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No. 21-81
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
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In the Estate of
Silllll1Cl1 D. llil:"il'llt.ll'l~
, deceaSBd.
To Register of Wills for thB County of Cumberland, In the Commonwealth of Pennsylvania.
Petltioner(s) Is (are) the execut OI'S
named In the Last Will and Testament of
Samuel n. Ilaseho/'e dated neC'c'llIbe,' 1.1). 1%9
Decedent was a citizen of the United States and a resident of tJ;>,"", /'/11,,,
Township (B~), Cumberland County, Commonwealth of Pennsylvania.
Decedent died on
Fl'idav
the 13 th day of ~Ia ,'cll
A.D. 19~, In the
County of CUl1Ibel'l.cllld ,Stateof 1'(,l1nsyl.vnniltltheageof~years.
DecedenUlll8'(has not) been married and1\Qs (has not) had children born to him (bel:) since the ex-
ecution of the above described Will.
Decedent was possessed of personal property to the value of unes t1l1Io tee!
and of real estate to the value of
none
as near as can be ascertained; said real estate situated as follows 110t npp Licable
Therefore, your petltloner(s) respectfully apply(les) for the probate of the said Last Will and Testa.
ment and for Letters Testamentary theron.
Dated April 1. 19B1
Name and address
of Petitioner(s)
-i ~~
\ (J</./i {! . (2,1)2 p
Frank E. Base lore
7n7 Robel't fit. ,
~lecl"'n1csblll'g, I'A liD""
COMMONWEALTH OF PENNSYLVANIA t
COUNTY OF CUMBERLAND j
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("Y ~_.tL4t-C:( J\"?.l v.--.:L-c/u-c/
rlol'ence IL LoSe let'
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Ned11ln1csbul'g, PA 1.7055
ss
PI'.nk E. Rnsehol'e and Flol'ence B. Loschel'
named in above application, being duly SWOl'11 according to law say(s) that the
statements set forth in this petition are true to the best of tlle1 I' knowledge and belief.
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Swol'n to and subscribed before r7.A,7,-d1 h , 11{)-:>.&lLa,/ i2
FI'i1l1k E. Rnsello.'e
me, "12f' April 1 tJ ~19B.1 ...Q ":{i-P
__ _~ l,fLZfj_t:, ;0 . ~ _ . --./7:'< ''--L 1"'"( )i(:'J. (' J!.c--a-<,ku
f' Register FloI'pncc"Il. Loscllc'/'
&,~t ___...____
Filed: April 6. 1981
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Attorney fimd.lmkl'I', ~lcCHeb IV EUckel'
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and direct that the one so qualifying shall be the sole Executor
hereof, to serve without bond.
IN WITNESS WfillREOF, I, SAMUEL D. BASEHORE, have hereunto
set my hand and seal to this, my Last will and Testament which
consists of three (3) typewritten pages to each of which I have
affixed my signature this
" t /"'_
day of December, A. D"
One Thousand Nine Hundred Sixty-nine (1969).
( \ ./.. .,' ~~ J~'-~.-.. .. - L
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(SEAL)
The preceding instrument, consisting of this and two (2)
other typewritten pages, each identified by the signature of the
Testator, was on the date thereof signed, sealed, published and
declared by SAMUEL D. BASEHORE, the Testator therein named, as
and for his Last will and Testament, in the presence of us, who,
at his request, in his presence, and in the presence of each
other, have subscribed our
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OATil OF SUIISCIUIIING WITNI':SS
COMMONWEALTH OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND
This 2ne ~ay of Apri 1 A.D..19 A1,
before me, Regisler for the Probate of Wills an~ granting lellers of A~ministration in all~ for said County of Cumberland, in
the Commonwealth of Pennsylvania, personally came IU (~I1i1I'd C. SIH' LiJ'lkl' I' '1Ild Cntl1i1l'illC' I:. lIoUSUIlI
the subseribing witnesses to the foregoing instrument of writil,g purportiug 10 be thL last Will and Tcstamcnt of
Samuel. D. BasC'l1or~
Dated _
D~~(,llIiJ0I' III, 1.%9
late of
Upper A llel1 'I'oWl1sllilJ
Cumberland County Pa., deceased who being duly
SWOPIl according to law, depose and say, that they \>JOI.'(l
present, and saw and heard the testa to I'
Samuel D. IlBsehore
sign, seal, publish, pronounce and declare the said
Testament and Last Will, and at the time of so doing.....h('
instrument of writing as and for h is
was of sound and disposing mind memory and understanding, to the best ofL-
knowledge, observation and belief. ./
Swam to
and subscribed before
17;/11 e. .if/~/
Register
otl, <?? .?
C a ,,~.;.,€ &. 10H~a.a-rn/
.iI -1H-lI'lIH:~ I:.. 1S0USUl11
AHIDA VIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND \
rloren~e II. Loscher
being duly
swo,-~n
says that as nearly as can be ascertaineo the said decedent
Saml1~1. D. lI<ls('I1()I'('
died on
F l'iday the 13tl1 day of
at or about lL: 1.S o'clock, ~M.
SWOl'n to and subscribed this
1st day of April
~I'II.'"h
A.D.,19~,
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Fl OI'(,I1",o/Il. LoschC'r
19,.!!L.., before iJ
?JJ??VI' (t ~/UC~
Register ""O.~
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ss:
COUNTY OF CUMBERLAND
Before me, the Register for the Probate of Wills and granting of Lelters of Administration in and for the County of
Cumberland, personally came
F P':lllk r:. IJiIHC,IIOI'(I ,llld 1'lol'l'IH!l' B. I.W:i(!I1(~I'
who, being duly sIVa I'n
,do
Jepose and say that as
J-:xpeutol'S
of the last Will and Testament of
S,lllHH' If). l~ils('hnl'(1
deceased
they will well and truly administer the goods and chattels, rights and credits of said deceased according to law. And
also will diligently comply with the provisions of the law relating to Transfer Inheritances. SIVO I'll and subscribed before me.
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April 1 A.D., 19..Jl..L ' 7/!~w J~ (,' h,),(JP',hl.1'J-f' 0
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Be it remembered that on the
6th
day of
DECREE
April
,A.D.,19-R, there was probated and
recorded the last Will and Testament of
Silmll"l 11. BilS"llOl'<'
late of
'UPP"I' ^ll"n TaIVnship
, Cumberland County, Pennsylvania,
!'mnk I:. Bilselrol'" illlll 1'101'('11"" n. Losehel'
Deceased. Letters Testamenta I'Y , were granted to
Witness my hand and official seal the day and year aforesaid.
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Register .
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
55:
Fr-'l!lk"E. Bas~JlOr.e and F10l'ence ILJ.,Q.~.c.:Ilel'. -.-.-- .-. .-..... .-
being duly _____ S\lJO~!!___.. n____ according to law, deposes and says that thcy_..__~~.~~~.I_~.c=..._ ...----.--. ,----
_.__.__Ex12.c..u1o.!'.s. _.__ of Iha E.lala of _._Samu~._J)~Jlas.eJ.!9re_________
lale of IIpppf' All pn Tm.n"hip ..___, Cumberland Counly, Pa., deceased and th.1 the
within i. an invenlory made by Fr.ank .1::.. Bas"IIOr_q....a_llcJJlor.~1c;,eIl..~~sc,h:i.1~ .aid_.J::..xecutor!L__
of Ihe anlira estata of .aid daceden~, con.;.fing of all the personal propclrly and real e.lala, axcepl real e.lale oulside
the Commonwealth of Penn.ylvania, and thai tho figure. oppo.ite each ilem of Ihe Inven20r repre.enl il'. fair value
a. of Ihe dale of decedenl'. de"lh. -i~ . /) (Z' / n
L _1.r/;f,~Kf. t..:L^<' ,J ~,n..{ SL
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Sworn and .uboeribed before me, ./. __'~-t l..-LL~,~:'JcIL'c::l.."'--__.
Exec or ~ ~~"r
01.('/>.r '/ 19.F..L._ 707 Robert Street
/)..J./. . .J:? 4' _n__.....tlecha!!.~.c:~l?l!.1.1h. Penll.sY.1Yan:i..07055_
I //(I'//)~/~? ~ ~~. I.fOl East ~lal~b1e Street
CATHA~~~H;N~~SU;UU:G ~g:~~~I~UBlIr .__tleS'l'llnJ~sbu~:g~- Pennsy 1 vaDJ.a_EO.~.L_
Addren
CUMBERLAND COUNTY
\.tV r.nMMI$SlnN n:rnn' FF.R 21 10\1'1
13th
Dale of Oealh ...__m._'
--,---~_._.,_._-_..._--_._--_..._------_._----_._-~--~- -.---.-
Narch
1981
D.y
tYionlh
Year
INSTRUCTIONS
I. An invenlory mu.t be filed wilhin Ihree monlh. afler appoinlment of personal repre.en!alive.
n
2. A supplemenl invenlory mu.t be filed within Ihirty day. of discovery of eddilional assels. n::;;
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3. Additional .heels may be attached as 10 personalty or realty co":'
tTIC
4. See Arlicle IV, Fiduciaries Acl of i 949. f!:;;
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Inventory of the reol ond personal estate of
SA~llIE[, D. BASEIIORE
decea .ed.
REAl, 8S'1.,\'1'[;
NOl~E
TOTAL RE!\L ES'I1\TE
!::!~SONAL'ry
1. Om! shat'~!, cOlllmon, CUlIdJf!pland Valley Cooperat:i.ve Asslle:laUlln
@ $iO.OO per shar~
2. 3'1 shares, prefel're,j, Cumberl and Valley Cooperative AsscJciation
@l $10.00 pel' share
Accumu latcd rIJ vJdel1ll
3. 16 fjhare~, common, '1he Commonweal th NCltional Bank H; $<11.50 [lel' share
1I.. Everg!:'een Savings Account No. 11l-00iOil65-7, Commonwealth National
Bank, balance on date of death
Accrued intel'est I
5. Certificate of Deposit No. 61-92015616, Hamilton Bank, balance on I
date of death
6.
Accrued interest
Hamilton Bank, in joint
herein) or Fannie V. Basehore
of death
Accrued interest
Trust Company
Date of Death Value
$5 ,01lJ.. 66
5, Oq.l. 66
3,016.66
Total
Single Payment Savings Certificate No. 002-20-05979, State Capital
Savings and Loan Association, Balance on date of death
Accrued interest
Single Payment Savings Certificate No. 002-20-06579, State Capital
Savings and Loan Association, Balance on date of death I
Accrued interest
Passbook Savings Account No. 002-00-07996 (formel'ly full-paid Savings
Certificates No. W1701l, \n901, W1958, \'12028, W2350 and \v2377), I
State Capital Savings and Loan Association, Balance on date of deat
Accrued interest
Certificate of Deposit No. 61-9201511n,
names of Samuel D. Basehore (decedent
(predeceased spouse); Balance on date
7.
Certificates of Deposit,
NLunber Amount
1987 $5,000
2626 5,000
26i17 3,000
'111e First Bank and
Accrued Interest
$ilJ.. 66
1I.J.. 66
16.66
8,
9.
10.
11.
12.
13.
m.
15.
16.
17.
Medicate benefits
Blue Shield 65 Special benefits
Capital Blue Cross; return premium
Columbia Accident and Health Insurance Company: return premium
Polyclinic Medical Centel': refund
Seidle Memorial Hospital: refund
One share, common, Southeastern Penna. Artificial Breeding Cooperativ
(Atlantic Breeding Cooperative) l'edeemed on 8/25/611
TOTAL PERSONAL'lY
RECAPITULA.TION
TOTAL VALUE REAL ESTATE
TO~L VALUE PERSONALlY
TO'D\L APPRAISED VALUE
NONE
$52.965.81
$52,965.81
NO E
NO E
10 00
3110 00
2 86
392 00
21,072175
2qOj32
1I,000iOO
37 52
6,000jOO
2111 86
13,099 98
1,000 00
13159
1,000 00
13 59
5,000 00
55 30
217 88
511 ll7
17 30
39 76
89 1I.3
27 20
$52,965 81
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COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICI.IIL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*'
COUNTY FILE NO:
,/ ..
DATE
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TO:
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ESTATE
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FILE NO.
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COUNTY
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DATE OF DEATH
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Appraised Value of Estate:
Real Estate
0"'-
Personal Property
+ ';, ':.1 'It,. 1)--: ~~ J
Jointly Held PropertylTransfers
+
';-1
'.. i-,!
,,:. 'f.' '_<' -
Total Gross Estate
o
./
,
{! .::',::
Total Approved Deductions
/ II /'-1; ,>. (/.
,
Clear Value of Estate
o
C .. ,; ,/..)
--,'./." A
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$ <'(;
~-,,/."'.,;
-, "
1_....,
Amount Taxable @ 6% Rate
s '. {- <.;/::;. /:;!
tax due
S ::0 'j J9.5"1
Amount Taxable @ 15% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
s J '3 J 9. '5''-1-
* * * * .. * 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
s
+ S
s
=
$
+
=
+
=
Interest accrues 8t the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
Is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
$
"", /' 9~-l
//.,//, (,
Assessed by: " .' "1..-.'
See Information on Reverse Side Agent tor lhe Co,m)"onwllllh
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INFORMATION
To insure propol credit to your account, ttlC name 01 tho cstnle and lito number should be clearly print-
od on the check or monoy ordor.
This assossment Is made in accordanco with Section 708 of tho Inheritanco and Estate Tax ACI of
1961(72 P.S. 9 2485.7081.
To the extent Ih81 inheritance lax is paid wilhin three 13} months after the dealh 0' Iho d(lcedcnt, a
discount of five (51 percent is ellowed (72 P,S. 9 2485.716),
Inheritance Tax. other than tax on a future interest, is duo at the date of the decedent's death and becomes
delinquent at the expiration of nine (9) months after the decadent's daolh (72 P.S. S 2485-711). Inheritance
Tax on a future interest is payable within three (3) months niter the transfer tnkes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. 9 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 ,00166 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 .00264 27 days .00454
8 deys .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 representative, not satisfied with
the assessment may object thereto within sixty (60) days after receipt of this Notice as provided by Section
100101 the Inheritance and Estate Tax Act of 1961172 P,S. 9 2485.1001).
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below:
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REV.455 EX+ 13.80)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
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'.
Estate of SA~lUEt. U. BASJ;I\URJ; Date of DeathJ:llll'l'l1
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
L')~l .
13, IFile No.-&HJ.=-~~S
Clnimunt
Relationship to Df~cedent
Claimant's AddreS5l'lt time of Decedent's Death
ITEM OATE NAME OF PAYEE REMAHKS AMOUNT
NO.
I.. Pa. Department of Revenue OutHtand:i.ng ell eek 76.00
2. Tax CDllee tor. [j')')er AUen 'l\y). - Outstand:ln" check In ,;n
3. CDwlev AssDe:lateH P I'ofessional services 170. 00
IJ. Ri.chard [I. Basehore Reimbursement: l' Dr funeral luneheDl 225.00
5. Snelbaker, NeCaleb '" ELiekcr Reimbursement I'DI' probate costs 32.00
Ii. Cumberland Law .Journal Advel't:ls:i,mr Exceu tOl.'S 1 notice I 18.00
- 7. Tr:lnd] (' S"r:ln" LuthE'r'ill'l Chlll"'e 1 - IJo:i.ld:ln" fll'll! :,~ nn
n Vi S'; Hnn' "",.cn lIss,",;" H nn PI'"F"SH'; ,-,n:.' I sn.'v';C'C,c I;n nn
Q Nvers Funeral HomE! InC'. funer'al exuenses 3 169.92
10, (i:i.n"rJeh ~lemDr:lals Let terinO' 32.00
11 CDm~M'.'''" 1 1-1, "" H on" I I),.. "k Safe del10sit blJX l.n\lentorv fee 1.0 . on
1 ~ ~..,'.n., ~lnmm,i,,' Ilqs"';'I':il lI"nnnnl- 1 , 1 70
13. ,James P. Yean'er ~I.IJ. 1.'1'11.[l~s:3i(Jnal sCI~vices 128.01J
111. \vest ShDre '1.'inles Advt'l'tising ExeC'utnrs' notice 19.39
15. Reg:i.ste~ of Wins Filing fees .. . 'J. 00
16. FI'ank E. BasehDl'e Cn-Ex.ecutor', s cOlllmissio11 1,6li5.o0
17. n 01'enC8 B. LOSt'her' CD-Executor's commission 1 6'15.011
lR Sne 1baker., i'leCaleb & ELi.ekel' AttOl.'nevs fee 1.97'1.00
1 Q Rpsp"oo" F"" '''<1:,,~ ''','nlH,t' R >1P"sp" .m.1 llliHcellalleolls eosts 75.00
TOTALT $9,/i7/i.['6
1 hereby certify that tD the best of my knowledge and belief the foregoing is a just and true statement Df debts, funeral
expense~,~d exp~/ se~~~in.ist(7tiOn submitted to the e~;-te as deductiD~. 5 r~r ~nherit,anceTax purp~/es. /
J ;-/4" '/t.' ~ /, ,JaVl?J<u9"l.-':"" .'T~::>~/~(~ L~_'~C( :..,::..(},..X-...L~-(L{,L/' cf 7, f/
SIGNA:rURE OF FIDUCIARY IOATE
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $
9 :/1t/: li>t- AT
&
% TAX RATE
//-AJO - (3
)
~
tj-//-,f/
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedent prior to his/her death ore deductible against his/her taxable
estate. In addition to debts incurred by the decedent or estate, other items ore claimable including the cost of
administration, attorney fees, fiduciary fees, funeral and burial expenses including the cost of 0 burial lot, tombstone
or grove marker and other related burial expenses.
All debts being claimed against on estate ore subject to the approval of the Register of Wills with whom the
Inheritance Tax Return is filed. Evidence.to support the decedent's or the estate's liability for the debts being
claimed should be attached to this schedule.
A family exemption may be claimed by 0 spouse of 0 decedent who died domiciled in Pennsylvania. If there is
no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is 0 member of the some
household con claim the exemption. In the event there is no such spouse or child, the ex_ption con be claimed by
o parent or parents who ore members of the some household os the decedent. The family exemption is allowable only
against assets which pass by 0 will or by the Pennsylvania Intestate Lows,
NOTE: Compensation paid to on estate representative; namely, on executor or administrator, for services
performed in administering on estate is reportable for Pennsylvania Income Tax purposes. This taxable income
item should be reported on form PA.40.lndividuallncome Tax Return.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the family exemption is being claimed, indicate the claimant's nome, address and his/her relationship to
the decedent. Enter "family 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 a brief explanation in the remarks column for each debt claimed.
6. Enter the amount of each debt being claimed.
7. The form must be signed by the person who ha~ assumed the responsibility for paying the debts.
IF ADDITIONAL SPACE IS NECESSARY USE 8Y," x 11" SHEETS.
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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 to property at the decedent administered 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 liable. . .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 like 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
The tax assessed on the transfer of property reported in the return is due 9 months aller the decedent's death. Interest
at the rate of 6% per annum accrues thereafter until payment is made. All payments received are first 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 resided and are
received subject to the final determination of the Department of Revenue.
7. FAILURE TO PAY
The taxes imposed, together with any interest thereon, are a lien upon real properly, which lien remains in effect until
the taxes and interest have been paid in full. The taxes may be sued for against any real property in 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 3 false return or report required of him shall, in accordance with Section 793 of the
1961 Statute, be guilly of a misdemeanor and, on conviction thereof, shall be sentenced to pay a line not exceeding
$1,000 or undergo imprisonment 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 PA,40,Individuallncome Tax Return.
REV"4M\ EX+ (lo-eo)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEOENT
SCHEDULE" A"
REAL PROPERTY
(Instructions on Reverse Side)
ESTATE OF
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ITEM DESCRIPTION ESTlMA TED DEPARTMENT
NO. MARKET VALUATION
VALUE (OFFICIAL USE ONL YJ
NONE NONE
TOTAL NONE /l'1--~<-L A
. . I" " A/.1
SANUEL D. BASEHORE
If add,llonal space IS necessary. use B/l x 11 sheets,
SCHEDULE "B"
PERSONALPROPERTV
fH:V-4~1 I.At le-1l0}
COMMONWEAL TH OF PENNSYL VANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
Estate of
ITEM
HO.
(Instructions on RI!VtJrSf.' Side)
SA~JUEL D. llASEIlORE
DESCRIPTION
UHIT
VALUE
1.
One share, common, Cumberland Valley Coopera-
tive Association LO.OO
31\. shares, preferred, Cumberland Vaney Co-
operati ve Association 1.0.00
Accumulated Dividend
16 shares, common, The Conunonwealth National
Bank 211.50
Evergreen Savings Account No. lLl-00101\65-7,
Commonwealth National Bank, balance on date o'
death
Accrued Interest
Certificate of Deposit No. 61-92015616, Hamil'on
Bank, Balance on date of death
Accrued interest
Certificate of Deposit No. 61-920151jJ.l,
Hamilton Bank, in joint names of Samuel D.
Basehore (Decedent herein) or Fannie V. Base-
Ilore (predeceased spouse); balance on date of
death Accrued intel"e-t
Certificates of Deposit, TIle first llank and-
Trust Company
Number Amount
1987 $5,000
2626 5,000
261\7 3,000
2.
3.
If.
5.
6.
7.
8.
Date of
Death Valu'
$5,01\1.66
5,01\,]" 66
3,016.66
Total
Single Payment Savings Certificate No. 002-20
05979, State Capital Savings and Loan Associa
tion, Balance on date of death
Accrued interest
Single Payment Savings Certificate No. 002-20
06579, State Capital Savings and Loan Associa
tion, Balance on date of death
Accrued interest
Passbook Savings Account No. 002-00-07996
(formerly full-paid Savings Certificates Nos.
W-1701l., W-1901, W-1958, \\1-2028, W-2350 and W-
2377) State Capital Savings and Loan Associa-
tion, Balance on date of death
Accrued interest
Accrued Interest
$111. 66
Ill. 66
16.66
9.
10,
11.
12.
13.
1.11.
Medicare Benefits
Blue Shield 65 Special.
Capital Blue Cross: return premium
Columbia Accident and Ilealth Insurance
Company: return premium
TOTAL
If additional space is necessary, use B'.," X 11" sheets.
Continued on Page 2
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ESTIMATED
MARKET
VALUE
1.0.00
3110.00
2.86
392.00
21,072.75
2110.32
1\,000.00
37.52
6'2Rt~&
13,099.98
1,000.00
13.59
1,000.00
13.59
5,000.00
55.30
217.88
511.1\7
1.7.30
39.76
DEPARTMEHT
VALUATIOH
{OFFICIAL USE aNL Yl
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any material part of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No".) No
2. Did decedent, within two years of death, transfer property from himself/ herself to himsel [(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 of 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 decedent, in his/her lifetime, make any transfer of properly without receiving a valuable or adequate considerationN
therefor which was to take effect in possession or enjoyment at or after his/her death? (Answer "Yes" or "No".) 0
a. Was there any possibility that the property transferred might return to transferor or 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 lifetime 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 therefrom?
(Answer "Yes" or "No".) No
6. If the answer to live b. above is "Yes," was the right reserved in decedent alone ( ) or decedent and othels ( ).
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 time, 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.4e4 EX+ (8-eO)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT OECEDENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
(Instructions on Reverse Side)
Estate of SAMUEL D, BASEHORE
ITEM TOTAL PE VALUE OF DEPARTMENT
NO, DESCRIPTION MARKET RC DECEDENT'S VALUATION
VALUE EN INTEREST (OFFICIAL USE ONL Y/
T
l. Checking Account No. 11l2-1320113-1
Commonwealth National Bank in
joint names of S. D. Basehore
(decedent herein) or Florence B.
Loscher (Daughter) ; account
opened on 9/11/78. Balance on
date of death $2, 911l. 119 50 1,'+57.25
!
Savings Account No. 11l.-DOll0689.6
Commonwealth National Bank in
joint names of S. D. Basehore
(Decedent herein) or Florence B.
Loscher (Daughter); account
opened on 9/11/78. Balance on
date of death
Accrued interest
22,708.86
LIS. 77
50
50
1l,35'+.113
22.89
2.
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1
1
,
TOTAL
$12,8311. 57
If additional space is necessary, use 8\~" x 11" sheets,
- . .
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INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangibie and intangible property are to be
included, List real estate first.
1. Describe all real property as indicated in the instructions for Schedule "A," Describe all personal property
as indicated in the instructions for Schedule "B," Include the name, address and relationship to the
decedent of the co-owner[sl and the date the joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3. Indicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest.
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REV.4~7 EX+ (1-80)
INHERITANCE TAX
APPRAISEMENT
r
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
o SUPPLEMENT AL
[KJORIGINAL
Estate 01
Samuel D ~~as~hor~.
File No. ___21-:~H1J.5
County
Cumberla,nd
Date 01 Death March 13.1981
In the event that any future intere$t ill this estato is transferred In possession Of enjC\ymcnt to collateral heirs of tho decedent after the
expiration of any utote for life or fOf yBors, the Commonwealth hereby oxpressly reserVQS the right to appraise and asseSS transfer
Inheritance toxes of the lawful collateral rote on any such futuro interest.
PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH
,
ASSET SUMMARY
DEPARTMENT'S
APPRAISED VALUE
1. Total Real Property _ SCH. "A". . . . .. $ .-N.oPP.
2. Total Personal Property _ SCH. "B".... $ ~~Jq6~.R1
3. Total Jointly Owned Property - SCH. "E" $ _12..l3.34.S7
4. Totai Transfers _ SCH. lie". . 0-. . . .. $ Nt'lnA
Unreported $
Unreported $
Unreported $
Unreported $
$
$
$
$
$
o LIFE ESTATE
DANNUITY
TOTAL GROSS ASSETS
DREMAINDER
TOTAL VALUE
None
S2rQ6S.81
12,R14.~7
Mnn~
65,800.38
$
I do hereby certify that the above appraisement is mode in conlarmitt with Pennsylvania low and has been Iiled this
day with the Register 01 Wills. ___. ~ . ~
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I. APPRI) ER DATE
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INFORMATION
To insure proper credit to your account, thll name 01 tho ostlllo and tile number should bo clearly print.
ed on the chock or money order.
This assessment is made in accordance with Section 708 of the Inheritance and Estate TalC Act of
1961 (72 P.S, 924B5-70BI,
To the extent that inheritance tax is paid within three (31 months after tho death of the decedent, a
discount of five (5) percent is ollowed (72 P.S, 9 24B5.7161
Inheritance Tax, other than 'tlX on a future interest, is due at the datu of the decedent's death and becomes
delinquent at the expiration 01 nine (9) months after the decedent's death (72 P.S. lj 2485.711). Inheritance
Tax on a future interest is payable within three {31 month!i after the transler lakes effect in possession and
enjoyment and is delinquent thereaher (72 P.S. S 2485.712). Calculate interest from the delinquent dale shown
on the face of this form to the date of actual payment using tho following interest table:
--------------------- - -------- - -- - ---- - ----- - - - - - - -- - --- --------- -- -- -- - -- --
1 month ,005 4 months ,020 7 months .035 '0 months .050
2 months ,OlD 5 months .025 8 months ,040 11 months ,055
3 months ,015 6 months .030 9 months .045 12 months .060
1 doys .00017 11 doys .001B6 21 days .00352
2 days ,00034 12 days .00203 22 days .00369
3 doys ,00051 13 doys .00220 23 doys ,003B6
4 days .0006B 14 days .00237 24 days .00403
5 days .OOOB5 15 days ,00250 25 days .00420
6 days .00101 16 doys ,00267 26 doys .00437
7 days .0011B '7 doys .002B4 27 doys .00454
B doys .00135 18 days .00301 2B days .00471
9 doys .00152 19 doys .0031B 29 days .00488
10 days .00169 20 doys ,00335 30 days .00500
--------------------- --- - - -- - - - -- -- -- ---- -- - ---,---- - - ----------- ------
Any party in interest, including the Commonwealth and the personal representative, not satisfied with
the assessment may object thereto within sixty (60) days afler receipt 01 tllis Notice as provided by Section
1001 of the inheritonce and ESlDte Tax Act of 1961 (72 P.S. 9 2485.1001),
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below:
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