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Nfl, 21-81
PETITION FOR LETT~RS OF ADMINISTRATION
IN '1'lIle 1'1H'1',\'I'I\ (n' ",,,,,,,,,~,W~,,,r~l..I,,)U,(l,~,~,,,,,,,,,,,,,,,,,,,,,,,,, 1ll\C1MHI<JIl,
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nllmed widow 01' hUK1Jtllld, 'hoh'K IllId l\!Ixl 10 kill, In 11'11:
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I\ollllloll~hlp
1931j. JOdyH(~k\!;adO
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John W. Diet~
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O. Donald Dietz
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Tho Hlild .c1oo0cl0I1\. Willi pOKKoHKncl 01' pOI'KOlllil PI'Olll!l't.I' 10 lho. 11KtltUlllod vllluo of $",*.crl".9,9.9,~,9.9...."..
lI.nd of ttolll I~Kt.llt.O, IOKKllwlIlllhl'1I1100, 10 t.ho UKlInlllllld vlIIlIU of *..t~~~,Q.Q.Q",9.0,,,,,,,,, ilK 1101lt' I\K elln 11"
1I1I001'llllnod.'
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rThel'ofcl'O, ~'O\ll' 1101l11oilol'llll 1'01l1100ll'lIl1y npl1ly(llllll I'll\' .Loltol'K of AdnlhilKII'nllon 111 lho I\bove
I1l1mecl,olllnlo.
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of PullllolllJl' (II)
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Dlltod
Maroh
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Signature 1I1\c1 Addl'lIl1K
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\, ~SPONSIBLE FOR RETURN
SOCtloll 7010! t1io Inhorltanco nnd Estnto Tnx Act of 1961 provides thnt tho following persons sholl prepnre ond file
o roturn; ,
A~ The porsonol rOlllesontutlvoof tho ostote 01 tho docedont as to proporty oflho decedont odmlnlstered hy him
ond .suoh oddltlooolproporly which Is or moy be sublecl to Inhorlll1noo TAX of which. ho/sho sholl hAve or
noqul ro knowl edgs;
b. The tronsforoe 6f prororty upon the tronsfor of which Inherltonce Tnx Is or mny be Imposod by the 1961 Stotuto,
IncludlnR n trustoo 0 proporty tronsforrod In trust, provldod thntno seporolo roturn nood ho modo by tho tronsfsree
of property Includod In tho roturn of nporsonol rOlirosontollvo.
2, PLACE FOR FILING
Tho roturnls to bo fllod In dupllcole with tho Roglstor of ,Wills of tho county.wherelnlllo decedont resided.
3, TIME FOR FILING
Tho roturll Is due.lllno months oltor the decedont's deoth, unless on oxtonslOn for flllrlg hos boon applied for ond
granted by tho SecretAry of Rovonue wlthlnlho nine-month period,
4, fAILURE TO FILE RETURN.
Seclien791 of the 1961 Stntute provldos thot", , .any porson who willfully foils to fllo n return or other. report
roqulred of hlnll , .sholl be personollY liable, . .10 a peliolty of 25% of tho lox ultlmaloly foun\ltobs dus or $1,000
wnlchover Is tho lossor 10 ho rocovorod by tho D~pmtmont of Rovenue as dobts of Ilko I1Inount ore recoverable by
law." '
5. TAX RATES
Inhorltance Tnk Ispnyoble at the rote of 6% o.ntronsfors tollneol doscolidants, such AS fother, mother, husband, wlfo,
son, daURhter, grandchlldren;-Rrandpnront, son-In-law ond douRhtsr-ln-lnw find at the rate of 15% as to all others;
6.. PAYMENT OFTAX
Tho tox asssssedontho transfor of proporty reportod In thoretum.ls duo 9 months after ,thO decedent's dsath, Int.orest
at tho rnto ofG%per.annum accruos thereaftsr until payment Is modo, Allpnyments received are first applied to ony
Intorest Which Inoy boduo with any remolnder Applied to the tax, IF TAX IS PAID WITHIN 3 MONTHS AFTER THE
DECEDENT'S DEATH, A DISCOUNT OF 5% OF THETAX PAYMENT IS ALLOWED,
All,' ch,ocks'shollld bs mado poyoble to tho Roglster of Wills of the,collnty whorslnths decodent.roslded!ond are
received sublect to tho flnol determination of tho Dopnrtmont of Revenuo, .' ,
7, FAILURETO PAY
. ,
Tho taxos Imrosed, 10Rother with ony Interost thereon, nroa "lon.IIPon reol proporty, whlcnllen remolns In effect until
tho taxos amlntero.st havo beenpold In full, Tho tnxos mny bo ,sued for Rgalnstnny rool property In the dacodent's
ostnlo or oRalnsLnny proporty holonRlng to a transferee Ilablo for tho tax,
,
8, FILlNGOF FALSE RETURN,
Any person who WillfullY makes a fnlso return or report requlrod of him shall, In accordnnce with Ssctlon 793 of the
1961 Stnllrto, he guilty of 0 mlsdomoanor ond, on conviction thereof, .shall be sentenced to pny 0 fine not oxcssdlnR
$1,000 or undergo Imprisonment not oxcoedlng one,year or both"
tlil.ll: Comppnsotlon paid to an ostate ropreson\alivo; nmnoly, an oxocntor or ndmlnlslrator, for servlcos porlormed
In odmlnlstorlllB nn ostnto Is roportablo for Ponnsylvnnlo Income Tax pllrpOSOS. This taxablo Incomo itom should be
roporto(lon 101mI' A.40-lndlvidual Income Tax Roturn.
IIF'I.4n3 (1.001
(lo"''''()NWftA~TII or l'BNNBYI.vANIA
(lnl'Af1TMHNT or I1HVUNUft
TI1ANOrUn INllnlllTANOt TAX
nftOlPRNT llftOnOnNT
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RCH~DULE "0"
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OllStrllC!,lo/lS Oil I/lII'nl'~o SIr/ol
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BeNEFIOIARleR AND AoDIIl!R8UR RU(.ATION911Il' DATI! OF INTIll11l8T OP BIlNIlPICIAI1V
, OllceDaNT BIRTH
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0 Ponuld n10 brl 8,on You Ollo-,f,'OUf' o,c
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M~ohRnl.oobur~1 PB, 170$5
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The obovB benofl,nlorlos ore living at this time except for the followlngl
NAMI!
" bATE OFOEA'tH i
lliiTRUCT10NS PORCOMPL.ET1NG SCHEDUL.E "E"
Sohedule "E" mll~f1noludo all proporty, roo I and porsonul, owned by thodoood 11t lolntly with "nothQr
party or partlel oll,olnt tOl1on\9 with rlullt of 8\lrvlvorlhlp, Botl1'tonolblo and Intonul 10 proporty oro tO,bo
Inoluded, LI8t roolol\oto flr8t, ' ,". ,
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,,, Delorlbo 1111 reall1roporty 08 Indlooted In thalnltruotlqns for sohedlilu"A," D,asorlbo all par80nol prop or tV
o81mlloatad In tho Instruotlons for Sohud\i1o "B," 'Inoludo tho nome, oddr088and,relotlonehlp to the
deoedent of tho,po.ownor{s) and tha dote tho lolnt ownarshlp was ostol)l\shed, ' '
,,2,' Indlca\o ,tho total morl<ot volueof the jointly ownod proportYI
'3, Indloata the peroontaoo of tho dooodont's Intor08t,
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4, Indlcato the market valuo of the deoedon\'elntereel.
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II~V.~DD \IX' (a'OOI
oOMMClN\'ISA~TH or rSNNSnl/ANIA
OBPAIITMSNT Qf RBVBNUB
TIIANBfSII INHUnlTANOS TAl<
IIUIOSNT CReSCBNT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DElDUCTIClNS
-~_.-.
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Estate,of_ Alelo ~1..!--j)1.ol;7, ,Dote of Doolh..-G/?nLill
WHEN CLAIMING THE FAMILV EXEMPTION, COMPLETE THe FOLLOWING:
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File No, 21...[\1"'173
RI,IIIIIOllnlllp 10 P''';\I<I\lII\
CllIilnolll
Clolmonl'n Ad<lrU88 lit liI"n pI Dnc,\lclollt's POOUl
NO,
CATP,
NAMS Of PAVSP
Re~lBtar of W~11n
),1 tn'lI ["uno 'f1J. lion A
'. S. ,Wl1,'U,B ft. iJonu
ASMARK8
AMOUNT
["fd;\;Ol"H ,'I'nfll'.fJ.TlIonbtu'y
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li1Ul1f111n'
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If~ CI. I. UrLO
PElnnn. l'oH,ll'r.. 1,Jgh\; On. Eluobl'\O
,1l'lohunt.ofJhlH" Hobol' 00",')011' ~'[\t,fJl'
n,bbr lllu'dwn, fJ
'.101010 l~nm()1'1011!on )'It,,~l
Pho Wva n 1.'11' :-:Ion t'Lnol
~1!lob07' oon\;l"ol j'01" l1.,ht;tj
tinction], Bill duo
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l<1f1!;/t!;o Not:\.oo
l/n' 1. 1111 ,Dill Iw
.. Sj 10111110 & Sono
~Dr'ou!h Dr 1'loohunlcwlil1J;"
'Annu. }lOW"'I' r" tJlf'.hl; 00.
10y W. AndurRon, TraSH.
tUN W. Andl~8on, TrUMB.
H1H1iH t,o Notl (
A "10\171 Ii dul'J
Jlontln 1 f'l1fl1
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~RAL. IN~ERITANCE TAX INFORMATION
Unl~tllfled'liablll,tlOIlngurrod by tha dagodont prior to hll/hor doath aro dodugtlblo agali'lt,hll/hor ta~ablo
..toto, In addltlontodebtl Incurrod by tho docodont or oltato, othor It0l111 aroclalmable Ineludlng tho COlt of
admlnlltratl9n, <<tlorneyfeui fiduciary feol" funeral and burial &Kronsos Including the cq.t af a burial lot, tombltone
or gravo markflr and other relat,ed burial eKpensos,
Alldobtl bolng clalmod against on oltale are lubloct to tho appro~ol of tho Regllter of Willi with whom tho
Inherltanoe TaK Re,Iurn Is flied, Evldengq.fo lupport tho degedent'. or the estato'lliablllty for the debts being
glalmed should be attaghed to thllaghedule, '
A family exemption may bo glalnied by asp9UlO of adeoedent who <lIod domlolled In Pennsylvania. If there II
no spOUle, or l/'the apouse hal forfeited hla/her rlghtl, then any ghlld of the decedent who la a ,member of the lame
household gan olalm the e~el11ptlon.lnthe event thore,ll nO such apouu or child, the e~lIl11ptlon oan be claimed by
a parent or parents who are memberl of the 10m, houaohold as the docodent, Tho family exemption II allowable 9n1y
against on~tl whlgh pan by a will orby thePennsylyanlalntoatate L.aws. '
,
NOTEI Compensation paid to an estate represontatlvel nO'1'oly, an eKe,cutor or admlnllfrator, for urvlcOl
performed I," admlnlstorlng on estate Is reportable (or Pehnsylvanla InC9me TaK pur,pons, This taxable Income
Item should boreported on form PA.40.lndlvlduallncome TaK Return,
.
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INSTRIIOTIONS FOR ,r.OMPI FTINn ~rHFOIII ,:: "'::."
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QE~ERAL INHERITANCE TAX INFORMATION
Unsatl.fI,d lIabllltlos Incurrod by tho docodont prior 10 hls/hor doolh ora doducllblo qgalnst hla/hor taKablo
ostoto. In addition 10 dobts'lncllrrod by tho dooodont o,r ostolo, othor Iiams ora clalmablolnoludlng tho cost 01
administration, altornoy foos, fiduciary foos, funorol and burial OKponsos Including tho cost of a burial lot, tombstono
or gravo ma,rkor and othor rolatod burial oKpensos.
All dobts baing 'clalmod against an ostato aro sublect to tho approval 01 tho Roglster 01 Wills with whom tho
Inhorltance TaK Roturn I. fllod. EYldoncoto support tho docodont's or the ostale's liability lor the dobts bOlng
claimed should be,oltachod to thla schodulo.
,.
A family eumptlon may bo clalmodby a spouso 0/ a docollen,t who dlod doml,cllod In Ponnsylvanla. If thore Is
no spouse, or If the spouse has forfoltod hls/horrlghts, then any child of,tho docodont who Is a membor of tho samo
housohold con claim tho oxomptlol1. In tho ovont thoro Is no such, spouao or child, tho oXlll11ptlon can bo clallned. by
Q paront or paronts who are mornbors of the same household as the decodont. Tho family exemption Is allowablo only
against assots which pass by a will or by tho Ponnayl vania Intostato Laws. ' ,
,
NOTE I Componsatlon paid to an o,stato ropresontatlvol namely, an OKecutor or administrator, for services
performed In adrt1lnlstorlng an ostato Is roporlable lor fonnsylvanla Income TaKpuq\osoa. This IQxablelncomo
Itom should bo repQrtod on form PA.40.lndlvlduallncomo TaK RotlJrn.
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INSTRUCTIONS FOR COMPLETIN G SC~EDULE ",F"
I. If thefamllyellomptlon Is being olal~ed, Indicate tl;o clalmant1s nome, address and his/her rolatla,~shlp to
tho decedent. Enter "family exemption" In the remarks oolumn a"d t\1o amount clolmod In the amount column.
2. Assign consocuHve numbers 10 each Ilem 1,lsted. .
3. Enter the dato on which oach dobt Vias Incurrod and/or paid.
4. Ent.r the names 01 each payeel
5. Provldo a brle( explanation In the romarks oolumn lor oach dobt olalmod.
6. Enter t\1o art1ount"of eO,ch dobl being claimed.
7. Tho lorm must be signed by the person who has assumod tho responsibility lor paying the debts.
IF ADDITIONAL SPACE IS NECESSARY USE BW' x 11" SHEETS.
.lliillBMlI1\.Q1i.
To Iniure plopor orodll 10 YOIII aooClulll, 'II," 11011'" of 1110 oslolO al1d fllo nUlClllUl shouldbo olollrly print.
ed on IIW oheok or mO,lIov oldor,
Thle 08Boumonl Ie modo In oooClrdllnoo wllh Sonll"" 708 of tho Inhorllunoo and aOllllo To~ Aot of
1001172 P,S, g 2405,708),
To tho, o~lol1t tl1111 Inlwrllonoo In~ Is' pnld wllllln IhlllO (3) monlhs 111101 Ihs closlh of 1110 dooodont, s
dlsoou"t of f1vo (6lporOonlle ollowod rn P,S, G 240&.7161,
Inhorllanoo T~K, qlllOI tllon tll" on 0 Illtll'o Inioroet, Is duo ClI tllo dols,ollhll doolldlllll's.cIIlOlh IInd booomos "
dollnquonl 01 Iho o~pllOllol1 of nino (01 manilla altor 1110 doootionl'.' lIoalll 172 P,S, ti 2486.711), Inhorllor,oo
TOl( on 0 futuro intorosl Is pavablo wllhln Ih,oo 131 0I01l1l1S altllr 1110 HonolD, lakoa 011001 In 1)088088lon ond
a"loymont end Is dqllncj(lOl1t Ihoroohtir ,112 p,u, ti 2408.712), ClIloulalll 1010'08\ from 1110 dollnquonl dftlo'shown
on tho Isoo of IlIls form 10 Iho dolO 01 IIClluol poymonlllslnu tho lollowlhu 1I1luroslloblo:
......_____""....-- ...__ _......... _... ,.,.__....._....._......_... __................_ ____ _._ _ H" _ _T"" ..__ ......, to' - ~......- -- --... - - --...-
1 month ,005 4 mOl1th. ,020 7,nonths ,036 10 monlha ,060
2 months ,010 & montl" ,026 6 lClunths ,040 11 mOl1tlls ,065
3 months ,016, 6 mOl1ths ,030 o ,Tionll" ,046 12 monllls ,000
1 ~o'ys :000 17 11 cloys ,00106 21,days ,00352
2 doya ,00034 12 days ,00203 22 dOl'I ,()(j~6e
3 doye ,00051' 13 dovs ,00220 23 days ,00386
4 cloya ,0006S 14 doyo ,00237 24 doys ,0040~
6 cloy' ,00065 j 6 'doVo ,00250 L 25 doys ;00420
6 cloys ,00101 16 dovs ,00207 26 dsys ,00437
7 cloys ,00118 17 days ,00264 27 dsya ,00454
a day. ,00135 10 doys ,00301 28 dsys ,00471
a dayll ,00162 10 dsys ,00318 20 dOYII ,004S0
10 days ,00109 '20 dllYs ,00336 30 days ,00600
w_ __.... ------ --- ...----...- -,_........ --- ~.- - -- .....-.. --.... -- - .;...-~-_.__...- - -... - --...o...........-.. -..........
Any porW ,In 'Intorosl, lnolucllno 1110 commonwoolth and 1110 pOlaonol roprosOnlallye, nol sollsflod With
the ouossmortt may objoot thorolO wllhln sl~IY (00) doyo IIftur rooulpt of IlIls Nolloo as proVldod by sootlon
1001 01 tho Inholllonoo und ESlalo To" AOI of 1061(72 1',5, n 2486,10011,
Meko Oheck,or money errlor payable tOI
"Reglstor of WlllsI Agent"
Mall'to tho address IIstod bolow: