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HomeMy WebLinkAbout81-00148 ~ IH'V.ht~ td(t O"'QI COMMONWP.A~ T~ or pnHHIY~VAHIA onPARTMRN" OP ReVeNUf. TRANlPnR INHRRITANce TAX, RellDeHT peCROONT INHgRITANCE TAX RETURN FOR INSOLVENT ESTATES (Inaltuctlol15 on Rayorao Sldo) COUH TY HO, .~ 1-'81 ~ II f? ITATBHO, I.Ia,Ieof-t.O"../,. ,('I l{.,.f":,, L.a'I od~ro" I {\ ',1//'" 'II" i, (1 '," ,'t tHI.HTI I Yl~A'" (I"... Cl Oth.r J ' ( ) Exoo, (I Adm, Hamo.~/IJ. -.: .. .' 5oclalSoourlty ~D'/ /";'? ~~t,,"P ~J"" " I.,~'l<~;' .1,.-'\. ......,,) . ~ ~ . . c:. ij" ~ , """ .~ '.111 '"J'i1'.l LV- . ,,~ ,~"j ..,.1-"': (' I? ' ' ...r.~ ~""_'r~fJ._"" _J.J(\)~! (iltAtUl ,. _lill~1 t.i 7' , "" ~ Addro.. I /i --r~rf. I -" ~ -' _,I,.. i ''''1< j 1 o . fl' (~Tnli"TI " ' ~ '1..)' ",.' fl,. r "/r,,,.. (' '! ,.f' f(~.. I ~1111 (\ ,'(llTVI ,OTAT"I ", ".IPI Un""' 1'",,"111"' of no,jU,y, I "oolo,olholl haw QMomll1o" Ihll ,Ollun o"d 10 Iho boll 01 UIV knowlodoe and bollnf 1111 IIUO, 00"001 ond oomplole, ,,' ","II ,. ',', '/' / ~ "..(t..'-o,.v_- l"~',-{~,.,,-, _r'- hlll4lUro ollrhhllJldf 1 '0." /) Dal. .1 Death (j .' (/,.1 ,-~:........,J..f..Lt 1'1 X' I) (I ' 50GIOI Sodurlty'Ho, .:l f' I /J....:J.....!L2.L-- TYPR OP AURT ct....;{t.."',.r,../t. ~ I I, . , Iri,1 ;,~ i,_' I ~~ I , 1:::,-' ~ , ::]!;J <;;01 . O:I-!' Cui ~~! OPPICIAL USI ONLY OATH g 5 m CI ~ ~ m CI O.PlCIAL USI ,~ ONL~ / ;,..U/- ,y DHSCRIPTION elllMAlHO MARKer YA~IJ~ DRPARTMBHT VA~UA liON (OPPICIA~ usn OH~Y) I 'l 7,,1... 1.'1 c: 'I ~~ .- 1')41, ,\,...) ~ ,,,'" : ;(,1 ..lIC.,! ~'1~r: ,':-":1: llif5 ,\:~ l~w !.. ;','./, i",..<.t",ccj ""Jl; Ie ,o. .,(\ 1"'c:Y1 ftti.J /.../ 7' I~ (( l,.t,'il--ji_ _I !' 'I h ,,' I (} 0 , ~~ fr ., LeO' C\ . l \ (', TOTAL. , do hor~bY cor" Iy thaI the "boyo ."eta wore approl.o 4,fK~H{1 J~%"j4/JI.{) _ ~,,^j, R _ . II, HAMS OP PAYsa HATURS OP C~AIM AMOUHT C~AIM80 I J '.It ,I \ ~, ..' ~! 1, , ,/ ' fi / . .. .. .X ~ J "_t:<,. " ,j;a> t;titAcA, -(.4:,,-' ,er ,i, I' 'ii' , I' J . j IiI I ~. I , n.; l.' ':-, ij ',: o. TOTAL. ,55- " H:aJ ~. ~7-t5'/ OA 1'1 INSTRUCTIONS ASSBT$I 1YPI! O~ ASSI!J -Indlollto whothor tho 11..011. roul o.Iulo,llo,.onal praporly"Irun.lor or lolntly,ownod, OESCR PTION- l-I.t qllu..oll ownod .aloly by ,tho docodonl lit ownod jolnlly wllh onothor porly or purllo. u' tOllant,' In oommon,or u. oln, tonuni. with rlghl of ,.urvlvorohlp ut Iho 11010 ol,doolh, Includo tho dopodont'. porconlago ,01 owno,.hlp, 'tho noma (.) and rollltlon.hlp to tho dooadonl oltho .urvlvlng I.olnl awnar. and tho o.lImatod murkat valuo al tho dooodont'. Intoroot I" of Iha dula of da"th. Inoludo Intanglbla I'ar.onal praparty tlllad In tho nama of Iho docadont but payablo ut death to anothor party or rortlo. Inoludlng but nol Ilmltod to P,O,O, U,S, Saving. Band. and lontatlvo Hu.t ucoaunh. LI.I any proparly tran.forrol bV Iho docodanl wltliln two your. 01 daoth fo, which ha/.ha did not rocolvo valuohlo and adoqualo oon.lderatlan. ' , Do.orlba all rool".tata I,ooatad In Pann.ylvanla by lot und bloGk numbar, .traot addra"'''~f11bcit 01 aoro~ and Inoludo a' gonarol da.arlpllon 01 tho land and building., AI.o, Includo Iho book IInd pago iwmburln which Iho daad I. roqordod and tho , O~lIct IItlo u. Indlcolod on tho doad. t1BllTS & OI!DUCTIO~ _ Un.atl.llod Ilobllltlo. Incur,od by tho 'dacadont prior to hl.ihor doath ora doductlblo ogoln.t hl./har lo~abla o.tata.,In addl.llon to dabh Incurrod by Ihu dacodant, athar 110m. ora clalmabla Inoludlng tho ca.t of "dmlnl.I'atlon, attornoy foOl I flduclory fao.,Iunoral und burlul "pon... Including Ihaca.t of 0, burial lot, tomb.tqnallt gravo morkor. l-I.t tho dOlo,on which oach dubt wo. !ncurrad and/or paid ondtho noma, of aach payee. P,ovldo a brlnf uplanotlon of tho natura of aoch dobl olalmod andlha umOunt bo!ng clalmod. I!vldonco to .upport tho dOGodont'. or tho o,tota', liability for tho dob" baing elolmed .hould bo attaGhed tothl. ralurn A family e'emptlon may bo clolmod by 'a .pou.e of a <locodant who dlod domlcllod In Penn.ylvunla, If thoro I, no ,pouu, or If tho,lpou.011<l' lorfaltodhl./hor rlgh", than any ch!ld 01 Ih'o doaadant who I. a momborof tho .ame hou..hold con 010101 thoo~amptlon' Iii tho ovont thoro I. no .uch 'pou.."ar ohlld, Iha oxompllon caa bo clolmod by a paro"t or parqnl. who ora mombor. ,of tho .amo hou.ohold o. tho doaodonto ,," ~ % ~ - 0 ~ ~ m g rn ~ a .!l .,' ~ ~ rl "' t " '%1 . In 10 '" if ~, " ~ It .it a' 0.. g' ~ r "0 8, 8 !; ~ i ! i ~ 111 G'l ~ ~ 1:1 ~ ;~ ~ m ;Ill is :z: z !!l' rn ;;l 0 ? ~ . 0 0 z ~. 0 "II "II , 0 z -< '~ -< Y! 1O t-I ] INFORMATION pLACE FOR FILING _ Thoroturn I. to ba !!lod In dupll.ota wllh tha Rogl.tor of will. of tho caunty wharoln tho dacodant ro.ldod. " " TIMa FOR FILING _ Tho rolurrt I..duo nine montl" after tho daoadont'. da~th, union an o,ton.lon far filing haa,boon appllod ~y tho, Soorotaly of Rovonua within tho nlno'n1alllh p,e,lod, ' , E..A!.!J!JiJU.Q FILl! RETURN _ Soetlon 791 el the ,1961 Slot~te praylde. that" , . ,any por.on who,wlllfully fall,' to fila a rolurn or olhar roparl roqulrod of ,him .holl,bo poroonully lIubla,. . .10 apanalty of 25~. a,f Iho 'i~ ultlmotoly found t. bo duo,er $1,000 whlchavor \. tho 10.. to ba rocovorod by tho O.po,Imant 01 Rovanuq,o, dobt,' of Ik. o'lu,unl ora rocavorablo by low." NOlEl Faa. paid to 011 ealote repreael11atlve, I1omely, nil execulor or odmll1latra,tor, for ,oervlcaa performed 111 ad.. !l1l11I.Iurll1~ "" oetota I. roportabla for P0l111.vlval1lo Il1como Tole purpoaa., Thle laxoblo Il1como'ltem ahoud be reported on Iprm pA.40,ll1dlvldualll1col11e Tax Return, I ~"-......_--~ ""__"H"~.'__,_~ I n! 0' /1, 8 ii' I I Q, ] vt, ~ ~ I'. .. 0' '( B 7~ '<'~ Fj ~l ~: ..- i . ~. I ~ 'U ..I '( , I .~ J ~', ,R'" :~ , ~.:" 0 I in I.J.l "fj N , ~icl4~ , l' ' iOl'Z I 1, fJ ,[ Qj .OJ 'lj,m 1/1 J ~: ..I ~~jitl' 1 ) til, n\ . ~ 'N t' M, :C ..; 0 ~ J'I-' \ ~ , , "'I ' 11>1> , ~ ~ ~ 'I'! .~ ~'\~~ 1 o lJJ ~!~ ~ r-' (f) -1 ~' ~~Ci ~ . CI t! 1 ~:' Od j ~' ,'i ~ u, M ~ ~~ J I . lit . 'l~ L1 '" " j; " , '