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HomeMy WebLinkAbout81-00170 " i , I I ij - .~ .1 I I I I, ':= ~ , . IQ . I , !'- iii I I <I' , " ~ , " ,.. C9' ,... C\I I. l' " " " i " \I, " '0 J ~. " j, "I "" ii' , " NO, 21 "81 /0 PETITION 'POR LETTERS OF ADMINISTRATION IN '['lilt NH'I' ^ 'I'll) 011' ."""",,,,I!:JI~j,~,,,~1,,~,,,,lr~~::,~:,I~ ~!l.~,f:J" "" ,',',' <'"'''' Ill!)( ~JQ"HI1JI), '1'0 ","." It., j, ""..t.1.",W~",Q"", ,~",""~~""""""'''''''''''''' 1""""""""" i,""" "."", "'"".' '" IIUlflHtol' or \\'IIIH 1'01' Ihu 'COli II 1,1' of CUllIhlll'llIlld, III 111(0 ('OIllIlIOIl\\'Olllth or l'uIIIIH,\'I\'IIIIIIl, 'I'lio Pntllloll II I' ",' """""""" JI9, \!J, fI,l~,,, 11.1,11, r!.\,,,, \\,1), II." ,~l\,~,II,I!J", r~,lI ,1!:IH"" ''''','' "",,,,,,,,,,,,,,,,,,,,,..,, '~""" "" I'OHpncll'lIlI,I' HlwwlJlh Ihlll I,owor ^11en 'l'wp, 're/l'lr/M'/I~I WAR nrcNldQnt of, ,,,,,,,,,,!..Q.U.lIf!)."H'I~/II~I."~,,,,,,,,,,"""'''''''~'''' Villi Ie, RlId Il CllIy,on or Unllocl 8111tOH, Ullcl doplll'Iud thllllll'o IIIIuHllllu III Ihll CfllIlIl~' of '"''',,',,''''''''''''''''' '1I11,91~N~~,~.~t,t~,~'~}", ,."" nud 8tn tu 0 f ". 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Tho Hulel douudonl wnH 110HHUHHncl of' pUI'Hflnnllll'ollOl'I,1' 10 Iho oHlIIl1111lHII'nltle of'$,~.o....O.Q.,O",o.D,i..:"", IInc1nf.Helll folKtul\l, IOHH,lnClIll1hl'unl\o, to tho uHtIIl111111c! .YllhlU (If lj\,!/,\'i",R,\J,Q",,,9.9,,,,,,.... IlH 1I1)nI' ilK CUll bo tlKccrllllnocl, 0' ,'I'hllt thu 'Rlllel HUIII 1')HIlllo hOw I'll!: IIH IH knllwn IH I(H'1I1nd In _ "", "~El."liry'''H1.'ih'11. '" {,~,ow:e'll" ,A<J, a"e l'I, ,Ill Ct W,ll (I, h .tv)", [),1I m b,Q l.',J,.a, n,\l ",00, un :t,y.,.", ,r. A.", .1,6,,': J J,i, /l. h,), n. n ,Q." ,0 ,r, ~,y, ,1";" i""""", Thoroforo, ,VOUI! polltionel'(H) l'oupllull'lIl1,v IIppl~'(lnH) 1'01' l,ultUI'H pf A,lmlnlHII'nllbn \n the ubovo nllmllc1 oHtntu, Dnto~ ,,,.,,,,t.t,~,~.~,,,,t9.""''''i'''''''''''''''' ", I)" I ,~~"'" Signature IIIHI Addl'OHH 01' I'otilllllllll'(~) OJ. j (.'__j ,_, / ;/'t,;.'r -:( t~...(~_./ """"1"''''''''''''''''''''''''''''''''''''''''''''''''''''''''-'.'''''''11'1/''11 LOUIS,l!l BL^Cl< .,..",. ~i rl..l,. i f~:It ,f, ;~, h. i ,P.J~. t, I'"" Xl, fMl ;~'" ,f: ,q.. ~ ,r. X] ,9, ~.,',. i r,A \ __I Ii' - _>/,,'-;__,},_,' ,;.(. - . .J' ". ,,:; ,.'(;-(: ..:1, (.-;(, ,;',~l;~(;(:(;I;II'" ..1/, ,." ,.,., ,." 'i ji 'II"" "'I'l'i'III'1 I N^NCm 811U1GY ,",' ",~~,J; ,9,,,,~ ,v,n,~ n....a ;~:;,,~ if .H,~~1.f~ Ih n.11,\\ ~,Rlt,',...n A, J.7 J..1. 0 /5/ '7t;7 <JQMMONWIMlil'l! 01" I'li:NNS\'LVANIA COUNTY OJI' cUMBI~r\l,ANI) f HH I 'it,,,,,,,, ,,,;, j II""" ,; ,,,.. H \"""""'" I "J,Q.U,ll1.l!)', ,n.l, f>.Jl ,I~ I. ,unltJ... ,~.^,<< ,c),lV.,. 0,11,1), 1\1,1.. \' j't."'" "",, '," 'I" 'Ii '1' 1',""'"'' It;, It l\nmad ,In the nbov~ IIppllclltioll hllllll~ clllb' '''''''"""""",11,,",0.'1111,,,,,,,,,,,,,,,, nlil!ol!clllIll ,10 lilli', Hill' lhnt thlltilulH sot forth In Ow IIhol'U nppllllnlloll III'U 11'110 lo 111\1 hUH I of ,,,l!,\~,\',;~,r,, 1<I\lII\'ludllu iIlUI',hullul', .It."", II""~ ,v. R,nl~,,,,,,,,,,, ',"'''''''' I""'" t! II nd HtI hHCI'lbucl ' ":,, I", i'), ,/, {" ,.,~ ..'/,\;, , ;~"" (,,-ljj'I,(, ~:,(,f,~-;1:-"" oj, II'"'' ,,,", I i ,ltllI l,OUIDl'] B!,MK betoro mo, '"''I''H;M'~''~~'~HI~'~''''''I''''''''''''''''~''' A, IJ" I,U~,~,,,,, , ,,,,,,'~?Jf(.;JI""(~:" I"'I;~:J~~', (.';'I~"'~;~~'i~t~'I~"" "''''''''''l,''''''''''''''''''!'''';''H''''''''''''''''''!!""''''''''''''''''11'111 t __ J I . , ~' , ,"F_._,~) ',"" to. __/'/'-'."",1._.,_ .",..'I!..,H,',I,I"I,,,,"t\......-,lIr,I,",',,,,,,,,,,,,,,,,,,,,,""'"'"''11'''''''1''''' NANUID OIlUlnV ' " ",..".""""""",..".;.,."",,,,,,,,.,,.,.,,,,,,,,,,.,,,,,",,,,,,,,,,,,..,,i.,, Flied: ,..{...~~.~~J:\",t.9"""l~.~;" "",,,h,,,...,,...,,,,,... Attm'lIu,\'I '"'''''"'''''''''''''''''''''''''''''''''''',''''''''' DONAt,D ll. 105 Mt, lUnolu, l'A owmN, TUaq. Viuw Dt'. 17025 OATH' OF PERSONAL RF.PRESENTATIVE " COMMONWIDALTH Ol~ PNNN8YJ.,v ANIA COUNTY OJ.' CUMBFJRLAND } H~: j lilt "'",, i I'" 1 tI"",,, I""""" """ );" ~ ,V, ~,~ }p,,,,~ y, fi~9.~". I':; n.~, "N ,(\ N ,9, NJ,,,,~ n. H ,JA X"",,,,,,,, i',,,.,,,,, ,II;.."".",,,., t pot I tlonor (R) bolng duly ..i,,,,,,,,,,,,,,,,..ft,t(/,p,r.>>,,,,,..;,,,,,;,,.,,,;..,, I\ccordlng t,o Inw clo ,""" ".". (IOPORD llT)d Any thRt fiR tho d I I t f th t t f mTJLA W. PECKENS n nl n R .rn 1l,;,Q,na""q o. : 0 OH n 0 0 ..1l'""...",,,,,,,,,,,JI,,,.....,,"Il'uiil"""'."...,,..,,..tl.,,,,,,,,....,jI.....'"''''''''HH''llIllii'' i..,II.'I..l."....,.."'...".'.'''I...I.l..'''..,....!.""'II.,..""j""'I'I....'I'.I"I..,.",j"'I""",/.""..""",.,.".""""..,."1"1,.,."".11",1"'"''.''''''i''''' dQcellsed "'" "V,)J.\l,'{". " " , will wcllond truly IIdmlnlstol' the KOocl~ IInd chnttQl~, I'IKht~ IIncl crodlts Qf RlIld dQOOIlSod, l\Cccrdllllt to hlW, And I\I~o will dllh!,ontly comply with tho pl'ovhHon~ of .tho IlIw rolntlnll' to 'rrl\n~for Inhorltllrloo~, 1I11.1.....I.llt"~.W.9,R.<<lltlj.."lt"".H".""'," und HulHwrlboc1 before mo. 1t\1'~"U ".",M,~~~~...~,~"",,,.,,,,,,.,. AI J)II luft,tll'" 07/ /i ," _~I ) ri~iilft{fr'''('~''''l''''i'' (;;6.{,(,~r.,;;::;;,,,,,,,,,,,,,,,,, 'I /" "), ~ __, / ' /{ ., r' "'I / ",j-t-rI~'r' 1ia(~_It., ';'fll,.l'.". '\"''''III,j'I''.'"H'lr1IlIlHI''.lt..."-."""u"..."'u"".,,,,,,".., I'PVIBID, llLAJK " , , ,//-;! /. I'/i, 1/1 _ . .., ,...,., ,j,.. ,,'(i "1' d." I /\,,-(. t.i 0'\.1"(7'''''' Ii 1""'11' '"''',,' tt 11111, IIIH" II' I" .',. . NANClD BIIUlD:t ' " A, DOl 10,fj,J"", I tt t A I I I t tl I th t t f E:LI,A II. PECKENI'l , ' .,0 ora 0, . (m n H' rn, on 11- C OR n-o o. ....11111'".''.,,,,,,,,,..,,,,,,,.,....,,,..,'111,,,,.1..1''''..'..11''''1111'''''IIl"l'''II''''"llll11''' Bo It remomberod thllt 01\ the DECREE lOth ....."".1''''...1..'..'..'.... dny of. ....,'"........~.~.~~.~I...!"..II...!".li '"'''''''''.'''','j''i"."j,;j'lfllH.;""..".."...""...""",11t11..,..i,,, lllte of C,\\mn" ,iJ.i"l.~, ." JNrl:1,r"r.",^,h~,\\/)" ,.'lhf.tlh"""".."."", wore grllnted to ",,,,!;4\I),r.Ii\IC,,,~T,AC,K,,.&,,,/Il,^,~W,E,,,S,lllJ,EY <;Jumberlllnd Coun~YJ PonnHy,l~IIllIIl, doeollRod, IIIIlH'lllll""l"I'l.II",,,,,,,,,,,,,,,.,,,j...;..il'iI'.'''I''''''tll.."'.'".i\""",......""...."...."",j,.iHII".iI'''...tlllill.lI'.'.""I"..".I\illllit...."lIltljj WltncH~ my hllnd and offiellll ROlli tho dllY IInd YOIlI' uforoslll~, j i ~"} ,2 ' '- ~ , f t' ,~#. ~, """"",,,,,,,,,,/.:2.l:.(.'''':'~'.J.'''{;,''''''\(I'' ,;6',(. I,m",,,,,,,, -r 1/, / Ro;rlster "3'1"(J'} . 1'--' ,... ~~""~"'t"~~-'o""W"~ii~.E'_.,;~""",,~", h l~~b~~n~~\;;' (Ilti"u~tl~I" Oil Roy",. Sld~l 1~_Fl l ,I'} " ';0 '* ......- RliV.....g o.eOl, COM'!\OHWBAVI II OP POtlH5HVAHIA Dep~kTMHHT C1P ReveHUe TRAHIPeR IHHIRITMICQ T"X RellDIHT OlceDeHT ' , =-~~""#;"';;"="";"','_~A'_jH'. ~j1l"J1~t-1'~~.~-~_ Eltote of 1!Jl,[,A \!,~,'~J~I:(:,I,(,I'I~,fl" Loet A~~ron __ J:"~uu"h!~hll~U.~L 01'1 VI'" , ' , 'T,OWOI' All(III ~'''Wliillll" ___ 0 '!~!Ll!~I_I!~.,I^ ", _ ll~1 t '(I lit t A II'I ll!i'l [1/0'(/(\1 Dillo 0/ /)on"1 ""'''''_'''~_''__h_ Soclol S~tU"'Y N(J",_I,I.~,~,()~!=)II :l'Ij).,,,.__,.__.. Uuruuu ,%,,~o, . ..,.,~'LL::_J.L7'.--L '7Sl._,,__ Coullly flllo NO."....~.:,H._.....~_...____ 1. Dooodent dledl (X) 'ntutnto (without u will) () Tutnte (loovll111 0 l(lNt wlll--OQllY uttilohacl) 2. I. tho filing of n Fodarul Eltoh l'il~ I'I0tum rOlll/lllII1 /Ill II,lu ".Into? Yos ....,_. No L 3. Elxeculor/Exocl/trlx (X) "'~""thUI/~"rIX;rn~IIlI~tlntrlx 1/ , Nome ~lt'lI, ""111110 JJlllill\ ..______-.~__n...,...~._ ,~__ '" ..,.. '" __,.._~, "-'-,~---"-,,-,,,,"-,.,._~......_.... /l1l(1 MI'II, Nunan 1', flhuoy A~drOl8 31 '( ,LU:HciiJuu .,~-~. .<."-_.~"~~.._.-.~,.~--_..- :H;10 (11'0011 St. 1Uu1.l...:.J!~I1.L~', v,j, u.w+-J' A n ,J.'( 0 lL~ ..~_, _..,~____ .__.._ (tl'fY) (Ii I "1 ';1 (ZU" lIul'l'lob\li'/1,. P^ J.71.1.0 4. All corre~flondenca ahould ~~, moiled to ( x) Altorn~y 5. iian ottorney II ropreaulI";li, tile ostnto, Illdlcllt~i N !l41NA1,fl Il. OVlmN. liJ(l(Jlt/ t'lJ ame '--.__.___._, ..u........"....'"'0""_",'"" Addrol&l.~~.!_::.jl_~:~.. I) I'. IUnnlll, I'A, I.'(on~ '_t (Ultyl --"---'rE-..~i~..rr,'w"."~ -,.+-Tiij"lj..~*z'.~-<-+...........- )rJI dllcllllY. -".~----..;.----_. " LI.t all aaledopqalt I/oxu rOlll.totedln the tloo, eden, ,'u IO,tllVlduql nOlllehor, 'IPlntly, with, or os a,n agontor doputy of another, or In UlIcedont'. IlldlvltlulllllllOlO with rlllhl of OCCOlS by anal or cs agent or doputy. Includo the .I1l1l1ltl and, addro.. 0/ the bank ,or nther Instllution whore tho 10/0 dopoall ~ox Is Ipcaled, tho llomo (a) In whloh tho liQx I. reglll"ed and the relotlon.hlll ~f tho lolnl holder~ 10 tho docodont, .. V'-"'_''il~''f"","'~'''''J,l . -.....o;1o"""H..i--~ HAMU AHO "DqRall ,9~ bANK On-ollleR IllSTlTlJTIOtl , IjAMt! OH'NAMEIIHWUIW IH WlucH DaCB1l8NT M^,HTAIN8D A ,,,pe nnrom II11X IA~b oaf'ollT BOX IlRBolneH8o P--'!.-w.u._;'~.....~.....I~~~_UV~ t.'l'i""'\4i-W4.1;I.::;:~n- - ~ . N/A \; RP.LATloHSHlr on JOIHT :...c. __!!2~!1!R5 T~ada~8HT .'- ...:"":ZIIII ~~---_._._.........'"--.,..-+ ............-......-..............-1-.'......,.....--------- _ , , ~-_.----.'--,~.-...-- ___., __....___u..'~_~'"~_ "h+_"',,,,,,+,,_.~..__ _.-___.......~_____~_ - " ..-........__H Un~erpenolt'IOI 01 porlury, Iducloro that Illove OXllll1hlOll this rotUIll, Inoludlnllllooomponylng scheduloa aod atatemenfl"and to the be.t 0/ pwkl1pwlodgetuul hollef It Is Iruo, oorrocl ,jl1d oomploto, ';;,,/,11 /' '. ,,'('.V.(' .~4~~~~c:L.c~(/~i~~im~__'-,__._~~ --",C!J/!r~L_ f\:I"/l,Jlill, \I I'll 0 I' I" I II 110 Iltr,:.' IIOHAHlnn Of' PlI1l1CIAHY P~TP. ~16..'Lt\llliilllli!HU1b.ti.QE TAX GEtiS!~AL.lli.FOHMATIO~ ' . \, fiR80tJ.S RE8P0tillJ3LEJ:.9JJJlqUR~ ' ' SocII on 70\ of \lw Inhorltnnco ond Estato Tr\x Act of 1%1 provldus lhat tho following persons shall proparo nlld 1110 u return: . " ' , , a, TholJOrSQn111 roprosonli\(iVo 01 \110 oslnla of tho (locadolllns 10 prop(JIlyof lho docodonladlllllllsl(l[(J(l hy 111m nn,d such I1d(lIt1onl1l plOporly which Is or IIH\Y ho suhlocl,lo IlIhorllonco Tox of Wlllch ho/sho sholl hnvo or I1cqulre kllowlodgo: ' , b, Tho trnllsforoo olllfollorly uponlho trnnsfol of Whlcl'llllhOlltnlll:O tax Is Of lIIoy 1)(IIIIHlOSod hy tho \96\ ShlMo, , llicludlng a trusteo 01 propor\y lronsfmlod 11I1(llsl, plOvidnd lhnlllo (lIlpnrnlll rotum IHlnd ho mllde hy \h(1 IruII6foroo of propolty Inchldod In tho rctUtll 010 pOlsonnl roprllsonlntlvo, 2, ELACE FOil FILING Tho rellirnls 10 ho fllod In dupllcalo with lho Roglsl(JI cd Wills of lho counly wheroln tho decodont fosldod, a, TIME FO.R FILING The rfilum Isduo nino months nl\or lho dQcodont's doolh, unless ao oxtol1sloa for (1I1nl\ hos,hooo appllod lor ood gtl1nted hy tho Secrolory of !lovunuo withlnlho nlne'l1Ionth po rind, 4,. EAILURE 10 FILE RETURN 8ec\lon791 of lho \96\ Stolnlo provides thol " , , ,ony pflrson who wlllhilly flllls to I\lu 11 rolurnor othu[(eporl requlrad of him, , ,sholl bo porsonollY Ilahlo, , ,10 a penl1ltyol 25% of IIw tox ullllllatoly found to be dlro or $\,000 whlchevor Is tho lesser 10,\10 locovered by tho Deportment of ROVOl\ue as dohts o( IIko Ilmount me recovorahle by law,1I ' . , ' , 5, rA~ RATES Inherltonco Ta~ Is payahlo Ilt 1110 ralo of 6% onlronsfors to Ilnool doscflndnntfl, such as folhor, mOlhor,liusband, wife, SOli, daughlor, grandchlldwn, r,rnndpfHOnl\ son.ln.low, and dflllghtor.ln.low ond at the rntoof \5% as to nil others, 6, PAYMENT a_flAX , The tax assossed on thu ttonsfer of property roporlodln t1io return l\lduo 9 monthsaltor the decedenPs death, Interest at tho rotoof 6% por nnnulllocCfllosthefenltor 1111\11 paYlllollt Is lIIodo, 'AII'paymorrts rocelved ore first npplled to any 'Interest which mnybo due with onyromnlndor opplled to the tox, IF TAXIS PAID WlnllN3 MONTHS AFTER THE DECEDENT!S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED, ." ' ". ' All checks, 'should bu 1I10do \llIyahlO to ,tho RoUlstor of Wills ol..thu county \'!Ilorelnthodecedontrosldod llnd me recolved subject to tho linn , de'terllllnotlon o( the Deporlmont of Rovenuo, 7, rAILURE TO PAY . The, taxeslil1posed,toRethor wllh OilY Inlerosl theroon, oro n 11011 upon rani plOI)urly, which Iten remains In, eHeet until the,tnxes oodlnterosl'havo bool1 pold In full, Tho taxes llIay ho suod lorngolnsl any real property In tho docetlont's ostate or ngnlnst ony proporty bolonglnR 10 n transforuo lIahlo for tho tox, a. FILING OF FALSE RETURN , Ally'porson who WlllfllllYlllnkos 0 folso rotuttlor report required o( hllll oholl, 10 accordonce with Soctlon 193 of \I)e \96\ Statuto, bo guilty of a mlsdlJlllel1nOr and, on conviction \110100(, sholl he sentoncod to pay 0 fino not exceeding $1,000 or lll1dorgollllPrlsonmonlnotoxceedlllflOIlO,yoar or hoth, ' nnV,4S1 ex. 13'001 OOMMONWB'ALTI,op PBNNAVLVANIA OBMHTMBNT OP flaVBNUB TRANePBR INHBRITANOB TAX RaeloBNT OBOBOBNT SOHeDu~a "B" PBRRONAl. PROPERTY '* " IIns/mot/olll 011 Rovorso Sldol EstB\e of _ mr,l,A W. PIUCKJUNS ITllM NO, DE80RIPTION UNIT' VAl.UE ESTIMATED MARKET VAI-Uli DEPARTMENT VAl.UATION (Of'f'ICIA~ USE ON~ YI 1. GASH ON llANO -----lli29 .2311 . III ~ 2. " AU Home 01' pOl'eonu1 oloth1.ng tlnd rtu'ld'bll'O wel'e donated to o~al'ity or WOl'e or little ol'no value duo to nge of dQoedont ~O~ ...0... 3. STOCKS as rollowsl a, WlIl,Lr,!NO!l'ON ~'UND, !NC, ~, 1,00 aharen @lO,265 t\ ehlll's, (C01llmQI1 Cnpitul stoak), Stook C~rtitibate # 0258612 1,026.50 b, OJi]URAL MO'l'ORS CORP., ~ ho o,hl\,rea '@ 18,2812' l,931.25 aalrare. (Oomlllon S'took) stook Certi~ianto #OLhg6-h19 o. Amerioan Tobnaoc> 00. - 25 aharos @ l6,81131 /tn.09 a ohal'e (Oommon Stoak ), 'Stook Oortirioato II NN3511921 ch Loomis OatIl Oorp. - 1 e hal'o - -O~ no proaent ValUe Common stoak, Cert~i'ioa:to II 1807 a, Dll S B 00/11 Oorp. - 1 ahure -0- no presen'G valUo Common Stoak, CorUf:loate IIl808 " f, 'l'ampla Doal Oorp. ~ 1. ahara ...o~ no Pl',eq,ent value Common Stook, Certi f:l oato #902 g., Truesdale Ooal C01')? - 1. ohare ~o" no present value Common Stook, COl'tU'ioLlte 111808 .;'. '1/. C!haoking Aoooun,t - pauphin Depoo:lt Bank 172,110 & Trust Co. , Aoat II 67"82lrI17-l rOTAL.THIB PAGE " *32 "185.65' J4.J 'r I$;"S' , ~....._~ " , , l!::!llRUCTIONSF~R COMPl.ETINO SCHeDUL.E "E" Bohedllle "E" mll',t InollJde ollllroperly, 1'001 oliel personal, ownod by tho c/oooelonl Jointly wlthanothllr perlY o,r partles,aslolnt tonolltB with rlllht of surVivorship, Boll1 tenulblo ond Inlonglble proporty ere to bo Inoludod. L.latreol ostolO .fIrst, , ,. Dosorlbe ell reol proporty os I,ndlootod l[l tl10 Instrllo'llons for Sol1odll.lo /' A", Des~rlbo ollllarsonol property as Indloeted In tho Instruotlons for Snl1odulo "B", Includo Iho nomo, oc/e/ross ond relotlollBhlp to,lhe deoedent of tho oo.6wnar (sl and the datetl10 lolnt ow~ur8hlp \'Vas 08tobllshed, ' 2, Indloate the total mar~et value of tho lolnlly owned proporty. 3; Indloate the peroentalle of Ihe deooclent's Intorost. 4, Indloate tho rnorket vellle of Ihodoooe/onl's Inlorosl, .....-...------........._--------_..-..... b :"'l 8 8 6 I'r1 ~ !l .. Vl ~ F::J ~ ~ t:l :-l z i z != m ,l- p P z z ~ r;! p p z 0 ffl 0 0 'T1 'T1' -. '. , ~ 0 . \:. ~ , ,.. r: 1._1 i \ Ch", ~ J, ~ ( Ii o:r;,' ~j'l' , ~ 1_..'--' LI__I :;i:~n ~":" L(' , , t J;jj' c:l ~r HJ..:I ...I ..i ,.. !?l ' 'f- --rr. lI!! Ci)~d -11i :<:'~ 0 ':I: 5 ~k! Si) F.i::n d'-' ~ S 'I !i "i ~ .~ ~' 8 ~ ~ z ~ z ~ Frl ~ I;l .~ 0 ~ p ~ ~ , ~ , , ~ ~ ~ " ~ "" , ~ ~ ~ ~ I i bi ~ ~ ,~ ~' I · ~ ~ 0 !?l l~t '~. , ~ ~ tl ot:l \, IH':V,"5~ (I)(llJdlOl COMMONWHAL TH OF I'UNN8VLVANIA DUPARTMeNT OP,R8VRNUS TOANSPHO INHRRITANCe TAX ReRIDBNT DBOBDONT , ,,)) no- " f,. / ,-, V ;' JCHEIJul!e'IIF" BTA1SMaNT OF DBaTR AND DBOUCTIONS __ _....ri__~' _.~ _ n. *""",,__' __~'__"'~,,~"".f,,",.r-;O'~'" .,_...--''''~''-''- Eslote of __ .J!:I.1,AW. ,.!'N~J1(l!:!i.~~,__.__._._ Onlo of rJ,;ntll..::)07 /~~L__Fllo Np,;;(L_1..L;.L!./..1l. WHEN CLAIMING THE FAMIL.Y EXEMPTION, COMPL.ETE THE FOI.L.OWING: Clolmont Clalmanl's Address HolOllomhlp to lJucoclont .. -. """,-~_." "" ---'-'-"-" U~ 0_. ".0- n '~~~ DATU NAMe OF flAVBS" ReMARKS AMOUNT 1 3/17/13 , "P^H'J!III':Mdhm lIUN1,:ng 1I0MN. l"lIl1') ral BIll III 2 ,271i .5" - -------. .________~_'T ..._~______________.._....__.~._..... " ,/J'I .....uor o elf! --....-----.----." -,.S!.tLlLJll.l1...--'~T-cm'Irl'r 'I -;to, 8'; 3, 3/10 Hocr,lllt') I' 0[' WI1:l II j,UI'lI ,or ^dlll:llH\,ti\J\;\i [)ElI; po lil"OO -- .....--------.---.--- Ii 3/1'1 PP1.I, , 1":1uo L L'la '(0. '76 ,-< " ,11'1 11,1 nql't!"n (1nllllo1IclIL,\;JllL_ ~.il.ll.1JU'__ (1 10 (1 ---,---~ 6 3/1.7 H~ymol1d Mnrtill/TroBd~ror Helll j'Jlltnto 'JI 11 X 0 a h6i?, 03 '3/1 '( -....-.- i-- -.-..-.---...-...- h2,09 '( Boll at' . P^. 'Polo phone -- '-r--~-- ~ n 1,/, n f,(lW'A11 ^ 1 'I nh 'Pwp. ----8.a..w.a.r_L n n r II n n 151 5'n - ....___.~__M_ 9 11/10 00111111, Oen. OwL hoput h:\. c II, np. l.tod:Jonl 206.20 , -------------... , ~ I, I, n PPR.t , lit'! nni- H I fl 11 '0 " . . 11'< 11110 !Jell ef P^ !l'lllophono I' 5. '78 , ---- , 12. 11/12 Intornnl Modicino ^unoe. Mod:lcnl 88.60 -----~ .----------- 13. 11/12 " Dr. Hoovel' 80huke ~l() ell. 0 nl :L5,OO " ",'(2.36 , L ,,}, n " " , " "Q"il' ' ---Ac1-'1-&l'4rJ,.fl~ ,I 1, e Il a:k- " OAillotcl'i'. 1.5. I, /J, 3 'Holling 0l'oon' 'mol" :~ l'lot/Pluque . 1120,00 " -- :\6. , 11/21, . Cumberlund [.aw JOllrnul ^dvert1nlns/LoBBl " ,3.8.00 I - , , 17'. 11/21, UOT OMJ JIIIi.53 18. h /2 h Dia,\\. lIt':\. tz, OHI , APDl'ld llul 100.00 , fiRll~gop~lgHl\oY /, mxeoli\~(1I'IIl/^c1ndn1wl!2:!l1,Ol'O ro 1113 38<).28 " ,,7 5/2 " 3.389.28 20. PONHD n. OWlnN. Jnuq. ^t;tornoy I n F()o_~_._~_,__ :n, 5/2 1~B(Jl'0W , ~ -. M 1[1 () ..!_JI:.!.P3_t.!!!..":!.____ 5 0 0 '. 00 22: r,/2 NFJW WAY pm8~1' CON'I'HO I, ~~WILt1lll.~ :\. 0 n ------- .-J.., 'iOO.OO , Orcan I!lB'Lute- "*6'(,. ,!85 , 65- Debt f\'1.])odu~~t;-:l.-onl;:-;1J 12 \ 15 5. 1r,;;;--~-- , wet lOll t.utli-:115r. 630. lip X 06%=:1:3 337 I 82911 ,()5'~ = 'I' x rlJ~I~ T~lij&~~'~11.1 <; <; .~ ~~;:::~r.~:~;:;,:~~t~~3~'~lro:"~~;~~~~i:,;i~;: :;'~::i~'~I:,:,7~: ~',~~::~,:~'V:-:",~~,:~~~;'! :?i~~~/" 8;l.gnntut.'o ()r l~:I,duotf,liry -:/!ilt1N^TurH~(Jr^'t'I'(]I'("'HY/rqnlJCIl"IV :n'^Tlf /I ~I<\' ~,.:\,1'7,',"';I'" I""''A I" ,;{ 1,1-" ,,' OFFICIAL USE ONLY }~,' ;r.t'l,,~ (I DEBTS ANODEDUCTlbNS ME ALJ.OWBOIN TH'r: SUM Of $ /,;,-1 /J I/o/'. I~, AT ~ rBRCt:NT, , , /' ,euH.~) IWOIHTfill JI- WlLl.H / -'" P (I' - 6 '/I I Df\'11r g~~EI1~L. INJ:lERITANCE TAX IN.E06MAT~ Unlatl~f1ed Ilobllltlos Inourred by the deoedenlprlor to his/her deelh ura doduollblo ogalnsl hll/hor toxnple estate, In addltllln 10 dobtB Inourrud,by tho clooodonl or &otote, olhor Iiams uro ololmablo !noludlng tl1~ oost of administration; otlornay feaR, tlduolory foos, fllllorallll1d buriol oxpenoeB Inolqdll1g tho ooat, of 0 bllrlollol, tomhatone or gravo,marker, All debts bolnll olalmod ogoll1st on oslo to nre subjoot 10 1110 opprovol of Il1e Roglstol' of WlIlswllh whomtha Inherllal100 Tax Rolllrri Is fllod, Evldonoo to sllpport tho dooedonl's or tho ostOlo's lIabllllY for Iho dobls bel nil ololmed shQuld be ottaohad to thl8 80hodlilo, A family exumpllon of $2,000 mny be olalmed by a spollse of 0 dooodunl Wll0 dlod domlollod In POl1nsylvonle, If thoro Is 110 Spo\ISe, or If the SpOllSO has forfolledhlB/her rlghl9, then OIlY ohlld of tho deoedont who Is a mom~or of the same h01l80I1Dld oon olalm tllo oxomlltlon, In'lho ovunl thore Is 110 slloh 8pOllSO 01' ohlld, Ihe exompllonoan be claimed by 0 partint or paro'nts who 111'0 momboraof tho samo housal1ol~1 os tho decedol1t. The family exemption Is olldwablo only o\lalnstossola which poss by a will or bylhc POl1noylvenlo Il1lestoto Lowo, ", ~ ~ ~ 8 ~ ~' ~ e; z ~ m C'l ~ t1 ~ IT! ~ ~ $' z z ~ ~ i1J, $' 0 0 ~ , ", 0 .~ 'Tl 9 'Tl 0 j". I,' ~ I' r. 0 L-'" Q' (, Z , , i, oCt: lilt; ~t<, I,i If' II ',;;~ ";,' ,--. d , I "''-1 r.:; g:_,,: ~ Lc ,.. i~)f~i u I Ii. r.t~: .'A11 ~ ~.." "..)' , h.1 U~.:; 9 , 1>: '50 ~:Iu ~ ~ u :1 , INSTRUCTIONS FOR COMPL.ETING SCHEDUL.E "F" 1, If the family exomptlonls being ololmod, Indloate the ololmont's nome, oddress and his/her ,relollonshlp to tho daoedo[lt, Enlor "famIIYllxemptlon" In tho remarks oolllmn end tl10 omolln! clolmed 111 tha amount oolumn, 2, Assign OOnseol/IIVe numbars to eaoh Item IIstod, 3, Enlor tho dete on whloh each qebt was Inollrrod ol1d/or Ilold, 4, enter the names of oooh Iloyee, 6, provldo u brlof oxplol1otlon Intho romarks colum(1 for onoh dO\Jt ololJnod, 6,' Enter tho omollnt of eaoh dobt boln\l ololmod, 7, ' Th,a form muSI be slgnod by Ihe person who hos asslll\1ed 1110 rosllonslhlllty for paylnll the clebts, " 1I'!f.01l.MAIln~ To 1I\.IIro ,propor 010<111 10 vou' nOOOIll1l, 1110 "'11111 01 1110 0'1011I 011<1 III!, nWIlII., 111<>ul<l ~II oloorlv prlnl' .<1 on lh. ohoek 0' mOllOV or<lor. TlIII OBB088monl IB 010<10 In 00110,<10"00 With Ooollon 70B of Iho Inhorllonoll IIn<l EOlnlo Tu AOI 01 1001 172 p, s, 6 ,2480.700}, To thi! OKIO'" that Inhllrllonoo \ilK In polri wllhlo Ihrllll (3) monlh. ofto, t'ne dllolh of Iho rlDoo<lonl, 0 dlloounl pf flvolO} poroonlll ollowe<l ('/2 1>,0, & 2400~7101, InllOrlto"oo TOK, 01110' 1I10nlo. on 0 IUlu,o Inlol.II. III <lno nl 1110 <loto 0' Ihll <looo<lonl's <loolh ond lIooomos dollnquonl 01 lho oKplrnllo" of nlllo 101 monlhs oftor Ih!1 <11101"'0"1'. donlh 172 1',9, ~ 2480,7111. Inllorltolllio TOK pn 0 fUlllro 1I\lorosl II pnyubla Wllhln Ihroo (3) l1Iolilho nftol 1110 Ironllol Inko. oflool 11\ p099osslol\ and onJpymonl ond I. dollnquonl Ihorooftor (72 1>.9. 6 2400,712), Colo!/Inlo Inl.,llol from Iho dollnquont <1010 III own on Iho fooo of Ihle 'o,m 101110 doto o"oolUnl poymonlllill1U Iho lollowlnu Inlll,08l10blll: ..._-.-...~,....-.._- -.-..-......-..;..... --..-- ............ --~. ........-- .......-.....~....--.......... ...... -.... - --... ..--.. -............- -- -- - - - -... -- lmonlh ,000 4 monlh' .Q20 7 nlOl1lh' .036 10monlhs ,080 2 monlh. ,010 6 monlhs ,026 B rnurllho 040 11 monllls ,060 3 mOI\1I1' ,018 o monlhs ,030 fJ monlllo ,046 12 monlllB ,060 --.--- 1 dOY8 ,00017 11 dov. ,00100 21 <loYI ,00362 2 davB ,00034 12 cloy. , ()Q203 22 days ,00309 3 <lavl ,00061 13 <Ioyo ,00220 23 dovs ,00386 4 d~ya" ' ,(lODe8 14 doya ,0023" 24 days ,00403 6 dOY8 ,00086 16 d"V' ,00260 26 dovo ,00420 8 doya ,0010\' 16 cloyO ,OQ207 20 doyo ,00437 !' 7 deye ,00118 17 dOYB ,00264 27 deVI ,00464 o daVI .00136 16,deY8 ,00301 28 dovo ,00411 o day. ,00162 1 D cloy. ,00310 20 db VI ,00488 10 dOV8 ,00108 20 cloyo ,00336 30 doYB ,00600 ..- - -..._<1-__...._ ___...____..... _~_ _... _~......_ +__ _ ........... _ .,.'-.-.... __... ....._.__ _...._ _ _ _ _...._..___.. _...__... Any pOlly In Inleroal, Inollidlng Iho COtn01ll11w/lollh nnd 11)0 pllraonol roplO80nlllllvll, not oell8110d wllh Ihe o8$08$monl ,moy oblool Iharolo wlthln"Kly (001 rlIlV' IIltor rOIlDlpt of 11110 Nollo. 0. proVldod by Soot Ion 1001 pf tll0 Inhorllonoo and EelUl. Tox Aotof 1901 (72 ~,s, ~ 2480, 10(1). Mako .hook or monoy o,dor Jloynblo to: "Raglator of Wills, Agent" Moll to tho oddroae lIelod bolow; lNf..QflMAT.lQ.N., To InBlHo propur orodlt to your nOOOl/IlI. Ow 11111110 uf Ow lJollltu 111111 fUll fHlIllhor nl10uld bo olonrlv print. oel onlllo chook or monoy ordor, This ou08smonl Is modo In u"o""lonco wllh Sncllan 700 qf Ih" Inhorllonul/ 8nd S.lolo To~ Acl 01 1961172 P,g, D 2466,708), To Iho ulOnl' lhol lohorllonoo lo~ 18 pllld within Ihroo (31 /I1ol1lhs ultar Ihu doolll of 111f1 dooodonl, 0 dlsoounl pf IIvo 161 po,oonlls oliowodl72 ",8, U241l6,716), Inhorllonoo To~, olllor Ihon IO~ on 0 fUluru Inlo,o61, I. du. 011/10 dlllo of Ih. doood.nl's dOlllh ond booomea doltnquoOI 01 lho o~plrollon of nino 191 mO"lhs 0110' 1110 \Iooudonl'o dooth ('/2 p,g, Y 2486,7111, Inhorllonoo TaB On 0 fUlUro Inlo,osl 18 jJoyoblo wllhln 11".0 lal monll'8 Ollar Iho Iron.for lok08 .IIoCI In l'OOS08slon ond 'enjoymonl and 10 dolinquoollhoroollor (72 P.B, Y 2465.712), Ooloulolo Inlorllsl from 11\0 dollnquo,\1 dolO shown on lho 1000 of thl8 form 10 Iho dolo Qf 1I0luol floymonl uolno 1I1l..folioWlno InlOrl/61lol>lo:, ...----...-.......-... --- ----- - ----..- -...- -- --...... ............. ..........__ _...... - - ... .~..... _-H _............-. ....___....._..._ _ _ _ __ __ 1 monlh ,006 4 montho ,020 7 '''0,''h8 ,036 1 0 monlho ,060 2 monlllo ,010 5 monlh8 ,025 6 montho .040 11 monlh8 ,OBB '3 mOnlh8 ,016 6 monlhs .oao 9 monlho ,045 12 monlh8 ,060 1 days Mol7 11 days ,00100 21 days ,00352 2 dsyo ,00034 12 doys ,00203 22 ,lays ,00309 3 days ,00001 13duya ,00220 23 doyo ,ooaoo 4 doys ,00060 14 doyo ,0023'/ 24 doyo ,00403 o doyo ,00006 10 doyn ,0021;0 25 doyo ,00420 6 doyo ,00101 10 doya ,CiO,07 26 days ,00437 7 daYs ,00118 17 days ,00284 27 days ,00464 '9 doyo ,00136 18 doyo ,00;101 26 doys ,00471 9 doyo ,,00162 19 doyo ,00310 29 doyo ,00488 10 days' :00169 20 doyo ,00330 30 doyo ,00500 ...- - ----~-...- -...... ..----..... ...,.... -....- -.... .~-_....... ....... -... -~.... _..... ..... --.....,..... -~.."'t -..... - ....-....-...---- --- ..... AnYPorly 111 Inlorool, 1I10ludlng tllo COfnmol1WO'llIh ol1d Iho "0'001101 roproool1lollvo, 1101 ,ollollod with Ihe oS800.m0I1\ may ol>loot Ihorolo Within ol~ly 1601 dny. oflor rooolfl\ of tlllo Nol/oo os provld"d by Sobtlon 100101 tho,ll1horllonoo ol1d ERlOlo To. AI" 01196,1 (72 P,S. \2485'1001), I . . Mnko chuck or niol1uy orrlnr pnyabiH to: "Register 01 W,lla, Auenl" Mall to tbo a\ll/ran~ IIntud bolow;