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PETITIO~ FOR
In the Estate of
No. 21..81 :172
PROBATE OF WILL, Al'4D UTTERS TESTAMENTARY
ANNA PIIAn!; Kl, lNIl
- ....-.-..........-
___, deceased.
T~, /)/ L';(;i' ;;:, ::i w,l....,,..... '-___, Register of Wills for the County
of Cumberland, n the Commonv-{eolth of Permsylvonlo, .
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Petltloneds) lQN the, executrilL..---..- named In ~he Lo~t Will and
Testament of tlnnn Poarl Kll.110 .__."",---" doted Novomhal' IB, 10,7~
Decedent was a citizen of the United S,totes and a resident of
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Lamoyno, Borough, Cumberland County, Commonwealth
of Pennsylvania. '
Deeed.ent died on _J;:_~~-- t.he ....J7t1l _. day of 11ohl'unl'Y
A. D.. 19....6.L.., In the Count~ of __!lllmlJll1!!ntl , State of
l'onnsYlvR!l!~~__.____ at the age of!1>> years.
.~. N~ her
Decedent hos not been married and hos not hod children born t'o :bl:m
slnQe the execution of the above described Will.
Decedent was possessed ~f personol property to the value of ? 0., 0 (l() ((Q.
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___ and df real estate to the value of
NONI1, .._'__ os near as con be ascertained; sold real
estate situated os follows NONn
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Therefore, your petltloner(a) respectfully applies for the probate
of .the ,said Lost Will and Testafl'1ent and for Letters Testamental)! thereon.
Doted flRl'ch ll, 1981. _., '.,. ./' I'..
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Nome and address, _,~~/l(.(t/!' .~},. 6?lqt{'
of Petltloner.~x Nancy K/ Smith , '
501 \'Ia 1 ton Court
I,omi'lyno, I'a. 17043
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-
CO.MMON~EALTH "OF PENNSYLVANIA ~
COUNTY OF CUMBERLAND ss
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Nancy K. Smith '
named ,In above application, being duly, Rwnl'n according to law
say(s) that' the statements set forth In this petition are true to the
best of her khowledge and bellet.'-.u
, S\~orn J
andsubsc;:rlbed before -~~;..;.~,
me,-->--,..!.\lU'.cll.... 1.1. 19..M._ (
I; C. /, {I .~)
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Flied:
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MarohH, 1981
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Attorney:
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ii I, ANN^ PI1ARL la.IN1\, wIdow, IInl'rhllll1.'Po, Ilnuphin Gount)', I'onneylvnnin,
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Ii he!nrt of' AOltllcl mind,momory nnel IIndontllndinr., do ma\(o, l\ublhh and deolaro ,
II thl.s'my LnRt IHU nod 'l'OBtllmont, herohy l'ovoklnr. lln:l nlaldl\ll void 1111 \~lll
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II or wills hy me at nny tl.1~O h01'lltof'orll mn(,\o.
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t dIrect thnt my dehts, 10rtlllly co1toctthle, nnel m)' f'uneral expeMos
Ii he paid I1A Boon as cnnvonlontly mllY he dono nftol' my llOQOIlRO,
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t 8i vo, deviBo nnd hoqolln th 1111 the l'ost, 1'0sJ:dllo nOlI 1'omalnclor 01'
,
my property, hoth 1'01\1 nnd pOl'sonnl, \~horesnevol' s!.tunted, of' wlil.ch t shnll
'i die uizod qr l'oRBoRBon or to which t mny boontition, 01' oV01.' which t shall
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Ii, :I. Howover, in tho ovont thnt my holovod dl\u!!htor, Nuncy K. Rrnith,
II predeceasos mo, I "1.v,O, dovlso nnd hoquonth hor 1!'l/20 shure in my ostato
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il unto hor SOli, my holovon r.rRndson, Vnnce 1.. Smith, ,11'., nhsrilutely.
. 19/2,0 unto my daughter, Nancy K. Rml,th ,l,emnyne, P~hl\syl vania
1/20 Ullto my grRndson, J, K. Rl.ohRrdson, ,4:16 lJn\~rellCe Rtreet,
RllvonllR, ohio 442/\6, nbsolutely, .. I
4. I hereby lIomin~te, constitute nnd Rppol.nt. my beloved dauw\tor,
11
il NIIMY K. Rmith, UlCootttrix of thl,s my t,Rst will and TestRment, or if' sh. shall
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II pred'Cllaso mo, or d~es 'not completo hor duties aB nlCllOlJtrl,x, Dlluphin DopoBit
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Ii Trust Compflny, nxocutol' of. this my l,flst Will Ilnd Tostamont.
1\ IN WtTN,nSS WlllWlllP, I, ANNA PilAR!. KI,INn, 'l'ostnurix,:hnvo to this my
II, 1"tBt Wilt IInd Tostamen~, typo\~ritton on one (1) pRlle, sot ,my hllnd and seal
II I c,,~#.
!' "this c dill' 01' November, 1976.
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Signod, selded, pl\l1ll.~hocl Ilnd doclarod hy thll
Ilbovo-nnmed ANNI\ PIl^RL Kl,tNn, liS and for hor
l,lISt Wi 11 I1l\d 'res.tRmont, in tho prosonooof
us, \~ho hRVtl horllttllto suhscrihod our nll.mes n9
witnesses, at htl1.'l'oquOSt in the pt'llsllnce 'of
,the IInld'Testatrix IInd of each other.
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OATH 0' PERSONAL REPRIUNTATIVI
H
CO"M, M,ONW, ML'r Ii all PBNN SYL'VANIA~'
, SSI
COUNTY all CUMBBRLAND
'Borare me, the Roglster (or the Prohate of WlII. and Brlll1tlng. of Letters of Admlnlutratlon Iii and (at the
County '~f ',Cumberland, porsonally camo .,."""~,~n~x.,.~:,!,, ,~I~!,,~!!..., ,...'.,., ,.', ,'......'"".",." ".....,......,..:", '"''''''''''''''''''','''''
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'II "be' I d' I R\~Ol'n d (l~ d' ' d tl t . Ilxoelltrl.x . '
W 0, ,og ~,Y 1"'"'''''''''''''1'';'''11''' 0 .";1,,,,,.. cposo nn arty 11\ "8 ....""..II"'........".."I...i.lIHll'.".....'lh.liillltl'..fHIIIH
of ' the laat,Wlll and TestRmont of .....It,,..,....~",''(t.r.9.l;\.l'JlI.~^i\n.qll...H;oI'.''I''......'''III..,,...........'....Wll'.."W..."" d~ccpsGd
"""..,....""".,~,I.\.~."i''''','~.... will wall and tnlly admlnlstortho goods ,and chattels, rights and credits of said decoued
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Accor~ln8 to law. And also wlll diligently comply with tho proYlslol1s of tho law relating to Transfer Inheritances,
...........,.\~ot.D....""" and lubscrlbed
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Bo It remembered that on 'the "'H"l;~'~~'~"'''''' dJlY of ......,t1.........!,\nr:Ah....,....I.'...ll'..II......i.i.;, A',D'f 19,,~J.'j' thoro
was probated and~orded tho last WI1l and Testament of ...."...~~~,~".:.~~.:.~".~L~~,~".."......."'".,,,,,..i......,,,,.....,,'"..'
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, . Lemoyne, ..'.. ' . . '
lat~ of ,............;.;...............,.",..............'...1...'...".."................',...'.".i Curnbcrland County, Penn.ylvnnhl; Deceasedl Lattors
".,,:. .......",.......... .;:.~ ,~~ .~.~ ~~ ~ ~.~,~ ..., ,.,.... wero granted to ..,,,..,..,.. ~,~.~. ~y... .~.:.: .~~:~ .7.'.'....,.....,...,,~.. ...............".,......., ..........
Witness mY hand and official leal tho day and yoar aforesaid. / . "
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eE~_W:1ERITANCE TAX GENERAL INFORMATION
1. f.r.LijSONS RE.~PONSIBLE FQ.IlIlETURN
Soclloll701 ollholnhorllonco.nnd Eslnto Tnx Act 011961 provldos lhntlho 101l0Ylln~ parsons sholl propora and 1110
n rotun]: ,. , '
0, Tho porsollol roprosontol,lvo 01 tho estolo of Iho docodonl ns to proporly of tho decodonl odrnlnl,storod by him
ond silch nddlllonol proporly which is or moy bQ SlIbjoclto Inhorltonco Tox of which ho/5ho sholl hovo or
ilcqulro knowlodgo; . ,
b; Thelransfaroe ofPro/lUrty upollthe tronsfor 01 which Inhorllonco Tax ,Is or may bo Ilnposod by tho 1961 Stolulo,
Includlrlga trusteo 0 proporty lronslorrod In trust, provided t1wtno soporoto rolurn nood bo mUllo hy tho tronsforoe
of proporty Includod In tho rotllrl1 of 0 porsonol roprosonl~t1vo.
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2, Pl,AG~ FOR FILING
TllIl relurn is 10 bo r1larlln dupllcato wllh,tho Roglstor of Wills of Iho county wheroln tho docedent rosldod,
3. TIME Fa R FII.IN G
'fho. roturn I~ dllo nino months aflor lho docodonl's doulh, IInloss on extonslon for filing h08 boon oppliod for and
granlod by tho Socrolary 01 Rovollut' within tho nlne-monlh period,' .
. '
4, EAILU RE TO FILE RETU RN
Sectl0ll191 01 (ho 1961 Stotuto provldos thot " , , ,any porson who willfully ,lollslo fila a relurn or olher roport
roqulrod of him, , .shall be porsonally liable, , ,10 a ponalty of 25% of lhe tax uHlmaloly found 10 be duo or $1,000
whlr-hovor Is tho lossor to bo rocovorod by tho DQpnrtrnont 01 Revonuo ns dobts of IIko omouul tHO rocovorobloby
law," '
5, TAX RATES
In. horllllnce Tox Is payabla al tho rale of 6% on transfers to.llnoal doscen,dants, such as fathor, nlothor, husband, wife,
son, dtll!Rhtor, p,rnndchlldron, grandpmont, son-In-law anddouRhtor-ln-law and at tho ralo of 15% oslo 011 othors,
6, ~AYM~NT OF TAX ' .
Thstax assossed on ,tho transfer of properly rollorted In t,ho return is due 9 months allor tho docodont's doalh. Intsrest
at the rato of 6% par annum accruos .theroaflor unlll payment Is mode, All paymonts rocolvod ore II rst oppllod to any
Intorost which maY.ho due wl,l.hany rsmalndor applied to tho tax. IF TAX IS, PAID WITHIN ~ MONTHS AFTER THE
DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS AlLOWED, "
All chockfshould bo maderOYOblo to the Register of Wlllsof (he county whorolnthe decodont rosidod.ond aro
recolvodsubjoct 10 tho fino detormlnatlon of tho Doportmont of Rovonuo. '
1. FAILURE TO PAY
,.
Tho t.axos 11.IIPoeod, together with onylntorostlhoroon, me allorHlpon roal proportYi WhiCh. lion romulnsln elfect until
the taxes and Intorest have beonpold In full. Thotoxos may bo sued for against nny rOil I proporty In tho decedent's
ostato or agolnstany property belonging to 0 transforeo Iloblo lor tho tax,
8, rILING.OF FALSE RETURN
Any p~rSQll who willfully. mnkos 0 false rotufIl or report requlrod of him sholl, In occordunco with Soctlon 793 of tl10
. 1961 Statute, bo guilty of 0 mlsdomoanor and, on conviction thoreof, shall bo sentonced to pay a finq not oxcoodlnR
$1,000 or undorgo ImlHlsonment notsxcoedlng one yom or both.
fiQIf: Componsotlollpo/d to~n estate roprosonlatlvo; namoly, on execulor or adminlstrillor, for sarvicospolformod
In'admlnlstorlng on 8slato,Is toportablo for Pennsylvania Incolllo Taxpurposos, Thistoxoble Incol1le ilom should be
roporlod on form P A-40-lndlviC/uollncome Tax Rohlm,
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QUESTIONS CONCERNING PROPF.RTY TRANS.f.ill
1. Old decedent, wlthl,n two yeurs of dO, oth, make any transfor of any motorial port of his estato without recolvlng
valuable and adeQuato conslderutlon? (Answer HYes" or "No" ,) No , '
2, Old deceden, t, wlt,lllntwo yoars of dooth, transfsr proporty from hlmsel f/ horsel f to hlmseil(horsolf ~nd anothor party
or parties (IncludlnR 0 spouss) ,In lolnt ownership? (Answer "Yes" or "No",) ~ .
3. If the onswer to ono or two obovo Is "Yes" and the transfers oroclolmedto be nontaxable, provide ths followlnll
Information:
a, Age of decellent at time of trnnsfor, -
b. Copy. of death certlflcato, .' .
'c, Affidavit by tile a\londlng physician Indlcatlnllthe state of docodent's hoalth .at tlmaof transfor.
d. All, other .Informatlon supporting nontaxoblllty of troi)sfer, ,i
4. Old docedont, In hls/hor lifetime, make any transfer of prollorty without receiVing a valuable or odeQuato consldorotlon
" therefor which was to take sffectln possosslon or onjoymont 01 or oller hls/hor death? (Answor "Yos" or "No" ,) JE-
a, Was thoro any possibility that tho proporty tr~nsfetred might rohl-IB to transferor or hls/11er estate or be subJoct
to his/her powot of disposition? (Answer "Yos" or "No".)
b, What was ths trans/ares's age at time of docodont's death? -
5, Dip decedent In his/her Ilfetlms make any trnnsler Without rocolvlng a valuable and adoquatoconsldoratlon thorofor
under Which transferor expressly or Impllodly ro&orvos lor hls/hor life or any period which dOOS In fact endboforo his/her
death:" .
0, The Possosslon or enjoYlllont of or thorlghtto Incomo fromtho'proporty transforrod? (Answor "Yes,,'or "No",)~-
b. Therlllht to deslgnatotho porsons who shall pOSSDSS or anloy tho proporlY transferred or Income therefrom?
(Answer I,yss" or "No",)..N.a._
6. If the ftn~wer to IIvn b, above Is "Yes," waS .1110 right reserved In decodont alone ( lor docedentond others ( ),
, ' '
7, Old decodentln hls/hor lifetime maks a transfer, tho consideration lor which was transforos's promlsa to p~y Incoule
to or for the beneflLor core of transferor? (Answor "Yes" or "No".) No ,
8, Old decedent, at any lime, transfsr proporty, tho blllellclal snloymsntof which was subject to chango, because of
areserv'adpowsrto ~!tor, al1lond, or revoKe.! or which could revert to dscedontunder terms of trensfor or by opsr~tlon of '
law? (Answer "Yes" or ~'No".) No
g, If ths answer to olght above Is. "Yes," wasths power to 01 tor, amend or revoke ths Intorost of ths beneficiary ressrved
In ths deco(lont olono ( ) or decodiml and others (), ,'. .
nf.\/;~nJ LX' pleol
OOMMONwaAL TH O~ rINNDVI.vANIA
, Dnl'AlITM8NT O~ ReVINU.
TRANopan INHlnlTANon ,./llC
n.IIDRNT DDollbaNT
SCH!lUULE liD"
Il11Ne~IQIMIIlII
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(lnNtfilot/Om 111I /I0VOrlO Slt/o)
1:8tO\0 of ^NN^ PIl^ItL KLINll
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BIlNBPIOIARIIlS AND ADDRllUIl~ RIlLATIONBHIP SUFiVlVBP DATB OP INT8RIl'T OP B8NIlPIOIARV
D&ORDIlNT BIRTH
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Nnnov,K. ~JJlJ.1b..-- .I) I\U II h~'ll.-,; ..-.... ...,.,...Y!lJl_ I,..nnl , 1\1120 neniuunrv
601 Walton Court, ,
--tmnoyne'T''lT.-t'1:6or. .-...- .-.- -'
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tJ" K.Jlichll~dRan_ , O'l'nnl!!lm.,-r-' YOR 1.t!J III 11 1 1/20 RoRidunry
437 Woodland -, '; , ;
. Ravonna, Ohio 44266 ,- ,,----..--
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The abovo,ban'tlfiolprlos arB living at this tlmo oxcopt for tha folloWlngl
NAMI!
DATB OP DeATH
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~IONS FOR 'COMPLETING SCHEDULE /Ill"
,. Bohedulo"'e/l'nlUst Inollldo,llll proporty, 1'01\1 ami porsonol. oWlwd by.tho dooq\lont 1~lnilY wlthllnother
perty or parties o. s lolnt tonan\8 with rloht 0'1 RllrvlvorRhlp, 80th tonnlhlo and Intonglblu proport.y ora to bo
Inoludod, List rool,ostoto flrRl, ,
1. ' Oesorlbo 011'1'001 proparty as Indlolltedln tI\e Instruotlons for Sohodulo "A,/I Dosorlhollll porsonol prop arty
oS Indlootod In lho Instruotlons for Bohlldtilo "13," Inoluclo tl10 nomoI oddroRs Dnclrdlotlonshlp to tho
deoeclont of tha oo.ownorlsl OI~rt tho duto the lolnt ownorshlp wus eotllhllshocl.
2,
Indlooto tho totul morkot value of the 101n\ly ownodproporty,
Indloeto tho poroontDod of tho duoedent's 1nIOrOs,t,
3,
4,
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Indloete tho market value of tl10 dooedent's Intoroal.
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To InHUIO plopor olotlll 10 YUllr rllllJo,erll, III. 11011111 0' 1110 uolOlo und 1110 numbol should ho. oloHrly print.
od 0" 1/10 ollook or monoy ocdor.
Tills OU088mont Is "'odll III IInomdOIlCO wllh (Wollerfl '/00 01 11\11 Iflho,lIonon ofld eslnto Tn~ ACI o(
1961 (72 p,a, 9240B.70B),
To tho O~lonl thol Inhorllonllo It.. lu "lIld wllllln IIIrllo 1:1/ ",onths I1Ilor IflO dOlllll of Iho lInoodonl, 0 "
lIl.o~unl of flvo (BI poroonl Is ollowocl (72 P,S, n 2400 7101,
Inhorllllnoo Tox, 011101 Ihon to~ 011 0 fllluro Inlor.sl, III dlln III IIw dlllo ollhu dooo<lnl1l'S <lIJn\h ol1l1 booom.s
dollnquont ot Iho oxplrolllll1 of nino (01 nto.nths ollflr Ilia dooodlHlI'u '10111" (72 /',8, 9 2400.'711/, Inhorltol1oo
rn~ 011 0 futurs Inlllr.st 10 poyoblo wllhln lhrnll 131 rtI11111he ollor Ihn Irolls'.r IDkllo off 001 In possos,lon ond
enjoymenl ond I' dollncluont III.roolllll'(72 P,fI, ij 2406.712/, 00101110111 Intllro81 flam 1110 (Iollnquont <lulo IlIown
on the fooo of this form 10 1110 doln 01 nownl pnymo"lllslng 1110 followlnu Into,oM tohlll:
----.~-_.........- --"'-"---," ...--.....-...-............ ....-...-...-....-.......-.-...- -.;. ....-... -..-.- ....-'..--...-......- -- - - -_..... 0-_
1 monlh ,005 4 monlhs ,020 7 nlUnlllS ,035 10 monlhs ,O~O
2 monlhe ,010 6 montha ,020 8 lllOnlhs ,040 11 montha ,066
3 monlhs ,015 6 monlhs ,03!) o '~onl"a ,046 120101llha ,000
1 doys ,000 17 .11 dnya ,00100 21 duys ,00352
2 dlyS ,00034 12 <luys ,00:W3 22 doyQ ,00309
3 doys ,00051 13 doys ,00220 .23 dsya ,00306
4. dlys .00000 14 doys ,00237 24 doys ,00403
6 doys ,00065 10 ,(oyo ,00260 26 dsys ,00420
o doy. ,00101 1 6 doys ,00267 20 days ,00437
7 doy. ,0011S 17 dsyu ,002S4 27 doys ,004B4
o days ,00136 ,10 doys ,00301 26 duya ,00471
9 doye , ,00162 10 doys ,00319 20doys ,004SS
10 doys ,00100 20 <lIIYs ,00336 30 dsya .00500
,
..--.---.....---t""...-----..__..... __ _..... ..,_...... ......~_ __ .._ _ ___... _... _.... ___.... _ _ _... _...._..__..... ...._.....
Any pollY In Inloroel, InoludlflUlho OorilmonWlIllllh ond tho pOIsonol roproaonlnllvo, not 101leflod With
Ihq'oaalumonl may objootfhorolo wllhln sixty (601 dnyn olio' ,"oolpl 0' this Notlo~ 'os Illovl~od by Saotlon
1001 of.lhL Inhorllnnoonnd SSlqlO Tn~ Aol of 1061'(72 p,s, 9 2406,1001),
Make oheok or 1l10noy ordor raYllplo to:
"Reglstor of Wills, Agont"
Mall to the address lilllod bolow:
IWV.4116 f)(I!JdHlI
COMMONweALTH OF rBNNBYl.VANIA
DBPARTMeNT OF AeveNue
TIIANBFen INHenlTANce TAX
nesloeNT DeceDeNT
SCHI1DUl-6 "F"
STATF,MENT OP onaTS
ANOOnOlJOTION8
.- ...~,
Hu~"""~"ff.it.Ai'~t'~~"-'''~'.-H'''''''.'''~_''''''",,'''4'
- _ .."
Estete of __-.MIt'M 1'1I.lli.!!!L~1l .~.~__u'-:".._ I)oto of Dootl1n_.?:.~?-1/.~~..__ Fllo NU".n::::l\l..:2:_~.__..___
WHEN Ol.AIMING THE FAMIl-Y EXEMPTION, OOMPl-ETE THE FOl-l-OWING;
Claimant !lltnny K, ~mith' : Rolllllul1Rhlp to 110011U0l1t I)III,nl1t01'
,. --...- ----..-
Claimant's AddrQss liOl I~n 1 ton Cnurt, 1,IPOtlVIlO, I'll, l'/o~ ~
__r........l. ;--',,--., <-~",~,",_..,~,-,.-,;-.,_I"""~,,,
'N~~ DAn NAMe OF PA yue , I\OMAIIIIH AMoUNT
"
. - -............. ..---
I . ~/llill HOld liter nf \Hll~ 1.ottnrl1 I, 'lhnrt l'wrt I r, c:\tOq 4'2'.'('10
.-- ---....-ffi.---.-'------.........---~~....--
2 ~/3 Ilrl,;1.n ^, .TuUuA [lllI1n1"" II l'nC'.t.I'1' . , _Y~10,00
- -- ._- -....--.--..--- ~ ___.--....____H_-'
~ 4/111 Ill'. ',lONOI;" c. r\1'lhh . .. ~O,OO
" ~--'- -' ..........--...4......-
4 4/1!!. \\,'11, linlRhlJ1'rr * Cnll\l'lInv, r.1'~ tncolI\O Tnx 1''''Jporo tion , 7[;,00
4/1!!" , .. . ..
" 5 I'n l- 11I11,t, or l:owmuu 1080, ,I noomu 'l'nx UR,aO
._--- .. .-------------...
Ii 4/22 1'1'0i'llsRl Cll1al I'hn1'mncy Ill'UilP 1,46
Cl'lvnl1nnt , -.'- ....,--_...-.."-.....--. :\00,00
1 4/211 I'roBbyta\'lnn (:h'l1'ol\ OI'{'r.l'lnn
" ' '.---....-----.--.....--.-., ---r,.r:on
, R 4/30 f'anloTA rlCl\~lll'B ., '
- - .--
. ('\ OUll1hcH'htnr\ J.!1\'1 '/nln'nlll Aclvol't.l,f,tllf1 l,ett.e,.~ lR,OO
....-....-..'.-;- - -- --~....-'. --
,n ' II~K"" ,I' <1.d.h , IIxp.cllt 1'1 x .0.
" ------..
11 \'!IUlnm "I. YOUl1!! . ~t'tnrnoy .IT::...~'l',f.'.!..!!L._. 3,463,~r.
12 Nnncv I~ . flmith, IlnllilhtCl1' flnnill Y r:X('I11lpt lnl1 2,(100,00
.,....--------- --........-
'13 ltJ'~lntf.~j' of \'IH1~ 1'1,1\II!' Ii I\(~ ~1 , 0,00
-...~,-
l~ Prv CIl'1tll\tll' crtl nn~" T'10. ^liVI,'l'd, nIl1l' (,Ott,1l1'11 .
~-----_..--.- .,. -.---
!ll~Cllllcll1"()ltl1 (';\:or.l; !'~t \'H n n f'o' ( ~ f\li II; If\ . , "<Iv" Ilt,~.) , If>O,OO
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, TOTAL THIS PAGE r n ,(\8(,
I heroby'oertlfy that to tho best of IllY Imnwlodgo end bellaf Iho fnragoll19 Is II ILlsl nl1d ll'uo slnlonlont of dobIs, fUnAl'll1
expenses und expol1ses of arlminlstrollon submlltod to tho osto 005 doduct (1\ n 111110/,ll, nco Tnx l/lirpr,1sos.
a/14/8~ .
=
OFFICIAl- USE
DeBTS AND DeDUCTIONS ARe ALLOWEO IN THe. SUM OF $ t~tt lli:J, Is, I
~r",g.;,,,
AT
?
J/"ndJ
1I~L!i
DATE
PE RCENT,
j, -.:? 1/-11
nf'TE
aI!N~6i\L INI;tERITAl)loe TAX INPQRM8ll01'l
Unsatisfied Ilebllltloslr\oUl'lod by thll duoeehmt prior to hls/hllr doeth oro daductlble ollAlnBt his/her toxabln ostato,
In addition to debtslnolll'rod by tho dacodont 01' oslote, otllar ItolTls 01'0 ololmublo 1I10ludllll1 tho oost ,of lIdmlnlWotlon,
attorney faas, f1c!llolllry foes,'funnfal, end IJurlol oxpal180S Inaludlnu the oost of 0 burial lot, tomhstona or graya mlll'kor,
All debts belno alelmod oooln~t un cstute pro sub!lIO\ to tho opllroyol of tllu Roolstor of Wills with wham lhe
Inholltonoo Tux Roturn Is II10d, r.yldonoo to support tho t1uoodant's or the astuto'sllablllty for the dobts bolno olnlmod
should bo,attnohed to thla sohedule,
A femllY exomptlon of $2,000 moy be ololmeel by u spoueD of 0 ducodent who died domlollod In Ponnsylvonlo,
If thora Is no spouso, or If the spousu hos forfoltoelllls/her rlohts, ll1Qnony ohlldof the dooodont who Is /I member of
the same household con 0101l111ho axemptlon, In tho ovont thoro Is no suoh spouso or ohlld, tho axomptlon oon be
olalmed by a Peront or parents who ere Illor,11bers of the sllmohousohold os the dooedont, Tha fmnlly oxamptlonls '
o lowoble only ollolnst assots whloh P098 by,o will or by thePel1nsylvonlo Intostoto Laws,
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It;.lSTRUCTIONS ~OR OOM~LeTING SOHeDULE "P"
1, If the family eKamption Is being ololmad, Indloote the olalmont's nome, addross and his/her relationship to the
decadent, Enter "family exemptlon"ln tho remarks oolllmn and the amount ololmed 111 the amount oolumn.
2. Assign ,oonseoutlye numbers to eooh Item IIst.ad,
',3" Enter the dole on whloheoah debt waslnourrad and/or paid,
4, Enter the nomos of each pay eo, ,"
I), Provide 0 brlof explanation In tho romllrks oolumn for eaoh dobt ololmed,
6, Enter the omO~111 of ooch dubt bolno ololmecl, , ' '
7, Tha,form mtlst 'bo slonocl by the persor who has assumed the responsibility for povlno the debt~,
COMMONWIALTH OnlNNSYLVANIA \.
COUNTY Oil CUM"RLAND J
'"
,___~______~!!:ngJ_.fu 'Smi]ll'__._' ,______~_ __.u..u+,__ ___..._~_,_.______________.u___+_~_
bolnll dulV --lIljtlrn..____+_.~_ ~.ooordl~1l to I~w, dopolol ~nd laVI th.t 1lI0 j,./L'-"'-"'___h".' _d_ ,
llX8cuH,t1L____.____~____ _.____ of thoElt~to of Annn Penrl Kline ____
lato of _.l!!l.t:.QIMJhQf li0I119)'1\8.___,.___, OurT1borl~ndOou~tv,'P.,' daoui.d .nd.th~tth.
wllhl" ,II ~nlnventorV mod, by h_.__~__-~__.__.__'_u,___.____h~__" tho uld IIX8outrix,,
of 'tho' antlra "t~to of uld d,.,odont, oonlhtlnllof ~II tho peraon~1 prop'~rtVend rOIl Dlhte, eKo~pt rul Dllata ouhlde
th, Oommonwulth of PonnlVlvenl~! and, th~t tho fl\lurol oppollte oeoh Item of tho Inventorv r.pr81ent It'I f.lr yel"e
II of the d.to ofdaondont!I duth, '
May
19 81
'}...:,~/A"'~J;rlfj "
, ~~-;';i,t,d.K""""'lnklf'''~
_~501 Nnl ton Court
I.emoyne, Pn, 17043
Add"..
Sworn
_ and lublorlbad bofor, mo,
alllY Publlo
D,te nfDuth ,_--_,.J7tIL
Diy
rebrunry
Month
1981
Vu,
, INSTRUCTIONS
I, An Inventorv'mull b. fllad within throo month I ~fter ~ppolntmont of parlontl roprehnhtlya.
2. A luppliln\ent Inventorv inu!! b.fllad within thirty daYI of dlloovary of ~ddltlon~1 uuh,
3. Addltlon,llh,," may be ~tt~ohad II to 'par,on,lty or re~lty
4: ,See Art'QI.IV"Flduol~rl81 Aot of 1949.
i:- t','-;' ~" . '
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COMMONWEALTH Of PENNSVLVANIA
DEPARTMENT Of REVENUE
BUREAU Of EXAMINATION
OfFICIAL NOTIOE OF
INHBRITANOE TAX
A88BSSMENT
*'
I ?-.iJt}-
DATU .-=:tJ '-J ," Ii J ~
ESTATU (0Y\N~~ '\)(U'lAQ 1\L.~rJ....
FILENO J.1-g'I/~
OOUNT~ (J.. r"'1~'Qr.\~
DATE OF OEATH ':riff\) 1./, /0 k'1
Approlled Voluo of EstOlol
Rool E8\olo
Pellonol P,operty
$
1.
Jolnlly Held P,operty/Tranlfers
+
Tolel Gran EItalo
$
,Total Appro'iod Ooduollone
,Cleor Valua of Gslate
Lon: Approved Chorllable EKampllons
$
I .
Claar Value of GItoto SubJeot to TaK
$
Amount Ta"obla @ 0% Rato
$
ta~ duo
$
Amoun..ro"ablo @ 15% Rale
tox'duo
TOTAL PENNSYLVANIA INHERITANOE TAX DUE .3>'3 r7 If ,,,Ii .,:l.,
. . . . . . A five peroent dlaoount tolollno $
will bo grantod II tho Inhorllonoo TOK Is paid by
Loea credltel
DATE OF PAYMENT,
"
II"Y-RJ
.
AMOUNT PAID DISCOUNT INTGREST ~OREOIT
. .3 r;? 11.f7 d,+ $ . . . . 3 t~ '7 L,I. ~.:l
-- . (" , .
+ "
+ , .
-_..-
Intaroat BoorU81 at tha roto of alx 161 psroonl per Onnum
on the unpold hllonoe of Inholllnnoo To~ from ~
to dato of payment, Intoreot duo If pold by_ la -
SALANce Of peNNsVLVANIA INHERITANOe TAX DUe
~~''';l~
, ....
9~
IN.F.o.UMATJJ)1i.
To l"suIU propol orodll 10 youI IIOOOUnt, 1110 11111110 of 11111 "'1010 nnd iii" numhu, allOulU ho ulosrly ollnt.
od on Iho ohook 01 monoy aldol,
ThiS nesoasmllnl 10 mndo In uuuordnl1ou wltll SucllrHl 700 01 Iho Inlwl\onuo (",Ii ESIOlo Tn~ AOI 0/
1001 172 P,6, 1,2465.700),
To tho oxlont tl10t Inholltonoo lOX Is pold wllhln Ih,oo 131 llion\llS nllor \Ill' dOll\ll 01 Iho ilooodonl, a
dllcount 01 IIvo (01 peroonlll nllowcd 172 p,S, 9 ~486.7141,
Inhorllnl1ce rll~, OlllO( IhonlO~ on n IU,",o'II1101011, is dun 01 tho doto pf thu dooodunl's dOlllhond hooomos,
~allnquanl 01 tho,oKplro\lofl of nlnq 101 monlhs 011 or tho duoudonl'a doO\ll(72 1',6, 9 2465,711), 'Inhorl\onoo
Tox 'on A fUIIIIO Intololl 10 pOYllhln wl\llIl1 th,nn 13) monlh_ IIl1ur 1I1n IllIn_loI IlIko. 011001 In I'osaslllon ol1d
nnJoymanl nnd Is dollnquol1ltll~roollor 172 1',6, 12466.7121, Clllnullllo Inloruol.lrom 11111 \Iollnquont dSlo nhown
on Ihofooo 01 Il1ls form to tho dOlo of Aotunl paymonl llslno Ihll fnllowlno Intorost IIIhlul
-...--...--..-.....- ...-.................. "'.. --..----................. ..........- ......-.-.-- -... --...... ........... ..~.... -..,........--- -- --... - - -- --
1 month ,005 4 monlhs ,020 7 monlh, ,036 10 iTlonl111 ,000
2 months ,010 5 month, ,026 o monlha ,0~0 11 monlhs ,066
3 months ,016 6 rhol1lha ,030 o montl1o ,006 12 monlhs ;000
1 doys ,00017 11 dSYIl ,POIUU 21 dsys ,00352
2 days ,00034 1~. dOYS ,00203 22 doys ,00380
3 doys ,00061 13 dllYs ,00220 23 <lays ,00300
4 days .0000S 14 doys ,00237 24 dsya ,00403
5 dsys ,00005 16 dllY_ ,00260 26 dSYI ,00420
o dny' ,00101 10 dnys ,00207 20 dsya ,00437
7 dAYS ,00110 17 dnyo ,00284 " 27 dnys ,0040~
,S dnys .001tJ5 10 dllYs ,00301 2B.days ,004'11
o day. ,00162 10 doy. ,00318 20 dllya ,004BS
10 days ,00160 2(J doys , ,00336 30 dnyo ,00000
__ _____....___ "_---0-...--- ....__.... nt"" -........... -.-... -....- ..- ......~. -- - ...........--...-..... ....- - -..........---.. ---.....
AnypnrlY In Inlorast, Irlollldlnu Ihll GOlllmonwoullh and tho pllraonol rOI',nsontnllvn, not 8/1\1011011 wllh
tho nn.ossmanl mny obJaollhorolo Wl\hln slxly 1601 IIny. ullor ronnlpl 01 Il1ls Nollon iI. f1,ovldod by Sootlon
100, of 1110 Inhorllonoa end E8Into To~ Ad 011001 m p,S fi 24B6,100li.
Moke ellook or /nOI1OY order pllyohlo to:
"Register of Wills, Agent"
Mali to the llddr~sa liSted beloW:
,.
ffcr-U 1~f171
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTEReD IN THE NAME
OF A RESIDENT DECEDENT
*'
COMMONweA~ TH Of PINN$Y~V"NI"
oePARTMINT Of RlVINUI
BURIAU OF COUNTY cO~~ICTIONI
<--,---,_._,,"' .--..------------...-.
---DA Ti--l?m"1\T--,__~=-m'__'
~
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE1
Application II h.reby mod. lor conllnl to the tronal" 01 the lollowlng "aurlllu of a Pennsylvania
Corporation or a Nallonal Banking Anoclatlon loaat.d In P.nn~yIYanlol
a) 2!HI ilhn'(b) p~nM. 1'0\'>(1)' " l.\i,"11 ;;0. ' (c) (~llnlll"1l!
INOTE' In ducdblnp IIcurltl.. .ntll In (a), ob 01', .lthll the numb" of ahar.. 01 Ilock or, the faae amount of
reglltered bondi, In (bl, Ih. nom. of the Inulng aompany and In (c) the clan ofllock or the Itat.d Interut rate
and maturity date of r.glllll.d bondl,) ,
ISSUED ON 11/:''11'/1\ , and having a TOTAL MARKeT VALUE OF $ 2,22[\,25
(Oat.) ,
al 01 the dot. of d.ath of the d.e.d.nt,
AI\I\!} 1;'.Iu'l L li 11(,1'
, on
~/27 Inl
(Oat~al d.ath)
t 7n1:\
(Ham. 01 o...d.otl
,
1\.ll,\r1;i'lVi"d n
who waa lat. 01
IlIll '.';n 1 trlfl """ft,
(Strtot and Humb.,)
1,;",1\1(\\',";; I r:i\-;j',r'" :"I\fl 1~)ll.lnl'Y I
(P..t Olllto)
(County)
(Itat.)
~~=~~r :lnlH\I' i:, (~~~~~h,
,\, ,':1/,,-.1 ,1llh~ nlld ,:.;-n{~\' \;Unc '.-r'lIth
(Ham. .' namos In whl.h oonlfl.atts all /lOI.tot.d)
i\O)It,l ton Cllll1'1, 1<'J'I\.Wne. \"1, J 7),1.1
("d~,.u) ,.
NAMEOP APPLICANT \'1111/11'1 '!, Y'"II", ^t1:m'oflV.ot..I,~lq
,
The naurlllu are rellllt.red cia followll
COUNTY FILE NUMBER ~ 1.~11. 1 n ADDRESS C)P APPL.ICANT \' ,0, ',,'x 17i1f!, !l'I:l'l'iQbUl'nt (1~1(m
BUREAU FILE NUMBER . SIGNATURE OF APPLICANT ~f\' [!V,'<L,.......'.?-,...,~' ---.,-()
MOTlcal IP yOU PAIL TO PROPBRLY PILL UUMY PORTIOM OF TH.IS APPLICATIOM,IT WILL MOT BE\.! , l'
COMSlDEREDCOMPLBTE AMD WILL BE RETURMED TO YOU POR COMPLBTIOM.
COMMONWEALTH OF PENNSYL.VANIA - DEPARTM.ENT OF REVENUE. JA
CONSENT TO TRANSFER SECURITIES' DA TE~' :~ . /1/'1
I hereby aonaenl ,lathe tranlfll of the above ..eurltl.. now reglllered In Ih. name 01 the aforuald "
Deaedent and wolve Ihe filing of a certlflcot. certifying to the poym.nt of the tronaf.rlnherltance 10K to whlah
the property o/sald D.cod.nt la m.ad. lubl.ct purluanl to tho provlllonl of the Act 01 Jun. 20, 1919, P,I., 521,
a' amanded and the Aat of Jun' 15,1961, P,L, 373, aa om.nd.d. Thll II oliO In acaordanaewlth th. provl.lonl
01 the Aat 9f'April 9, 1929, P,L. 343,
Thla Con..nt to Tranafll the h.r.ln ducrlb.d property opera'l.. only In r.le,.nc. to the utot. of the
above.nam.d Dea.d.nt,
'*'
nee.,;!: I\I-IUII '
COMMONWBAL TH Of PBHNSVLV.IINI.II
OePMTMBNT Of RBVBNUB
BUReAU Of COUNTY COLLeCTIONS
APPLICA TION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
'*'
.~,o-_~_~~______"~U______~__---.-- -........~--.-""''''.......,n.._
Aefb.!WUW (MUST BE FILEi) IN TRIPLICATE)
TO THE peNNSYLVANIA DEPARTMENT OF REVENUE,
' Appllaallon Is hereby made for aQlnnl to tho transfor of tho (allowing ..aurlllos 01 a Ponn~ylvanla
Corporation or a Notional Bankhig Auoclallon localod In Pennsylvania, '
(a) lO() ~;hfl. (b) 1':;;IIIlII. l'n"'OI' ii LI " >(, 'III. . _(a) COI'inIUII
(NOTE, In d..,c. rlblnp ncurlll.. ontor In. (a), ab Oiel ollher tho numb,er o( sharos of sloak arlh. faoe amount of
reglslered bonds, In (b" the name 01 the leaulng company and In (c) the olan 01 stock or the staled Internt role
and malurlty dole of regl.lered bonds,)
DATE
,~,LilJ/jU--
ISSUED ON p/?:;,!"/! 1 and having a TOTAL MARKET VAWE OF S l,"Ul.()(i
(Dot.)
as of the dale of dealh 01 Ihe decedent, /'01111 !'I.'lIt'1 !,'IIIP.- ,on..,-,- ?/~'inl
(Nom. of D.aad.nt) (DOl. 0' d.alh)
who was laleof
401 I.\nltoll I~nul"'. l/(;',nVI1i'e, (:\!I11~'u,,1'!1l!1 (;;11Illty, Pr1l11~.vlvlll'I-la 17iMJ___
(SI,.., and Numb,') (Pa" Of/I a.) (County) (Stala)
The ncurltln ore reglltered os follo\\,sl
!'. I"~II ~1 :11111"
(Nam.., nam.. Inwhlah a.rll/laat..o,. l.ol.tarod)
~~~~b~n~xxx 'Inne,'" ;~a~:';\Jt:111 11111 "nltnn ('nq"c, 1.1;'''''II1f.!;. ;~~;I.J.~;)II.'\
NAME OF APPLICANT "'1111,,,,,,, I'n'm"
I .-r
COUNTY FILE NUMBER :n .11\-171 ADDRESS OF APPLICANT
BUREAU FILE NUMBER SIGNA TURE OF APPLICANT 1-
NOTICEI IP YOU PAIL. TO PROPSRL.YPIL.L. IN ANY PORTION OF THIS APPL.ICATION,IT WIL.L.
CONsloeReb COMPL.IITB AND WIL.L. Be RIITURNIID,TO YOU FOR COMPL,IITION.
^ 1:tgJlll11~'-1\ t,I.!UI
i1'I,.,.:1 ~1111'1'1l, I'll.
~,u.o.I'
TBB -. .,~
,
COMMONWEAI.TH' OF PENNSYLVANIA .., DE.PARTMENT OF REVeNUE jJ
~ONSENT TO TRANSFER SECURITIES , DATE~~1.1'1
I horeby.conunt to Ihe Irans(er af tho eboYe.aecurllln now reglstored In Ihe nome 01 Ihe aforuqld
Deaedentand wolve Ihe tiling 01 a tertlllcale terllfylng to the payment o( Ihe Iranller Inh~rllance laK 10 which
Ihe properly ?Isald Decedenl Is me de lubleclpuraunnt to Ihe.prov.lslons ofjhe Acl of June 20, 1919, P,h. 521,
,.
as amended and Ihe AllI 01 June 15, 1961, P.L, 373, aa amended. This 'I also In accordance wllh Ihe provisions
of Ihe Act of April 9/ 1929/ P.L, 343,
This 'Connnl 10 Translerlhe hore.ln dascrlbed properly operalu only In reference 10 Ihe nlate of Ihe
aboye.named Decedenl.
Ii
'*
51':" :;;t',~."...". oj R, "~ .~
By, .J{t/1~..n J~
_ /{?A()l~~~__.~. . ___ ~L
TJ'iJ~-"lo (Cavnty)
COMMOHWIAI. TH O~ ~IHH.YI.YAHIA '
OIPARTMIHT O~ RIYIHUI
BURIAU O~ COUHTY COl.l.ICnOHS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
'*
~
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE,
Application II h.r.by mad. for canllnt to th. tranlf.r of th. fallowing. IIcurltl.. of a P.nnlylyanla
Corporation or a National Banking A..o~latlonlaaat.d In P.nnsylvanlal ,
(a) 450 Shs. (b). nuquosno I,j f!ht Co. (0) Common
(NOTE, In d..crlblnp IOcurltlll .nl.r In (0)/ ab 01', .lth.r th' numb.r of Ihar.. of Itaak or tho. fac. amQunt of
rogl.tlt.d bCll1dl, In (bl, th. nam..af th. IlIulng company and In (c) the clall Qf .tack or th. .tat.d Int.rllt rat.
and maturity dot. of regllt.r.d bandl.) ..'
DATE4/22/R2
--
ISSUED ON~~I?()/71' , and having a TOTAL MARKET VA.LUE.OF $ S,6A:S.50
(P"'")
a. of the dot. of d.ath of the d.aedent, Annn l'onr,1 Kllno , on. 2/27/81
(Haln al P...d'ntl (01" al death)
who WOG lat. of 401 ",'nlton COltrt, 1,0mOI'I10, Cl\mhorlnl1d Count\'. fl~nn9Ylvnnill 17M:S
(S"." ~nd Humb.,) (Pllt Olfl..) (County) (S'a1I)
,
Th. IIcurltl.. are regllt.r.d 01 fallowll
~. Ponrl KlIno
(Haml or nl,"1I In wh!ah ..,tllloa'lI ara IOgl,'"rad)
A1mtM~A~
EXECUTORX . r
Nnnel' K. Amit",
(Ha,"l)
401 with on COllrt, '''31'\01'00 I Po. 17043
(...ddr..s)
lill Illnm 'I. ,Solml1, ,'ttorriov~nt~I,,,,~
r.n, l',nx'170R.lInrl'lnhut'n, rn, 17105
NAME OF APPLICANT
,
COUNTY FILE NUMBER ,,21~81~172 ADDRESS OF APPLICANT
BUREAU FILE NUMBER SIGNATURE OF APPLICANTA.I.l.\. ~'...... '"').\rl ~--~~
HOTICE, IP YOU PAIL TO PROPERLY PILL IH ANY PORTION OP T~ISAPPLICATION, IT WILL T Be .'
CQHSIPIlREPCOMP.LE1'E AND WILL BE RETURNI!lD TO YOU POR COMPLETION, '
COMMONWEALTH OF PENNSYLVANIA. - DePARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES 'DATE ~'/. ~~ /fl':<
I h.r.by conllnt to th. tran,sf.r of .th. above lIaurltl.. now reglllllted In .th. nome of th.;rc;r..ald
D.c.dent and wolve th.flllng of a cerllflcat, qertlfylng to th. paym.nt of the tranaler Inherltanc. tax. tc whl,ch
th, prop.rty of laid De~.d.nt II mad. subl.ct putluanttQ th. provislonl !If ,h~ Act of June 20, 1919/ P.l. 521,
01 am.nd.d and th.'Act of Jun. 15; 1961iP.l, 373, alamend.d. 'fhll II alia In aacordanc.' with th. provlllonl
of the Act of April. 9, 1929, P.l. 343.
Thla Conlentto Tranlflt the h.r'ln descrlb.d property ap.rot.. only In ref.renc. to th. ..tall' of.lh.
cbov..nomed D.c.d.ni.
*'
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HCC_" ta.....
COMMONWBAL TH 01' l'eNNSYLVANIA
DePARTMeNT 01' RlVeNUI
BURIAU 01' COUNTY COLLer;:TIONS
. APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
.Affl.J.W1Qtl
'*
DATE
~122/R2
TO THE PENNSYLVANIA DEPARTMENT OF ReVENUE. '
Appllcallan I. h.rtby mad. far aen..nt to the tran.f'r of the following ..aurltl., of a P.nnlylvclRla
Corporation or a Nallonal Banking Anoclatlonloca,t.dIn P.nn.ylvonlal
(0) 1:\0 !lhn. (b) ur1l Corp.. . . (a) 2.7fi !'Pd.
(NOTE I In dllcrlblnp IIcurlll.. .nter In (a), ab 01', .lther the numb., of .har.. of stock or the fact amount of
r.gllt.red bond., In (b), the nom. of tho IlIulng company and In (c) the alan of.tock or the .tat.d 'nterllt rat.
and maturity dot. of IIgl.t.r.d bQndl.) .' , '
ISSUEDOH 7/1m , and haying a TOTAl. MARKET VAI.UEOP S, 2,7(,2,fiO
(Oat.) A I' 1 Kline 2/27/Rl
olaf the dot. of d.ath of the d.c.d.nt, nnn 001' , on
(Ha"" ,I D",d,nt) (Dut. of d..'h)
'0, I, Wnltnn nOIl1't, I,ol~ovne, nllmharlnncl COllntv, l'tlnnsvlvntHo 17n~3
who was lat. of "
(S1"at and Hu",ber) (p..t Offl..) (C.unty) (S'a'a)
Th. ncurlll.. aie rtgllt.red d. followll
A. flonrl I:Hno
(H,,,,, 11114I"'" In """.11 .."IIl.at,. a" "illlarad)
~i>Mtttt5l1IM~
EXECUTORX )
Noncv K. Rmotth, ~Ol Wolton nOIl~tf t.omrWl1 0 , I'll. 17n~3
(Ha"'a) (Add,,")
NAME OP APPLICANT "'i 111 nm 'I. Vnll11ff. Att01'110v-nt-t.ol'l
~1-Rl~172 '
COUNTY PILE NUMBER ADDRESSOPAPPLICANT P.O. Tlox 17nR. lIn1'rhhur~1 fln, l7ln5
BUREAU FILE NUMBER. '. SIGNATUlfe OF APPLICANT~\', u..: h , If 'r~I*''-'' ( /.tC.--
HOTICII IF YOU PAI~ TOPROPBRLY I'ILL IN ANY PORTIOH 01' THIS APPLICATION, ITWIL.\.HO'PBB' (:r
COHSIPIlRIlD cOMpL.nB AHD WILL BB ReTURNBD TO YOU I'OR COMPL.BTlON.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OP REVEI'lUE
. CONSENT TO TRANSFER SECURITIES DATE tl;",,~l~~ /I//<..
I h.reby connnt'ta the tran.fer of the above IIcurltln now regllt.r.d'ln the name of the~lIold ,
Decedent and wolve the filing of a certificate aertlfyhig to the paym.nt 01 the tronaler Inherltanqe lax to which
the property of sold Dec.dent I. mad. .ubl.ct pursuant to the provlllonl of the Act of Jun. 20, 1919, P.L. 521,
, al amended and the Act of Jun. 15, 1961, P.L. 373, a.amend.d. Thl. 1101." In accordo,nc. with th. provlllans
01 the Act of April 9, 1929, P.L. 343.
Thll Conllnt to Tranlf.rtheh.reln dncrlb.d property operatll only In relellnc~ to the ..tat. of the
obove.named Decedent.
'*
e Secretary of Rev.nu
By ~;
~) (1,00 IuI "~' . /,' .
_ ~' ,,~__ " ,tttd~~~L
r,tr ) County)