HomeMy WebLinkAbout81-00139
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No,21-81 139
. PETITION FOl' PROBATE OF WILL AND LETTERS TESTAMENTARV
, . In the Estat,e of OUJRTRUDUJ AMET.IA UROOKUMNl~",,-
, deoelllled,
TO Register of Wills for the Oounty of Oumberlll'nd, In the Commonwealth of Pennsylvania,
, l/ir!l,t Codicil to the .
Petltloner(s) Ie (are),the exeout,t;;1lL_..,;" named In the/Last Will and Teetament of oertrucle
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~1ll~tt!\1~ro~,~l6banl~, add Will," dated~EE.~, 2, 1971, and aaid Codicq, dated
D~Re1it wah' a olilzen of the United Statell,and a rellldent of Camp lUll , ,
11WM1I1i1Rt (Borough), Cumberland Oounty, commo'1wealth of ,Pennllylvanlll,
Deoedenldledon:Thursday tho, 9th day of Ootober A,D, 11ilL-, In the
County of ~ Dauphin , , Stah, Of Penna, ._ at the age of ~ years,
Deoedent~J (has not) been married ljn~has not) had ohlldren born to 111m (her) slnoe the ex.
eoutlon of the above desorlbed Will. ", ' ,
Deoedsntwas possessed of pereonal property to the value qf _~ 000,00
and of real Bstate to the valUe oflicne
,
as near as can be aeoertalnedl said real as tate situated as follpws._ N / A
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Therefore, youtpetltloner(s) r\lspeotfully apply(lee) for the probate Of the ellld Last Will and Testa;
ment and for Letters Testamentary theron,
20
Date'il ,February H, 19~1
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,Name and address Eleanore Rose Borek
, of Pell\loner(s)
_~~ark8ide.Road
pRmp Hill, ,ennsylvania17011
COMMONWI:ALTHOF PENNSYLVANIA)
OOUNTV OF OUMBERLANOf ss
El (H~nq!1l_Rose.J3.~L___,___,
named In above applloatlon, being cjuly __sworn , ' acoordlng t~law say(s) that the
statements set,forlhln \hls petltlol1,are truE) to the best of het' __ knowledge and,bellef.
_c,[worn __ and subsorlbed before ~_m6~~~~" ,', ,'ld,)
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F,br~.ry 26, 1981
,
At,tqrney .
James t, Arnold,Bsquire
p, 0, Uox 73.7 ~
Camp Hill, FA 17011 @;J!!-~
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IlAIR~ AND .JENNINGS
ATTORNEY' AT ~AW
OUNlDIN. P~A" "'U
LAST WILL ANOTIDaTA~ID~~
I, ,aIDR'l'IWOIll JIMIDLI/\ J3ROCKLDll3l1NJ<, a l!esident of t>inElllas
Oqunty, Flo#da, do hfll:'eby make, publiRh and declare th'ill all and
d
por"my Lal!lt Wilr and Tl!Istf\ll\ent, hereby revoking any lInd all former
Willa and CodicHa thereto by me at any Ume heretcfot'e made.
FIRST, I desire and direot that my body be bUried in a
Ohristian like manner, suitable to my oiroumliltanoelil in life.
8JJlCONOl "1\1:\. the rest, residue and remainder of my estate,
both rea1,persorlell and m;l)ced property, of 'every kind and nat\\re
and wher,eSOlilVel1 situated, of whioh I may die sshed or poi;Jsessec;t,
or to which I may in anywise be entitled at the time of my decease
or thereafter, or over wlUoh :t may hiwe any power of dilllposition
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or appoi'ltment! whi,oh power I hereby ,e~eroise and so appoint,
'indluding the prooeeds of any i'lsura1'lce on my life payable to my
estate or to my personal representative, I give, devise, bequeath
and appoint to myh\\sband, FRffiO D'ENTONBROCKLEBANK, for /!Ind c;turing
his'natural Hfe, tOf1ether with all the ren~s, profits anCl inoome
,the7'eof, during saJ.d time, without bCJ:ld or o;t:her security. ' Upon
the death of,my, said husband, q1' upon I11Y d!9ath, if he predeo,ea~es
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'me, :t 9~ve and bequeath to, my daughter, ELJJlANORE ROSE BOR1llK, ,and
my gra'ndohildren, BARB;\R1I JIDA~ BOREI< and JOHN B. BOREK, ".m., in
,
equal shares, or to the survivor of them, all qf myccmmOn stocks,
mut\\al funds, and 'bonds off' ~ny,kind and ~ature Whatsoever, and :t
give, devise and bequeath the balanoeof said residuary estate,
inoluding but not limited to, all t~ngible personal property ~nd
,
cheoking aooounts snd saving's accounts, t,o my daughter,' ELEANORE
ROSE BOREK, 427 t>arkside Road, camp lUll, Pennsylvani/!l, if she
'shall be t'/1en living', ,or if she shall be not then living, to her
ohildren, aA~aAR1I JIllAN BOREll< and JOHN B. BO~EK, JR., in equal
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the prElsenoe of eqoh other,1 have her.~unto sUbsoribaq our namos as
witnesses t~e day ~nq year last above written,
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residing in Duneqin,U'l'orida
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F I / ' i \o.:....t~-tfi'~ 'C"l ,I..
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residing in Dunedin, Florida
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C J<.;) {~l,7'?J' /}, l:JI"t't'/,')
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res id in'i1 , in Dun,lfldin, Florida
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BAIAD AND JENNINGS,
. ATTORNEYS ^' LAW
OUNIOIN, ,u., Ims ,
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OATil nt' l'ICIUIONAI, RICI'RICHt;N1'A'I'IV~
COMMONWEAI-TH 011 PIlNNSYI-VANIA 9RI
COUNTY OF CUMIHlRLANI)
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Before me; the Reslste(for th" Prllbale of Wills and sl'nnUns of Lellers of Adn11nlslraUon In nRd for the County of
Cumberland, personally come_ Eleanora R\;lse Bor.~l(
who, belns duIY"Rwnrn , do...l:.tS.._deposu nl1d say thnt us Exacllcr.ix
of the Ipst Will nnd 1'eslomon( of GSt'trllda Am~lia Brocklebank
deceaRed
RhA will well ond Irulyadmllllsler the SOOdS and ehnllels, rlshtsnnd credits of 8ald deceased aQcor~lnalo Inw, And
also wlli dlllaenlly comply with the pro~IRlons of the IlIw relaUns 10 Transfer Inherltllnces, Sworn and subscribed before me,
Feb 20 A P 19 81 .j >' ) j f,",'
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Be It remembered thlll all the
recorded the 11181 WlIi and Testllment of
26t.h dny of
G\!lrtt'ude
DECREE
Februlu:y
Amelia
81
__,A,P,,19
Brocklebank
,there WIlS probl\ted,lInd
late of
camp, Hill
Occells~d, Lcllers Te.t.amentary, were sruntod to
Wltnes~ my hllnd and official ,8elllthe day,and yellr IIforcsald,
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,Cumberlllnd CPUl1tY, PennsylvlInla,
Elm.nore Rose Borek
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, Resister
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COMMOHWIAL TH OP PIHHIVL VMHA
DPPAKTMIHT DP RlVINUa
TRAHIPIR IHHIRITAHCP TAX
RBlIDIHT DBCIDINT
APFIDAVIT OF
FIDUCIARY
(Inetrlletlon.' on Rov".. 5Id.)
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cstoto of"-:GERXlUJDD: AMltI,IA--BaoC1Q..ii:BANI'-
Last Add rm __ 42 LJ?lll:!sJl idg.J1Q.iUI._.___
C Qmp_ HU1....-b,.....ll.Q.lL-_,
lelTYI InAlCI 11I"1 .
Ooto of Doolh Q.9.tQ.~,er2,,~J..2.au_ _.,__,
Social Sociurlty No. _.._..31l.9d6~6--~__.~__H
Buroau 1'110 Nil, __'..___.._____..___.,." .,...
Coullly Fllo No. __2hal.d.J9...:.....___..__..,.
1, D~oedent dledl
( '), Intostoto (wltliout 0 will)
(K ) Tostdte(loavlng a Inat wlll--oopy attached)
2, I. tlie filing of 0 Fodornl eatate TC1K Roturn required fat Ihls 05lnlo? Yos__ No ".lL-
3. K) lSalU4.Q{cxocutrlil ) Adinlnlstratorl Administratrix
Name 1ij'...lltl~~Ro.8.Q....aG~k----,-_..~-
Address __4~7 Pa.rkside_Ro/.!9
Camp Hill, Pa"..j,lOll
lelT"'I (S"T^"l!,1 '; ttlr;)---...._.
4,' All correspondonce.should bo mollod to (,K) Attornoy
5. "If an attorney Is reprooont!ng thcostato, Indlcatol
) Flduolury.
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Nom\!
Address
James K ,Arnold, JUsquirliL-,__-,,---,-_
Arnold, Slike & Bayley
2109 Marke~ at~Aat
Camp liill,.Pa.l?.QlJ:
ICiT'(1 I'TATUI
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List all safe de,pO,S,lt bO,xes registered In tho dcoedopt'e Indlvlduql nomohor l,alRtlY with/ oras,a~ ay, o~t or dO~ILlty
of.anothor, or In dooodent's Individual name with right 01 ocooas by anot or as ogont or doputy. Inoludo tho n01l1t'
and oddress of tho bank or other Institution whoro, tho snfo doposlt box la locatod, tho namo (s) In which the b(l~
Is teglsteredond the rolatlonshlp of tho lolnt holders to the docodont. '
HAMI AHa AOORUSI or BAHK OR OTfIUR'IHlTITUTION
tH WHICH OPCBOINT M'AINTAIHBO A IAPO ottPOllT oox
~...:=:n=
HAMB OR NAMUS IN WH{C!i
SArBOUPOllT nox IS IlsallTBRBO
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AOLATIOHIHlror JolIH
__!iOLOSRI TO PBCB~~~!..,,~
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lIaHAIURO or PIOUCIARV ,
g -t!)O' nO',
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Undet pllnoltles of porlury~ I daclare that I havo oxamlned this rntum/ Inoludlng nocompanYlngschodulos and
statomonts, and to the bost of myknoYiledgo and ballof IHs true, corroot end cemplato. '
e.Etilill'.6Y-i'\tM.1Nl1Jl1I1IMillU~XJl!iliE.!L^L INFO flM A TI()~
1, WSO~S flESPQNSI BL EJ9JJ. IWTI}Jlli
Sectlol' 101 of the Inhorltonco 011\1 Estoto Tnx Act of 1961 provi!los Hwt tho following ~orsolls sholl proparo Ilnd (110
o roturn: , . ,
0; Tho norsollol roprosontllllvo ollllO 0510to o(tho !looo!loll( ns 10 plOllllrtyef tho !locodent odllllnl~torod by hi 111
olHI sur,hllCldlllonnllHoporly which Is or 111ny be subjoctlo Inhorllunco Tnx ol which ho/sho shnlllHlvo or
nC(lulro kllowlodRO; ,.
b, Tho tronsloroo of nm/,orty Ul101llho trnns(or 01 whlcll InhorltunclJ Tnx Is or lIIuy'bo Imposod by tho 1961 Stiltuto,
IlIcludlilR 0 tmstoo 0 plOnorty Irnllslorrod in IrusI, provldod lIwlllo soniHnto rulurn nood bo 1II11do by tho trllllsloreo
of proporty IIlcllldollllllho retull' 0111 porsonlll roprosolllullvo, '
2, PLACE FOR FILING
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Tho 1010m Isto bo fllod In dupllr:!llo with 1110 11oRIslor 01 Wills oUho couuly whoroln Iho docedonl rosldod,
3, TIME FOfl FII.ING
Tho IllIum Is duo nino months nllllllho docodont's donlh, unlo$s 1111 oxtonsion lor fillnR hilS boon lIpnllod (or lInd
~rnnto(IIIY 'ho Socrotmy 01 flovolIl/o within the nll1o-mo"tli porlod,
4, WdlligQ.fILE RETUHN
SecllQn 791 of Ilio 19GI SlllIl/to provldos Ihot " , , ,lIny person who wl.lllullY foils to fila 0 return or othor ropor\
required 01 him, . ,sholl ho pUJRonolly 1I11blo, , ,to h ponolty of 2!i% 01 Iho lox ultll1\i1tely found tobo due or $1,000
whlchovor IB llio lossor 10 110 rocovorod by llio Doportmonl 01 Rovonuo as dohts 01 IlkonJlloullt ora recovorahlo by
low,"
6, m.BATES
II1horlloncl1 Tnx Is llilynblo ntlllo rate 01 G%ol1lrnl1sfors to 1I110nl dOGcondllnts, such osfother, mother, husband, wife,
son, dmlghlor, gJOndclill<lroll, l~rnl1dpnronl, son-In.lnw olld rlllllP,hlor.in.low and at tho rlllo of 15% os tqall othors,
6, llY.MENT 0 F TAX
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Thti'tnx assossod on 1110 lrllnslorol property ronortodln tlio rotuJll Is rluo 9 months lIltor tho docedont's doath, Inlorost
oUho rato of G% por annulII aceruoS thorooltor I/ntllplIYlllolIlls illudo, All pnYlllonls rooelvod ote first applied to OilY
Intorost wlilclldl10y bo duo with ony romnlndor IlllPllod to tholnx, IF TAX IS PAID WITHIN 3 MONTHS AFTER THE
OECEDt:NT'S DEATH, A DISCOUNT OF 5%OF THI: TAXPAYMENT IS ALLOWED,
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All chocks should bo mmlo jlllYllblo 10 tho Roglstorer Wills of tho counly whoreln tho docedont rosldod ond me
reoolvorlsuhloct 10 tho IInnl dotormlnallonof tho DopiHtlllOnt of Ruvonuu,. '
7....fAILURETO PAY
Tho tuxos llIII1050d, 10. Rot.lllll willi IIIIY Intorost thoroon, IIro 1111011 uponroolplOnorly, which Ilo.n romolnsll1 Offoctul1\1l
Iho toxus Hill Illtorosl hOVO.llOUII pnld In (1111, Thu luxos muy ho mlod for ORlIll1SlllllY ronl proporty In lho docodonl's.
ostoto or agulnst auy proporty bolonglng 100 lrons(eroulloblu lor tho lox, .
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8, FILINOOF'FALSE RETURN
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'Any purson 'w110 Willfully nlilkos II falsQ roluJIl.or ropoll roql/irorl of him shull, In I1ccordnl1co wllh.Sectlon 793 ollho
IgGI Slaluto, ho WIlily of u mlsdumennor IIl1d, on eonvlcllolllhorool, shrolf' bu sOllloncod to pny a fino nol oxcoodlllR
$1,000 or Ulldorgo IrnjJrlsolllllollt Ilot oxcoorllllR 0110 YOnr or liolh,
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lIghedule'IE" mUlt Inoluds ell property, reel and purlon81, ownad by tho dooudont Jointly wltllonothar
per\Vor pertles ellolnt tanantl With right of survivorship: Both tangible and Intonglble proPerty MO 10 bo
Inoluded. Lilt reel aRtate first, ". ,
UiUaU~TIPr:ii FOR OOMPLETING SCHEOULI! "E"
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Desorlbe all reef proporty 0& Indloatod In the Instructlon.s forBohedula 'W', Dosorlbe a.llperaonal property
as Indloated In tl1o.lnstructlons for Scheelula '''B'', Incl\lelo tl10 nomOi oddross und rolotlonul1lp to tho
deoedent of tho co.owner (&) anel tho elata tho lolnt ownorshlp wal ostulill&hocl.
Indloato the to,ol market value of tho lolntly ownad proporty,
Indlcata the Percentage of the deoedont's Intoro&t,
Indicate ,tho markot valuo of the deoedont's Intorost.
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',COMMONWHAl,TII 01' l'I\IINSYLVAl-II/,
Pf.i'AIl1'MlilH Of' Ill'VENUI
TA"N5fUR INHURlr"NCU' TAX
RU~!IJUNTDUC!DUNI '-.. _ __
. .' ~ORIGINAL
INHERITANCE TAX
APPR~lseMENT
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SUPPLliMENTAL
autata of _.__~_._" ..~a.or.~r.I.!~~~J1l!31~,IU\r.,ool~!llbl,l!lt,_,_~_
Fllo No, ~~'m_u2J:-~!:9t3..9,
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County ~__.._._",: CU\1l~I!t.'Jl\nd
Onto of Donth _u,QE~E.~~!..,~,--1.2!!.L._
~-q .... _. _ '_. .'-"T'r~-"'-O"~_F'"-'""l-~~--_.-l-c.--Jlf_--. "'" .~ -
In; thl elv.nt that, uny f"lu'" 1,,'oruI' III _Ihlll uhltu ,.frulufnrr,)d l!11;UIUIIII,," Of t1nl"YITHJf\', to \lalll/leuul helnul. t'" dootld.nt after_ the
.lCplratlon (,If ~lOy UleUI for Ilf. hr 1M Y'HlU, IlIlt Cornmullwoull" IUH.by dMlu,..ly tourv"' the rluht to Ill'flruha Glld_ulI,i.. trunl'"
lnh.rltalt!! talCI,' Qlth~ ~~ul'c~llqt"r!~I~:~~U~.~~J~!!!!~JQ.J:.~.t~'~~""L~:;;=1.'t:~.;..~~:z;:;!.~-=ti-!mcr':",,__. "~'-=r. _. ......
. 'PROPERTY NOT INCLUDED IN ReTURN BUT APPRAISED BY THE COMMONWEAL TH
. ._--.-...__-.-..-..-....________n__._.._........_____H.__._........_____"_............,,..._......_..___.-.... _.__
......-..._....._-*..-._-_......._~-...._~_._-....-._,.._--"-..----.~~"-*~"'-. ......----,-..*~.._...._----.,*_.._._-_.-
,
_..._____......_____________~~..__..~_~.,u___~_.......,_........_.~*n~-<._._.__._...._...u~.~_.............___....__"-'-__H
...-....------~--..............._---~--
,
_ .....-------.__+<_..._....._.u___ u.......-......._....._,,_~...o--~__.___._~.,._,.....___*...___~.__..~_-<.,__..
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, 'ASSET sUMMA'RY A~pEl~~J~'V1IJE
_.................___._.._._._...~..~___............h_<'_.,~...____~~. .--.--..-------.------.......................---"---:--~..---.---.-~.,.~-___ti_~~ ...__.------,._
1, T.lol Real Proporty _ SCH, "A" , II , " $ ,__...._,___J1on.!-_
~, Total Personal Property ~ SCH, "B", , , I $ --6i,,6.9~, ~1
3, 1'otol Jointly Owned Property - SCH, "e" $ .~-!l~l. 7)__:
4, T~'tol Trani/en ~ 'SCH, HC", " ,', , , " $,.::~..-~
. -~~.---_.._-_....-..,-....,*....~.~~.:.~_....._--
Unreportld' $ --..
Unreported $ --._-+
Unreported $
Unreported $
$ none
,
$ ~l".,698j51
$ '_mlLm...:1.~_ i,
$ _ none
70,630,26
TOTAL GROSS ASSETS
,,:J:]'LIFB ESTA_T~ '~-~~~~~__.__..~~~~~DER .. ~:..~~.=.
------_.._----.....__._..............,..........,~....~~
--r:--:--....--...
~_._.-------":_;-.....-:-~'.__-.-----+-"-+.~........-,---..-......-.--~....-_____-.n-...u.___.._..____,_..-..._
_"_-;-~~."_..___'__'_.'..""_Ln....'~".__u ,....,.. TOTAL VALue ,$
~. _____.........-..-..___r.............--H.... _....-._~......_.~__~-r-...__.___.'u_....._._.,'_._."._...... ..._...u--,.~~~__.._"..__~___~~~._,_.,.....~~.~__ ...~_~____.~.__~ _", ...
I do horoby cllrtlfy tha.! 1!10 nllt/vo '(IPI)inlum~"t Is made In ~o"formlfY with Ponnsylvonlalnw ,and hns boon 'flied Ihls
day wllh the Regllter af Wills. , , ",
_,___,~ILJ:JI1abJlII / May 29. 1,981
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COMMONWIALTH OIlP~NN.VLVANIA
OOUNTY Oil OUMIIR~AND
III
,,~u IUeanar,e l~oSG 'Borel~, ....u".._,,~_~,..,....'........."........~.T.._'___
. bolng duly "c...lIwp;n.. noootdlnQ to Inw, dopolOl nnd 'ny' thnll ho ~'_'_"".'.""~"'W.""'_"n..___'_~'m,
".,.'__,__..lJ;,ltJ~q\.l~;'~~, ", ,01 tho ,a,tnto of ._.."....Qe,l:j;J:Ug,~..All1f,\l.iLPJ:Q,Q.\~l~ba~llt.
laiD ~I u~a:'O\.l~h 0 ~, (:If.llllp_Uill__~______,.,,,,,..,.., Cumbo,rland County, Pa" dooellod and,thanh.
"within 1\ an Invontory mndil by Itiollll~o l\oseBo~Ql~..L-;-_,tho lftld-~lb:eQ\.lt~x-~
of tho onllro oltato olleld doolldont, oonll,lIn9 01 011 tho Perlannl prop.lltty nnd roal oltatO, oxoopt roal oltato ouhldo
. tho :OO/l\monwoalth 01 P,Onlllvlynnln, ond thot tho Iluurol oppollto ,enoh Itom 01 the Inventory ropralont It', lair valuo
II' oHile date 01 decodent'l dooth, '
~J-M""'.J ~,~ nnd ,ublorlbod boloro mo,
-" ~.f.J~ f
~duL,ng,,~/':L, !?'~H'_"
. hoc.tor i,A~'if"-- .
427 Parks ide Road
_ __" __._.-> L_~____~__ _~____ ___..........................~~.~.._..~____.---.__
,
lhelm. 5, MtCAUllin. Nolary PubRc
Mv (o,nmllllon !l"h., IuIv \, 1984
....... Ill.. PA (lI1\ltotllod COllI"
I - .. ...
,O~mp,_H.iU.,,~_~.!l-,,-U.O 1].....,...__",____
Addllll
DMe 01 Duth ."
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,9 .
Ooy
"
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'Month Vu,
T" ---.-'i--~-"'~"--'.
, INSTRUCTIONS,
'"An 'nv,~litory mUlt b~ III~d wlllifn throll month, oltor appointment 01 pOllonal reprolOntatlvoi
2, A lupplomont Invontorv mUlt bo IlIod within thirty daVI .of dllcov'ory 01 additional alloh.
3, Addlllennl,hooh mav boattnohod o. to porlonalty or ronltv
4. S~a Artlcl. IV, Plduclorlol Ac.l 01 1949, '
"
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InvflOtory 0/ the reo I Qnd perlonol utote 0/
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amR'l'RUDn:~IIMEl.4IA.,lJl\OOl~limIJAN1~--,,-, deoeo~.d,
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,
REAl':.-, P~OPIDRT,'{
NONID
PIDRSONAL PROPIDRT'{
Oommon ~took in the f611ow~ng companies I
300, shares of Middle South Utilities, INc. ~ert. No, Ul07249
issued 1/31/77 @ $11,9375
450 ~hares of Northeast Utilities Cert, No, U19852a is~uad
1/31/77 @ $8,50 '
1,200 shares of The Oetroit mdieon Co, Cert, No. 270700 issued
1/27/77@, $11.875 '. '
150 'shares, of American Telephone and Telegraph 'Company
cert" No~ 2944~1232 issued 1/28177 $ll,OO ,convertible preferred
s.tool( @ ljI54. 8125 .'
$6,000,00 Wisco,\isin Gas Oompany ,first mortgage bond 8ln7. sedes
due 1/15/94 Cert. No, R3949 issued 1/15/~7 @ $67.75
3,581 25
3'1825 00
14,250 00
8,221 88
4,065' 00
Thef9110wing Series H bonds issued in the names, of Gertrude .
Amelia Brocl(lebank and Fred F. Brocklebanl(, her husband, ,Said
Fred F' Brocklebank predeceased'hiswife, having died on 1/6/77
0747541.1H 1/15/64 500 00
07475412H 1/l.'3/64 500 00
07475413H 1/15/64 500 00
07475414H 1/15/64 500 00
07648058H 5/28/64 500 00
07648059H 5/28/64 500 00
, 06(18330H ' , 6/1.1/,64 500 00
064833Ut 6/11/64 500 00
08181037H ll/30/65 500 00
08181038H 4/30/65 500 00
00181039H 4/30/65 500 00
08181040H 4/30/65 500 00
bB181041H 4/30/65 500' 00
p8181042l-1 4{30/65 ' 500 00
'D8263377H 1 112/65 500 00
08263378H 11/12/65 500 00
08479463H 12/9/66 500 00
08479464H 12/9/66 500 ocr
D8471049H 12/9/66 500 00
084710,50H 12/9/66 500 00
1,,917,428 shares of Aff.iliated Fund @ $9.26 per share 7,7,55 38
61,698 51
"
COMMONweAL TU OP peNNsvlVANIA
DHPARTMIlNT OP RIlVIlNua
BURIlAU OP eXAMINATiON
OPFIOIAl NOTlca OP
INHIlRITANOH TAX
AssaSlIMIlNT
*'
--------_#-
COUNty P,IlJl NOI ex I.. g I - I ~ ~
r i..1 (},,-,\ (1/ I ,~. ~~J 1"il.1L.. '!j"fr:TK
TOlill l~IL;/ k: nll,Nt II "
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DATHj~ jl " I t) ~I
HSTATH ,,~uJ i. Chu" tfAr3JtcJJ:YJ~1
fllH NO, ,;( I .. ~I '- '/3 C;
COUNTY CA-Y",Jt,,J..(-lr<_Q
OATH Of OHATH (9, (llr / CJ .1; 0
-
f\..,
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Apprnlud Vlluo alllllalol
RoO I a.lolD
por.anll Property
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TOlol aran Illl0le
.
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.II. 731, 'IF,
~1)_(,,30..;J~
I J. , 9 (j(!.~.5"
,
S") b 11.3 ;J, /
+
Jointly Hold PraporlY/Trln.fer.
+
Talol Apprayod Olduotlan.
Olear Velue of all aID
.
lalll AppraYo~ Ohoriloblo H~omp\lan'
Amount TO"Bble @ a'll. Rale
. ,5 '~ {,1/3. '.<!.;/
L..? ~3: -1 .5 ,l/? 10" duo
/ :3 0 '7 t'/,
_ !L0 ta~ due
.
3 3~O, 13
0-
/ 9~ 1 '1
:3' fJI'1(", 30
Olur Vlluo 01 HI\III SubJoat la,Tlx
Amount Te"'bla @ 16% ROle
TOTAL PHNNSVlVANIA INHIlRITANCE TAX DUH .
, · * *'* * * A flyo poroenl dlaoaunt tatlllng ·
will bo granIDd If the Inhorllanco Tax IB pal~ by
LeuO"dill'
oATil OF PAYMS~T
3~3I,'r1
AMOUNT PAID DISCOUNT INTIlREST, ~XCRBCIT
. /ifG-,.I7 + $ - $ a $, ) 9 ~, I '7
+ a
+ a
Inte".\ Icorue. It thl rllte of el" (6) peroenl per ennum
on the unpaid balanoe of InherlllnDo TI" from
to date of, payment, Intereat due If paid by I.
BALANCB, 9P,P tl!tlN~r LVAN, IA,'NHBRITANOBTAX C, U,B,
-^,.-,J,DV"'{ ,- f\(. ,"1\ fl. rj - ~ 1 ,
. /Fi f ,/;,' 'r' "
A..e..ed byl 'I' I ~ ., ,7~ " / ( /'r:..1 ,,/
Soelololmllloo onR.v".. Bid. ..n"0:>;"7,~r';,n~}f.:':;_(,)"'(
Ilrcll~;,l\li IIl,Vvlll :-:) ._
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3'~gO, /j
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!l'/J:.Q!lMlIlI9N.
To InOUTO propnr orodlt tu VOllr llOmJllfH, IlllI rHHllU of 'hu UAlntll 'illlll flln nlHl\hUI- nllnuhl hu ulllnrl~ print;
od on 1110 ohook 0' monoy onlo"
Thll oeoouBmonl la modo In noqo,donon wllh [joollun 70ft 01 Ihll Inl""IIIIIIO'" lln<l litllnto Tn, ^nl of
1961 (72 p,e, 6 2496.7001,
To tho oKlonl Ihol Inho,llo'loo InK I. pold' wllhln Ih,ll" (31 m""II'8 "Iln' Iho dllntl, 01 Ihn doondont, 0
dlBOOUnl of five (61 flo,oonllB nllowod rn P,B, 9 2406,710),<
InhorltBnOo,TBK, olhor Ihon InK on 0 IUIl"o Inlo,081, In duo ollho dolO of 1110 dnoodonl'a d.olh onU booomol
dollnqulnl 01 Iho o.plrollon Qlnll1Q (91 monlha ol1.r Ih. dnoodonl'. dnoll, 172 p,o, 9 2496,'111), Inl1o,lIol1Oo
Tu on A fUluro Inlorool IB poyable within 111100 (3) monlha 0110' 11". \fnllBlor \IIko. offool ,n POBB080lolI Ind
"nloymonl ond II dollnquonl 111orool101 (72 r,e, fi 2400,7121, Col01llolilllllil'08ll,om 1I1ll dollnl\uonl ,1010 Ihown
on Iho fooD of IhlB lorm 10 Ihu dolO of 001\101 pnymonl uelno Iho 'ollowlllD Inlol..llobl.:
---.....--......-- --...........--..--........-...............----.......- ............----- -.. ...-..,... ..-- --.........--......- -_...- - -......-
1.monlh ,006 4 ",0111he ,020 7 milnllle ,036 10 monlhe ,060
2 monthl ,010 .6 monlhB ,020 ft n'ilnlhe ,040 11 mOlllh. ,066
3 monlhB ,016 o ",onlhn ,030 9 ",olllh. ,046 12 montlle ,060
I' -- --........,
,. 1 d,YB ,00017 11 <lny. ,00100 21 dnYB ,00362
, 2 dnye ,00034 12 dny. ,O021l3 22 doy. ,00369
3 dBYB ,00061 13 dilye ,00220 ' 23 dOYB ,C'6396
4 dBYI ,00066 14 doy. ,00237 24 dnYI ,00403
6 dlYI ,00000 16 dnye ,00260 26 dnye ,00420
6 dnyB ,00101 10 dny. 0020'1 26 dnYB ,00437
7 dnyB ,00118 17 dilvB ' 00~04 27 doye ,00404
9 dnye ,00136 10 dny. ,00301 26 dnye ,00471
'9 dnVB ,00162 19 ,Inyn ,00319 29 day' ,00468
10 dnYB ,00169 20 dllya .00336 30 dnye ,00600
..- - ----....--- ----- -..-.... -.- - -... --... -- .......-...- - ....- ~...... -...... ---.---..--. _. -- - -....---...-... ---.....
Any pnrlY ," ,nla'OUI, Inol"dlno Ihn com",ollwoollh end 1Ill! pO,il"nlll ,opru.orllnllvo, 110\ 8011.lIod with
Iho n88ooemolll mnyobleol Ihoroto wllhln ol,ly (,001 dilYO lltl", looulpl of Ihlo Nollo. .. "rovldo'l bv s.ollon
1001 of Iho InholllollOO ilnd E8IilIO Tll' ^"l 011061172 r.B, 9 2406,10011:
Make oheok or money order pnyoble to:
"Hnglslor of Wills, Agont"
Moll 10 .tI,e IIdelreso IIsloel beloW:
GENERAL INHERITANCE TAX INFORMATION
U"satllfloci lIahllltlOllncurrod hy Iho ,Iocodonl'prlor 10 .hls/hor doulh urn doducllblo agulnlthll/hor ta~uhlo
OItolo, In addlt,lon ,10 doh II Incurrod hy Iho docodont or OItoto, othor Iloms uro clolmahlo Including tho cOlt 01 ,
admlnlstrallon, ollarnoy 1001, fiduciary loas, lunorol and burial oxponsos Including the cost 01 a burial lot, tombstone
orij'ravo markorand olhor rolaled burlol oxponlel,
All debts helnuelalmed agalnlt an eltole ora lubloct t,o tho allproval 01 Ihe Roglstor pI Will. with whom tho
InhOl tanco T(I~ Roturn Is 1II0d, Evldonco to support the dec-odont'l or tho ostato'l liability lor tho dobts bolng
clrdmed should beattochod to thll Ichodule,
,
A lamll'y oxomptlcn may bo claimed by aspauso 01 0 decodont.who died domlelled InPonnsylvonla, If thero Is
ria spcuse, or II, tho sllouse hos 10rfe,Itod his/her right., than any child 0,1 Ihe decedont who IS,a member ofthe,same
houaohuld con clalll1lhe exomptlon, In tho evont there Is no such SpoU,9O or child, the eXlII11ptlon con be ,clalmod by
o parent or paronts who are members 01 the sqme household as th'edocedent, 1'he lamllyexemptlenls allowable only
against anetl which pa~s by a will or by the PennBylvanla Intestato Laws, '
NOTEI Cornpensatlon paid to an estataropresontatlval namely, an executor or administrator, lor aervl'oes
performed In ~dmlnlstorlngan estato Is reportable for Pennsylvania Income Tax purposes, Thl.taxable Inaomo
Item sheuld bo roported on lorm PA.40.lndlvjduallncome TaX Return.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1, II the lamlly oxemptlonls helngclalm'ed, Indlcatelho claimant's name, oddress and his/her relationship to
the decedent, Enter "Iamlly exemption" In the remarks column and tho amount claimed In t~e amount column.
2, Anlgn consecutiVe numbers to eac.h Item llstod.
3. Enter tho dale on. which each debt .was ,Incurred and/ot paid,
4, anler tho nOmOS 01 each payoe,
5, 'Ptov'lde 0 brief explanation In the remarks column lor each debt clalmod,
6, Enter the amount 01 oach debt being claimed, '
7. The lormmust bo signed by tho person who has assumed tho responsibility lor paying tho debts,
IF ADDITIONAL SPACE IS NECESSARY usa aWl x 11" SHEETS.