HomeMy WebLinkAbout81-00205
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T, Iwsn: Il, SI\I'1I0HI:, IIr till' IluI""I~h III' ~h'('hllld"sIJln'g, County
of' CUIIlhet'luIld olld CIIIIlmunwl'al.L11 ul' I'",n,sylvallia, be:ing uf SUUlld
Ulld d ispus:1 IIg mind, melllUl'y and nlldel'stullcl:i.lIg, do make, pub l.:ish
alld deeLal'e this as and 1'01' my Last Iv:ill alld 'I'estamelrt, hel'eby
revokillg alld makillg void alL fU1'lner wills and eodieHs by me
at any .t'ime 11(.n'etof'ul'P Illilde.
FIRST, T order' and direct that al L my jus't debts and
funeral expenses be paid by my ExecutOl' 01' Executr':ix, as the case
may be, hereinafter lJamf!d, as soon as eonveniently may be done
after lilY decease.
SECOND, I't is my wish ami desirc that my Executor 01'
Executrix, as the case lIlay be, hereinaf,ter named, shall not sell
and dispose of my pl'opcrty by public auc.tion; but should a
liquidation of my asscts be required, I request that i't be
accomplished by private sale 01' sales.
THIRD, 1\11 the rest, l'esidue and remainder of my Estate,
real, personal and mixed, whatsoever and wheresoevel' situated, I
give, devise and bequeath in equal shal'es unto my two children,
nameJ,y, WILLIAM L. BURTNER and PI\TSY J. SNYDER, share and share
alike, absolutely and in fee simple.
If either of my said chndl~en should predecease me and
leave J:awful issue to sUl'vi.ve me, I ol'der and direet that the issue
of such deceased ehHd 01' children shall be substituted herein for
said decederrt or dccederrts, said issue to take theil' respective
deceased ancestol" s share hereundel' pel' stirpes and not pel' capita,
LI\STLY,
I nominate, constitute and appoint my son, WIr,LIl\M
MART50N a SNELOAlCER
ATTORNEYS AT lJr,W
[" BURTNER, to be the Executor of this, my Last IVill and Testament,
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OATH m' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ss:
COUNTY OF CUMBERLAND
Before me, the Register for the Probate of Wills and granting of Letters of Administration in and for lhe County of
Cumberland, personally came
\;1lliam L. Burtner
who, being duly
sworn
I do es
depose and say that as the Executor
of the last Will and Testament of
ROSIE B. SAl'II0RE
deceased
He will well and truly administer the goods and challels, rights and credits of said deceased according to law. And
also will diligently comply with the provisions of the law relating to Transfer Inheritances. Sworn and subscribed before me.
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March 26
A.D., 19JL
Register
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Be it remembered that on the
26th
DECREE
March
81
,A.D.,19_, there was probated and
day of
ROSIE B. SAl'HORE
recorded the last Will and Testament of
late of
The Borough of Mechanicsburg
, Cumberland County, Pennsylvania,
William L. Burtner
Deceased. Letters Testamentary were granted to
Witness my hand and official seal the day and year aforesaid. .
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Register
GENERAL INHERITANCE TAX INFORMATION
Unsatislied liabilities incurred by the decedent prior to his/her deoth ore deductible ogainst his/her toxable
estate, In addition to debts incurred by the decedent or estate, other items are claimable including the cost 01
administrotion, attorney lees, liduciary lees, lunerol ond burial expenses including the cost 01 0 burial lot, tombstone
or grave marker and other related burial expenses.
All debts being claimed against on estate ore subject to the approval 01 the Register 01 Wills with whom the
Inheritance Tax Return is liled. Evidence!o support the decedent's or the estate's liability for the debts being
claimed should be attached to this schedule.
A lamily exemption may be claimed by a spouse 01 0 decedent who died domiciled in Pennsylvonia. If there is
no spouse, or il the spouse hos lorfeited his/her rights, then any child olthe decedent who is a member 01 tho same
household can claim the exemption. In the event there is no such spouse or child, the eXlll1lption can be claimed by
o parent or parents who ore members 01 the some household as the decedent. The lamily exemption is allowable only I
against assets which pass by 0 will or by the Pennsylvania Intestate Lows.
NOTE: Compensation paid to on estate representative; nomely, on executor or administrator, for services
perlarmed in administering on estate is reportoble lor Pennsylvania Income Tax purposes. This taxable income
item should be reported on lorm PA.40.lndividuallncame Tax Return.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the lamily exemption is being claimed, indicate the claimant's name, address and his/her relationship to
the decedent. Enter "Iamily exemption" in the remarks column and the amount claimed in the amount column.
2. Assign consecutive numbers to each item listed.
3. Enter the date on which each debt was incurred and/or paid.
4. Enter the names of each payee.
5. Provide 0 brie{ explanation in the remarks column far each debt claimed.
6. Enter the amount 01 each debt being claimed.
7. The lorm must be signed by the person who has assumed the responsibility lor paying the debts.
IF ADDITIONAL SPACE IS NECESSARY USE BW' x 11" SHEETS.
PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of 1961 provides that the following persons shall prepare and file
a return:
a. The personal representative of the estate of the decedent as 10 property of the decedent adminjstered by him
and such additional property which is or may be subject to Inheritance Tax of which he/She shall have or
acquire knowledge;
b. The transferee of property upon the transfer of which Inheritance Tax is or may be imposed by the 1961 Statute,
including a trustee of property transferred in trust, provided that no separate return need be made by the transferee
of property included in the return of a personal representative.
2. PLACE FOR FILING
The return is to be filed in duplicate with the Register of Wills of the county wherein the decedent resided.
3. TIME FOR FILING
The return is due nine months after the decedent's death, unless an extension for filing has been applied for and
granted by the Secretary of Revenue within the nine'month period.
4. FAILURE TO FILE RETURN
Section 791 of the 1961 Statute provides that". ..any person who willfully fails to file a return or other report
required of him. . .shall be personally Ijable. . .to a penalty of 25% of the tax ultimately found to be due or $1,000
whichever is the lesser to be recovered by the Department of Revenue as debts of Ijke amount are recoverable by
law."
5. TAX RATES
Inheritance Tax is payable at the rate of 6% on transfers to lineal descendants, such as father, mother, husband, wife,
son, daughter, grandchildren, grandparent, son-in.law and daughter-in-law and at the rate of 15% as to all others.
6. PAYMENT OF TAX
Thetax assessed on the transfer of property reported in the return is due 9 months after the decedent's death. Interest
at the rate of 6% per annum accrues thereafter until payment is made. All payments received are fi rst applied to any
interest which may be due with any remainder applied to the tax. IF TAX IS PAID WITHIN 3 MONTHS AFTER THE
DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED.
All checks should be made payable to the Register of Wills of the county wherein the decedent resjded and are
recejved subject to the final determjnation of the Oepartment of Revenue.
7. FAILURE TO P~Y
The taxes imposed, together with any interest thereon, are a lien upon real property, which lien remains in effect untjl
the taxes and interest have been paid jn full. The taxes may be sued for against any real property jn the decedent's
estate or against any property belonging to a transferee liable for the tax.
8. FILING OF FALSE RETURN
Any person who willfully makes a false return or report required of him shall, in accordance with Section 793 of the
1961 Statute, be guilty of a misdemeanor and, on conviction thereof, shall be sentenced to pay a fine not exceeding
$1,000 or undergo jmpri sonment not exceeding one year or both.
NOTE: Compensation paid to an estate representative; namely, an executor or administrator, for services performed
in administering an estate is reportable for Pennsylvania Income Tax purposes. This taxable income item should be
reported on form P A-4o-lndividuallncome Tax Return.
REV-4!iO I::X+ (Io-eo)
COMMONWEAL TH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
(Instructions on Rovorso SieJo)
ESTATE OF
HOR ill B. SUpIIOll('
ITEM DESCRIPTION EsTIMA TED DEPARTMENT
NO, MARKET VALUATION
VALUE (OFFICIAL USE ONL Y!
l. ^l.l. thOHI' l:I~1I (2 ) 1'(lI'I'uil1 IId,111 ill ill~ lilts of' lanel
S I tllll tl' (1/) till' NIlI'i'h Hldl' lIr WI'St f:I'('(!n Str'eet in the
BOl'oll~h lIf' f\l'l'IHIIIII'nIJlII'f-\, I:IIIIIIH'I'I and CllIll1ty, P,'nn sy I -
van III. hllVIIlf-\ l'11(11'lopd '-IIPI'I'tlll II h~lI-s tOl'Y rl~ame
dWI' III II~ 1<1 JI IWII 111111 I.\I\lllIJl't'pd liS US \~est Green Stl'ee t ~
mOt'f! 1'111'1' il'1111I1' I Y dI'HI'I'llJpd III lh'('d Book "AtT,
VOIIlIIll' I J. )lug.. '11)1) , II lid IIp!'d BlIllk !lX"~ Vol.ume 28.
I'II~l! 'i.
Sale price $20,OOfl,f10
--...
TOTAL $20.0flO.f11l .,,2(1.. H-(, 01_
I" " yr'.'
If additional space is necessary, use 8Ylx 11 sheets.
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any ttansfer of any material part of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No" ,) No_
2. Did decedent, within t\\\J years of death, transfer property from himself/ herself to himself/herself and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No",) ~
3, If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following
information:
a. Age of decedent at time of transfer,
b. Copy 0 f death certi fi cate,
c. Affidavit by the attending physician indicating the state of decedent's health at time of transfer.
d. All other information supporting nontaxability of transfer.
4. Did decedeBt, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consideration
therefor which was to take effect in possession or enjoyment at or after his/her death? (Answer "Yes" or "No".) No
a. Was there any possibility that Ihe property transferred might return to transferor at his/her estate or be subject
to hiS/her power of disposition? (Answer "Yes" or "No".)
b. What was the transferee's age at time of decedent's death?
5. Did decedent in his/her I ifetime make any transfer without receiving a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end before his/her
death:
a. The possession or enjoyment of or the right to income from the property transferred? (Answer "Yes" or "No".) ~.
b. The right to designate the persons who shall possess or enjoy the property transferred or income tllerefrom?
(Answer "Yes" or "No".) No
6. If the answer to five b. above is "Yes," was the right reserved in decedent alone ( ) or decedent and others ( ).
7. Did decedent in his/her lifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No".) No
8. Did decedent, at any tjme, transfer property, the bmeficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".) No
9. If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone ( ) or decedent and others ( ).
REV-453 EX+ (10.801
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIAR IES
(Instructions on Reverse Side)
Estate of Rosie Il. Snpl1ol'e
BENEFICIARIES AND ADDRESSES
SURVIVED
DECEDENT
DATE OF
BIRTH
RELA TIONSHIP
r~ .,
Hall
os
530 lIogestOlm Hoad
Meehoiliesburg I~ 17055
Patsy J. Snyder'
153 Enst IIHler'est Dr:ive
CnrUsle, P^ 17013
daughter'
yes
The above beneficiaries were living at the time of the decedent's death except for the following:
NAME
INTEREST OF BENEFICIARY
one-half
res id ue
one-half ('2) of the
residue
DATE OF DEATH
If additional space is necessary, use 8%" x 11" sheets.
INSTRUCTIONS FOR SCHEDULE "D"
1. List full names and addresses of all who have an interest in the estate
either vested, contingent or other interest.
2. Indicate the beneficiary's relationship to the decedent. Specify if
stepchildren or illegitimate children are involved.
3. Indicate "Yes" if the beneficiary survived the decedent or "No"
if the beneficiary did not survive the decedent.
4. Indicate the date of birth of the beneficiar\' if the interest is a life
interest, term certain interest or a future interest.
5. Indicate the interest of the beneficiary in the decedent's estate.
For example: Specific bequests of a diamond ring. savings bonds
or cash of $5,000; bequest of 25% of residue; remainder interest, etc. '
6. At the bottom of Schedule "D", state those beneficiaries who were
not living at the time of the decedent's death and include the date
of death of the beneficiary.
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included. List real estate first.
1,. Describe all real property as indicated in the instructions for Schedule "A." Describe all personal property
as indicated in the instructions for Schedule "B," Include the name. address and relationship to the
decedent of the co-owner[s] and the date the joint ownership was established,
2, Indicate the total market value of the jointly owned property.
3, Indicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest.
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REV-4S4 Ext (8-S0)
COMMONWEAL TH OF PENNIYL VANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT. DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
(lnstrLIct;oIlS Dn Roverse Side)
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EnMeot Rosie H. Suphore
ITEM TOTAL PE VALUE OF DEP ARTMENT
R
DESCRIPTION MARK ET cE DECEDENT'S VALUATION
1'10. VALUE NT INTEREST {OFFICIAL USE ONL Y/ .
5. (42) $100 United States
Sayings Bonds, Serjes f1E"~
registered to Ros:1 e H, Saphore
(decedent herein) or Patsy ,J.
Snyder (daughter) :
Serial Nwnber Issue Oa te
C 1 015 li89 172E ~Iarch 1973
C 1 015 li89 155E March 1973
C 1 015 li.89 UOE Feb. 1973
C 1 018 1163 050E ~1ay 1973
C 1 018 1163 037E April 1973
C 1 018 li63 021E April 1973
C 1 018 li63 103E June 1973
C 1 018 li63 186E July 1973
C 1 023 455 930E Aug, 1973
C 1 023 liS5 9311:: Aug. 1973
C 1197 119 8371:: June 1969
C 512 825 n51:: Oct, 1970
C 512 825 7911:: Noy, 1970
C li85 967 Ii71E ~1ay 1968
C li.90 900 I1S3E Aug, 1968
C 490 900 5891:: llano 1969
C 1197 119 7221:: Feb. 1969
C 1 009 097 5361:: Oe(~ , 1972
C 1 014 2-46 888E Jan. 1973
C 1 015 1189 1091:: Feb. 1973
C 525 lil3 591E Aug. 1971
C 525 li.l3 507E June 1971
C 522 927 281E ~lay 1971
C 522 927 209E April 1971
C 522 927 229E April 1971
C 512 825 868E ~larch 1971
C 512 825 837E Feb. 1971
C 512 825 818E Jan. 1971
C 1197 119 804E May 1969
C 512 825 826E .Jan. 1971
C 525 li.J3 61i3E Oct. 1971
C 525 li.J3 6881:: Oct. 1971
C 530 706 7081:: Nay, 1971
C 530 706 7321:: Oec, 1971
C 530 706 752E ,Jan. 1972
C 1 008 868 655E Oct. 1972
C 1 009 097 Sl3E Nay, 1972
C 525 lil3 6381:: Oct. 1971
C 525 q.n 606E Sept. 1971
TOTAL eOlltjl1lled
If additional space is necessary, use BW' X 11" sheets.
CONTIN UED ON PA GE
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship, Both tangible and intangible property are to be
included. List real estate first.
1. Describe all real property as indicated in the instructions for Schedule "A." Describe all personal property
as indicated in the instructions for Schedule "B," Include the name, address and relationship to the
decedent of the co-owner [s] and tile date the joint ownership was estabiished,
2. Indicate the total market value of the jointly owned property,
3, Indicate the percentage of the decedent's interest.
4. I ndicate the market value of the decedent's interest.
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"'" Schedule "E" must include all property, rcal and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. 80th tangible and intangible property are to be
included, List real estate First.
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
1.. Describe all real property as indicated in the instructions for Schedule "A," Describe all personal property
as indicated in the instructions for Schedule "8." Include the name, address and relationship to the
decedent of the co.owrier[s] and the date thc joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3. Indicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must inciude all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included. List real estate first.
1. Describe all reai property as indicated in the instructions for Schedule "A." Describe all personai property
as indicated in the instructions for Schedule "B." Include the name, address and relationship to the
decedent of the co-owner[s] and the date the joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3. Indicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest,
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REV.4,4 EX+ Ie-sO)
COMMONWEAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
(Instructions cn Reverse Side)
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Estate of Ros :i.e Il. SaphOl'e
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ITEM TOTAL VALUE OF DEPARTMENT
DESCRIPTION MARK ET RC DECEDENT'S VALUATION
NO. VALUE EN INTEREST {OFFICIAL USE ONL Yl '
T
C 1 009 D97 557E Dec. 1972
C 1 01lI 2"6 889E Jan, 1973
C 1 015 lI89 108E Fell. 1973
C 1 008 868 556E Oct, 1972
C 1 009 097 512E Nov, 1972 ,
C 1 009 097 535C Dee, 1972 i
C 530 706 709E Nov, 1971
C 530 706 733E Dee, 1971
C 530 706 753E Jan. 1972 ,
C 525 LIB 637C Oct. 1971
C 525 413 5lI4E oct. J1971
C 525 413 589E Oct. 1971
C 525 LIB 573E July 1971
C 525 413 592E Aug, 1971
C 525 413 507E Sept. 1971
C 522 927 282E May 1971
C 525 LIB 50BE June 1971 ,
C 525 LIB 550E July 1971
C 512 825 857E ~lareh 1971
C 522 927 22BE April 1971 i
C 522 927 210E April 1971 i
C 512 825 817E Jan. 1971 ,
.
C 512 825 82BE Jan. 1971 I
!
C 512 825 838E Feb. 1971 I
C 497 119 838E June 1969
C 512 825 776E Oct. 1970 I
I
C 512 825 792E Nov. 1970 I
C 490 900 591E Jan. 1969 i
,
C 497 119 723E Feb. 1959 I
C 497 119 S05E May 1959 I
C lI90 900 4S2E Aug. 1%8 ,
!
C 485 957 470E May 1968 i
I
Date of Death Value I
116.'24 I
115.96 I
115.96 I
116.2lI !
119.44 i
119.lilI
119.lI.lI
119.l!4 i
119.4lI
119.l!lI
119.16
119,16
-
Continued "
TOTAL
If additional space is necessary, use BYz" x 11" sheets.
CONTINUED ON PAGE
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included. List real estate first.
1. Describe all real property as indicated in tile instructions for Schedule "A." Describe all personal property
as indicated in the instructions for Schedule "B." Include the name, address and relationship to the
decedent of the co-owner[s] and the date the joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3. Indicate the percentage of the decedent's interest,
4. Indicate the market value of the decedent's interest.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship, Both tangible and intangible property are to be
included. List real estate first.
1., Describe all real property as indicated in the instructions for Schedule "A." Describe all personal property
as indicated in the instructions for Scheduie "B," Include the name, address and relationship to the
decedent of the co-owner[s] and the date the joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3, Indicate the percentage of the decedent's interest.
4. I ndicate the market value of the decedent's interest,
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INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
inciuded, List real estate first.
1. Describe all real property as indicated in the instructions for Schedule" A." Describe all personal property
as indicated in the instructions for Schedule "B." Include the name, address and relationship to the
decedent of the co-owner[s] and the date the joint ownership was established.
2, Indicate the total market value of the jointly owned property,
3. I ndicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest.
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INSTRlICTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship, Both tangible and intangible property are to be
included, List real estate first.
1. Describe all real property as indicated in the instructions for Schedule "A," Describe all personal property
as indicated in the instructions for Schedule "B." Include the name, address and relationship to the
decedent of the co-owner[s] and the date the joint ownership was established.
2, Indicate the total market value of the jointly owned property.
3. Indicate the percentage of the decedent's interest,
4, I ndicate the market value of the decedent's interest,
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INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included. List real estate first.
1. Describe all real property as indicated in the instructions for Schedule" A," Describe ali personal property
as indicated in the instructions for Schedule "B." Include the name, address and relationship to the
decedent of the co-owner[s] and the date the joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3, Indicate the percentage of the decedent's interest.
4, Indicate the market value of the decedent's interest.
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REV."U EX+ 15-801
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
File Number
?1.Rl-020S
[] Ori ginal
o Supplemental
o Remainder
Estate Name
RosifLfi--SaphQm
Dote of Death
March 19, 1981
Social Security Number
?04-01-2621-
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser In and for the County of ~er1~n~
Pennsylvania, do respectfully report that 1 have appraised the real and personal praperty as reporte In t e oregolng
retum at the values set forth opposite each Item In the last column to ~he right in Schedules "Au, liB", "C', and liE"
Dated: Seotember 21). 1981 ~~~'l)~
INHE TANCE TAX APPR R
VALUE AS APPRAISED ADJUSTMENTS REMAINDER APPRAISEMENT CODE
INVENTORY CODE (HARRISBURG USE ONLY)
Real Property (Schedule A) $ 92+
Personal Property {Schedule B} 10+
Joint_Held Property (Schedule E)
Transfers {Schedule C}
TOTAL GROSS ASSETS
Leu Dab.. and Deductions 40- 93-
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Estate RATE FACTOR PRINCIPLE VALUE CODE
o Annuity
FOR USE OF REGISTER ONLY
T ox on $
~
COMPUTATION OF TAX
S
S
S
S
S
6%
Tax on $
15%
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
TOTAL TAX
INTEREST FROM
BALANCE
TO
s
s
s
Less Credits
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT.
5
+ $
s
=
s
+
;
BALANCE
TO
s
~ .,,-,... ,. ",-..,
COMMONWEAl TH Of PENNSVL VAIiIA
DEPARTMErn or REVENUE
BUREAU o~ INDIVIDUAL l:"XES
DErT. 21l0UOl
MARI!.ISeURc. PA 1112~.OGO 1
NOTICE OF INHERITANCE TAX
APPRAISEMENT, A~~OWANCE OR DISA~~OWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
~OINT~Y HE~O OR TRUST ASSETS I DATE 08-20-90
EST ATE OF SAPHORE
ROSIE
B DATE OF DEATH 03-19-81
COUNTY
CUMBERLAND
FilE NO.
21 81-0205
S.S.lD_C, NO.
204-01-2621
ACN
30131174
BURTNER WILLIAM L
138 W GREEN ST
MECHANICSBURG PA 17055
REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
I Amount Remitted
. .C.U.T. ~I:q~~ J!:l~S. ~I~~. _ . ~ . _ _ Jl!=! ~I_~ .l:q~E.~ !'9~!19!( ~qR. Y9~!'l_I!E.CS>!I!>~. _ _ . ~ . . . . . . . .
REV-1548 EX (12-89)
NOTICE OF INHERITANCE TAX APPRAISEMENT, A~~DWANCE DR DISA~~DWANCE OF DEDUCTIONS. AND ASSESSMENT OF TAX
ON ~DINT~ Y HE~O OR TRUST ASSETS
DATE 08-20-90
ESTATE OF SAPHORE
ROSIE
B DATE OF DEATH 03-19-81
CUMBERLAND
COUNTY
FilE NO, 21 81-0205
TAX RETURN WAS:
S.S.lD,C, NO. 204-01-2621
1 X) ACCEPTED AS FilED ) CHANGED
~DINT DR TRUST ASSET INFORMATION
ACN
30131174
FINANCIAL INSTITUTION: DAUPHIN DEPOSIT BANK & TR CO
ACCOUNT NO,
TYPE OF ACCOUNT: ( X I SAVINGS
DATE ESTABLISHED 05-21-79
) CHECKING
) TRUST ( ) TIME CERTIFICATE
NOTE: TO INSURE PROPER CREDIT TO YOUR
Account Balance 13,069.44 ACCOUNT, SUBMIT THE UPPER PORTION
Percent Taxable x 100.000
Amount Subject to Tax 13.069.44 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions .00 PAYMENT TO THE REGISTER OF WI~~S
Taxable Amount 13,069.44
Tax Rate X .06 AT THE ADDRESS SHOWN ABOVE.
Tax Due 784.17 MAKE CHECK OR MONEY ORDER PAYAB~E
TAX CREDITS: TO: "REGISTER OF WI~~S, AGENT. It
PAYMENT RECEIPT DISCOUNT 1+) AMDUNT PAID
DATE NUMBER INTEREST 1-1
TOTA~ TAX CREDIT
BA~ANCE OF TAX DUE
INTEREST
TDTA~ DUE
. IF PAID AFTER THIS DATE SEE REVERSE FOR CAlCUlA TIDN DF ADDITIDNA~ INTEREST
tIF TDTA~ DUE IS ~ESS THAN SI, ND PAYMENT IS REQUIRED, IF TDTA~ DUE IS REF~ECTED AS A
CREDIT (CR) YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS,)
INTEREST IS CHARGED FROM 12-20-81 TO 09-04-90
AT THE RATES APPLICABLE AS DUTLINED ON THE
REVERSE SIDE OF THIS FORM.-
784.17
409.09
1,193.26
... '.! ; ':t
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PURPOSE OF
NOTICE:
To fulfill the requirements of Section 1740 of the Inheritance and ESlue Tax Act. Act 255 of 1982 (72 Pa, C,S,
Sec:;on 1740).
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the
reverse side.
--Make check or money order payable to: REGISTER OF WILLS, AGENT.
All payments received shall first be applied to any interest which may be due. with any remainder applied to the tax.
PA VMENT:
REFUND (CR):
A refund of a tax credit. which was not requested on the Tax Return. may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV- 1313). Applications are available at the Office
of the Register of Wills. any of the 24 Revenue District Offices. or from the Department's 24-hour
Forms Ordering telephone lines in Harrisburg - (7171 787-8094. in Philadelphia _ (2151 560-2065,
or in Pittsburgh - (4121 565-3601.
Any party in interest not satisfied with the appraisement. allowance or disallOwance of deductions. or assessment of
tax (including discount or interesll as shown on this Notice may object within sixty (60l days of receipt of this
Notice by:
--wrillen protest to the PA Department of Revenue. Board of Appeals. Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the mailer determined at the audIt of the account of the personal representative, OR
--appeal to the Orphans' Cou~t.
OBJECTIONS:
ADMIN-
ISTRA TIVE
CORRECTIONS:
Factual errors diScovered on this assessment should be addressed in writing to: PA Department of Revenue. Bureau
of Individual Taxes. ATTN: Posl Assessment Review Unit, Dept. 28060 I, Harrisburg. PA 17128-0601.
(717) 787-6505.
See page 3 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-ISO 1) for an
explanation of administratively correctable errors.
If any tax due is paId with,n three (3) calendar months after the decedent's death. a five percent (5%) discount of
the tax paid is allowed.
Interest is charged beginning with first day of delinquency. or nine 191 months and one (11 day from the date of
death. to the date of payment. Taxes which became delinquent before January 1. 1982 bear interest at the rate of six
16%) percent per annum calCUlated at a daily rate of .000164. All taxes which became delinquent on and after
January I, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 1989 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Oaily Interest Factor
- -
DISCOUNT:
INTEREST:
1982 20% .000548 1986 10% .000274
1983 16% ,000438 1987 9" .000247
"
1984 11% _000301 1988 11% ,000301
1985 13% .000356 1989 11% .000301
1990 11% .000301
--Interest is calculated as follows:
INTEREST . BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent Will reflect an '"terest calculat,on to fifteen (151 days
beyond the dale of the assessment. If payment is made after the interest computation date shown on the Notice.
additional interest must be calculated.
\
INHERI'rANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
REV-1&04 EX AFP (1-90*,
COI1HONWf:ALTIl or PENNSVLVANIA '11&~
OEPARTH[Hl or REVENUE ~
BUREAU or INDIVIDUAL TAX[S
DEPT. 280601
IlARRlSBURG, PA 171lS-0601
DATE 09-27-91
COUNTY CUMBERLAND
ROSIE
B DATE DF DEATH 03-19-81
.F.STATE OF SAPHORE
FILE NO, 21 81-0205
S,S/D,C, NO. 204-01-2621
ACN
30131174
REMIT PAYMENT TO:
BURTNER WIllIAM l
138 W GREEN ST
MECHANICSBURG PA 17055
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
AntQ.!,!nt Remitted
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
----------------------------------------------------------------------------------------------------------------
REV-1&04 EX AFP (1-90)
__ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS --
DATE 09-27-91
ESTATE OF SAPHORE
ROSIE
B DATE OF DEATH 03-19-81
COUNTY CUMBERLAND
" \!l
FILE NO, 21 81-0205 S,S/D.C. NO. 204-01-2621 ,At:;N
~
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION ....
~
JOINT OR TRUST ASSET INFORMATION .", ~
,-
- I
FINANCIAL INSTITUTION: DAUPHIN DEPOSIT BANK & TR CO ACCOUNT NO",', . .".
3013_1174
. ,
",n
. 1 ~-\
....J
.;,)
::-,
''-1
'~'.l
'1
.~
a
,c'=' ,:_,',
TYPE OF ACCOUNT: (X) SAVINGS () CHECKING () TRUST () TIME CERTIFICATEGi
DATE ESTABLISHED 05-21-79 '0
. .<1
'-j
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
,00
100,000
,00
,00
,00
,06
,00
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT', SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT
DATE
DISCOUNT (+)
INTEREST (-)
AMOUNT PAID
RECEIPT
NUMBER
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST ,00
TOTAL DUE
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATIOH OF ADDITIONAL IHTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRl,
YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FaRN FOR INSTRUCTIONS.)
PAYHENT:
Detach tho top portion of this Notico nnd subldt with your pay.ont to the Register of WUls printed on
tho reverso sido.
__ Hako check or lIoney ordor payable to: REGISTER OF WILLS, AGENT.
All paymonts received shall bo appliod first to any intorost which lIay bo duo with any rellaindor applied to the tax.
REFUND (CR):
A refund of a tax crodit, which was not roquested on the Tax Return, lIay be requested by cOllpieting an
"Application for Refund of PennsYlvania Inhuritance and Estate Tax" (REV~1313). Applications are available at
the Office of tho Registor of WillS, any of the 24 RllvenulI District Officos or fro. the Departllant's 24-hour
Forlls Ordoring telophone lines In Harrisburg (717) 787-8094, in Philadolphia (215) 560-2065 or in
Pittsburgh (412) 565-3601.
REPLY
TO:
Questions regarding errors contained on this notice should b~ addrossed to: PA Deparhent of Revenue, Bureau
of Individual Taxes, 'ATTN: Post AsseSSMent ReviElw Unit, Dept. 280601, HarriSburg, PA 17128-0601, Phono
(717) 787-6505.
DISCOUNT:
If any tax dUll is paid within throo (3) calendar lIonths after the decedent's doath, a five percan' ~5Z) discount
of the talC paid is allowed.
INTEREST:
Intorest Is charged beginning with first day of delinquency or nine (9) lIonths and one (1) day froll tho date of
death to the date of paYJllont. Taxes which b~calle delinquent be foro January 1, 1982 bear Interest at the rate of
six (67.) percent per annu. calculatod at a daHy rate of .000164. All taxas which bocalllo delinquent on and after
January 1, 1982 wIll bear lnterost at a rate which wIll vary frail calendar year to calendar year with that rate
announced by the PA Oepartlllent of Revenuo. The appllcablo Interest rates fOI" 1982 through 1991 aro:
~ Intorest Rate Dally IntArest Factor ~ Intorust Rata Dally Interost Facto"
1982 20Z .000548 1986 10% .000274
1983 16% .000438 1987 9Z .000247
1984 11% .000301 1988-1991 117. .000301
1985 137. ,000356
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNDER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
~~AnY Notice hsuod after the tax becoll8s dollnquent will reflect an interest calcuiatlon to fifteon U5} da~s
beyond the date of the assesSllent. If pa~1I8nt Is lIade after tho Interest cOllputatlon date shown on the
Notice, additional Interest lIust be calculated.
R(V,WOtxlt>S8j
,,~'j~'~~
-~..
COMMONWEAlTH OF PENNSYlVANIA
DEPARTMENT Of REVENUE
BUREAU OF INDIVIDUAL TAXES
OEPT 28060 I
HAR$IS8URG. PA 17128-060 I
DECE-OE~T'S f,iA~' )' . m . ;/
_ __CU':',J":-_,?-__.. /J
INHERITANCE TAX
EXPLANATION
OF CHANGES
S/'j!//( /(.' !:.
FilE NlIMBER
d/'?/ - O/C":;'''
"eNm. - - .e.__, ."._~_m__'________
}.OL_3d 7Y
SCHEDULE
ITEM
NO,
EXPLANATION OF CHANGES
. . .'. ~----~.- ,.,~-~---~-------'-
Abovc-reterenced ACN(o) arc being adjusted to reflect zero tDX duc since
ciley have beell reported on tlle probate return.
C)'. '" OJ
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J. I'aul Dibert
TAX EXAMINER, 'm______'_'____m.._____'_______.___'
PAGE ______
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*
COUNTY FILE NO:
"'I' "/
./ -~ ,'" --. ~
(: /)
DATE
,/
." /
L I
/4//
/ / I I
TO:
.' '/' I .'
/_-?iili',,/c'- /1/
I '
,,: .
',,( /1/,-
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(,. -/,";..../1./
/();-/ ,"
ESTATE
, ,
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-:.
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4<1
I" )
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--
,
;/
FILE NO,
-; /-~;. /,
,
/..',1 w_
<~/./;-, /J
--"JJ _, j, ",'
/....... ,......,
,
'P'I'i'
~'
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COUNTY
'" ~",'J P !.~ :. i4 /J./...~( -
''/. ,- "L; I/,;'
DATE OF DEATH' -'< ;: ,~/., I', / /' /
Appraised Value of Estate:
Real Estate
Personal Property
$ .-A' (/ LL(; . '.~(,'
}
+ / I if r.-IJ '/;1
, '
Jointly Held PropertylTransfers
+ "'~i ')/ ,1' -:5 ~
-
Total Gross Estate
,
$ ,', .",/ -ii" ~> -
/, "J j
- I
Total Approved Deductions
/ . '-'7 / 'I
_ / /i /, -. "
,
Clear Value of Estate
~. '1 It>
11 .'j ,,'/ /~.(';' , ,I
/ '
.__.--~---
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$ ~;'~/ l/) li /1(/
/
Amount Taxable @ 6% Rate
$ /~:'/ I~;! 1 /)(r-
/ '
tax due
$ ;/)//,;~ /;-';1
" /
$ :j.L/,:)( /J-"'/
/
Amount Taxable @ 16% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
* .. .. .. * * A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
, - (/
/~, - /1;"'1/(
$_")} /;tl-tJ '7) + $//;:,/0:/1 - $
+
= $ 1/1)-'),V1I
/
=
+
=
Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tal( from
to date of payment. Interest due if paid by
is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
$
" , ~
/9.f. ??j
See Information on Reverse Side
ht ix Ii :\ \
INFORMATION
To insure proper credit 10 your [Iecount. thl1 OlunD of tho oSlntc and file number should bo clomly print-
ed on tho check or money order.
This nsscssml.lnt is mado in accordance with SectIOn 708 of tho Inheritance and ESlalC TllX Act of
1961 (72 p_s, 9 2485- 708),
To the extent that inheritance tax IS puld within thrue (3) months ahor the death of the decoden!, a
discount of five (51 percent ;s allowed (72 P.S. S 2485.716).
Inheritance Tax, other than tax on a future interest, is due ut tho date of the decedent's death and becomes
delinquent at the expiration 01 nine (9) months alter the decedent's death (72 P.S. 9 2485.711). Inheritance
Tal( on 8 future interest is payable within three (3) months after the transfer takes cHect in possession and
enjoyment and is delinquent thereafter (72 P.S. !i 2485-7121. Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using the following interest table:
------------ --------- --------- - --" - ---- - ----- -- - - - --- - --- -------- -- -- -- - -- --
, month .005 4 months _020 7 months .035 10 months ,050
2 months _010 5 months -025 8 months _040 11 months .055
3 months .015 6 months ,030 9 months ,045 12 months _060
1 days ,00017 11 days .00186 21 days .00352
2 days .00034 12 days ,00203 22 days .00369
3 days ,00051 13 days .00220 23 days .00386
4 days .00068 14 days ,00237 24 days .00403
5 days .00085 15 days _00250 25 days .00420
6 days .00101 16 days ,00267 26 days _00437
7 days .00118 17 days _00284 27 days .00454
8 days .00135 18 days .00301 28 days .00471
9 days _00152 1 9 days _00318 29 days .00488
10 days .00169 20 days _00335 30 days .00600
-- ------------------ - --- - - - - -- --- -- - - ---- --- ---.---- - - - - --------- -----.
Any party in interest, including the Commonwealth and the personal (epresentalive, not SiHisfied with
the assessment may object thereto within sixty (601 days otter receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961 (72 P.S. S 2435-1001)
Make check or money order payable to:
. "Register of Wills. Agent"
Mail to the address listed below:
INFORMATION
To insure propor credit to your account, the name of tho estate and file numbor should be clcorly print-
ed on tho check or money order.
This assessment is made in accordance wIth Section 708 01 tho Inheritance ilnd Estate Tax Act of
1961 (72 P.S. ~ 2485-708),
To the extent that inheritanco lax is paid within three (3) months after the death of the decedent. a
discount of five (5) percent is allowed 172 P.S. ~ 2485-716),
Inheritance Tax, other Ihan lax on a future inlerest. is due at the dato of the decedent's death and becomes
delinquent at the expiration of nine (9) months aher the decedent's death (72 P.$. S 2485-711). Inheritance
Tax on a future interest is payable within three (3) momhs after the transfer HIkes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. 9 2485-712), Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using the following interest table:
------------------------------- --- ------------- - - - -- - --- -_._------- -- - - -----
1 month .005 4 months _020 7 months ,035 10 months .050
2 months .D10 5 months .025 8 months _040 , 1 months .055
3 months .D15 6 months ,030 9 months .045 '2 months _060
1 days ,000 17 11 days .00186 21' days .00352
2 days .00034 12 days ,00203 22 days .00369
3 days .00051 13 days _00220 23 days .00386
4 days .00068 14 days ,00237 24 days .00403
5 days ,00095 15 days ,00250 25 days _00420
6 days .00101 16 days _00267 26 days ,00437
7 days ,00118 17 days ,00284 27 days .00454
8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 days ,00318 29 days ,00488
10 days .00169 20 days ,00335 30 days .00500
-- - ----------- ------- --- - - - - -- -- - ---- - --- -- ---- -- -- - - - - --------- ------
Any party in interest, including the Commonwealth and the personal repres~ntative, not satisfied with
the assessment may object thereto within sixty (60) days after receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961172 P.S. S 2485-10011_
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below:
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
55:
______'_ ,_, ~'1jll iOIll I.. 111I1.tllel' ___ ,___ __ _u_ __- ___u__,___-----
being duly __~QJ::rL _ __, according to law, deposes and "ys that he - ,Js_il~,:,_____,-___u_ -----
___.sxecL~q!:__,-_" ' of the Estato of _uu~wsi~-Il, S[lflhor.en____,
late of thp QnY'n'lgh nF MP"h::\l,-i(l~llllt'1~ ___I Cumberland County. Pa., deceased and that tho
within is an inventory made by _ ' ' _,_.Ivi1li~ntJ,,_.!hll.tne-,::- _ _u_uu,_, the said Executor
of the entire estate of said decedent, consisting of all the personal proparty and real estate, except real estato outside
the Commonwealth of Pennsylvania. and that the figures opposite each item of the Inventory represent it', fair value
a' of the date of decedent's death.
Sworn
and subscribed before mo,
&-Ueia~".L~::::r~- __u_
hoc,I.' - 1(~MI(N~X
r72rL.l1u4./ /~ 19~!:-
r2utfUo-hu.- '[! ~-a..<.<--m.
CAtHARINE E. nOUSUM, NOTARY PUBUC
MECIIAi.ICSBURG BOROUGH
CUMBERlANO COUNTY
'~\I rt'l,~MI~"lllfi I \"Pl~r' FFIl 27, IqR~
__~5IIioge~~o~n Road,,___
Addnu
Mechanicsburg, penns)lvania 17055
-.------- --~---_._-------_._--
O'Y
Month
Yur
Date of Death _______ ___~j:h,____,___,___,__.J:la rc i'--_________198l,________
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative,
'"'
2. A supplement inventory must be filed within thirty days of discovery of additional assets, '''l~~
~:~~
3, Additional sheets may be attached as to personalty or Nalty n;-"
I"!~
4. See Article IV. Fiduciaries Act of \949. ;~:ij
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