSET DESCRIPTION ESTIMATED MAR~ET VALUE DEPARTMENT VALUATION (OFFICIAL USE DNLY} ~\J ,'I'i 11'\ k{ bCdl ~ (l ~ ~ O1t.ftfS In",\I..~ i.' [\.(",,1: (l(l c:"", r\ S 'J ,"7 < < a'). fJ1,J'j ~1i,IJ1 ti".J\ '" . t;; ~C'd' l...'r.(i;" '" '" .. I I .-L" j-h iJ..>/ J;f - I ,tu.I' r(1 " '" :)lJI~ ,e, ~ (~.j.r,'7) ) -0- TOT AL i::/i'J,f~ I do hereby certify that the above assets were appraised in accordance with Pennsylvania low. OFFICIAL USE ONLY 1/,!'()/7/~ J-/PI.t'dtlH /) .PPRAIS~R March 27, 1981 DATE DATE NAME OF PAYEE NA TURE OF CLAIM AMOUNT CLAIMED 7/:>>./'ib /1i-hq,).(I'fl:tf\ (:;,/1['(,.1 /L, ~ YjI3}SI) 2,:(/,S/I:". )/('lIe('''/ Sc'(I"1.C u ::l Q W Q Q Z .. '" I- '" W Q h.UlIl.j ( f-[-<" '>L.. I' - I( ~ L(""(;:.rt: il1dl " (:/ _, .] 0" / .:J '7 I. . " J... '/D, "L TOTAL 0'/.' / A :".;< -J/ ...~ Ilt;D Is .'-- . ---.....- DATE OFFICIAL USE ONLY II-JO(). - 3 $ / ill IkJ 6EDUC. TIONS ALLOWED 'UJnleM xCi awo)ullcnpl^IPul'OP'Vd WJOI lIa popodoJ aq pno4s WBIIDlUOJU! Blqoxol 5!41 'sosodJnd X01 OWOJUI O!UOAI^'iUUOd JOIBlqopodaJ 5! OIDlsa liD 6U!JOIS1U!W .po lI! POUlJOIJod S8J!^JOS JOI 'JOIOJIS!lI\WPO JO Jo.n;JOXO UD 'AloU/eu :O^!IOIUaSoJdoJ 910'50 liD a' Plod soo::J :310N II'MOI.{q OI~DJO^O:)lJJ DolO lunawa o1~!l JO '.ilqop so onu,MoH JO IUOWIJOdoQ ny. ,{q P.1HIAO::>,)J 09 01 0;5"\ O~I 5! 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