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OATH m' l'ERSONAl. REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ss:
COUNTY OF CUMBERLAND
Before me, the Register for the I'robute of Wills and granting of Letters of Administration in and for the County of
Cumberland. personally camc Thelma V. Hollenbaup:h
who, being duly ~worn
,do e~
depose and say that as Executrix
of the last Will and Testament of Lee R. Hollenbaugh
deceased
she will well and truly administer the goods and chattels, rights and credits of said deceased according 10 law. And
also will diligently comply with the provisions of the law relating 10 Transfer Inheritances, Sworn and subscribed before me.
April q A.D.. 19.B.l-
)
Regisler
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Be it remembered that on the
DECREE
lOth day of April
81 h
,A.D.,19_. I ere was probated and
recorded the last Will and Testament of Lee R. Ho llenbaw;h
lale of
Borough of Carlisle
, Cumberland County. Pennsylvania.
Thelma V. Hollenbaugh
Deceased. Letters Testamentary ,were granled to
Witness my hand and official seal the day and year aforesaid.
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. :-Y. Register
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 of 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
acqui re 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-Iaw 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 after 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 property, 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.
a. FILlNGOF 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 guilty of a misdemeanor and, on conviction thereof, shall be sentenced to paya fine 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
reporled on form PA.40.lndividuallncome Tax Return.
Rf.V-4!\O EX+ (lo-eol
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REveNUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
(lnstrudions on Rovcrs(: Sido)
ESTATE OF Lee R, Hollenbaugh
,
ITEM DESCRIPTIOtol ESTIMA TED DEPARTMEtolT
tolO. MARKET VALUATIOtol
VALUE (OFFICIAL USE ONL Yi
;
None -0-
TOTAL -0- "..-t-'-1t.'-'L
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II add,lIonal space .s necessary. use BY! x II sheets.
INSTRUCTIONS FOR COMPLETING SCHEDULE "A"
Schedule "A" should include a detailed description of all real property located in Pennsylvania
and held solely by the decedent or held jointly with another individual (s) as tenants in common. List the
decedent's percentage of ownership and the estimated market value of the decedent's interest. (Property held
as joint tenants with the right of survivorship or tenants by entireties should be reported on Schedule "E".)
All real estate located in Pennsylvania should be described by lot and block number, street
address, number of acres and general description of land and buildings. Also, include the book and page
number in which the deed is recorded and the exact title as indicated on the deed. If the properly has been
sold, allach a copy of the selllement sheet. If the property is subject to a mortgage encumbrance, include
the name of the mortgagee, date, rate of interest and the outstanding balance on the date of death and
alloch a statement from the mortgagor verifying the outstanding balance.
Property taxes and interest on mortgages as of the date of death, assessments and other
encumbrances should be listed an Scl1edule "F". Do not deduct them on Schedule "A".
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two yems of denth, mnke any transfer of any material part of his estnte without receiving
valunble and adequate consideration? (Answer "Yes" or "No".) Yes
2, Did decedent, within two 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 of death certi fi cate.
c, Affidnvit 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 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 possibi lity that tile 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 five b. nbove is "Yes," was the right reserved in decedent alone ( ) or decedent nnd 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 time, transfer property, the baleficial 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 ( ).
INSTRUCTIONS FOR SCHEDULE "0"
1. List full names and addresses of all who have an interest in the estate
either vested, contingent or other interest,
2, I ndicate 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 beneficiary 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 "0", state those beneficiaries who were
not living at the time of the decedent's death and include the date
of death of the beneficiary.
-
REV-",4 EXt (e-e.ol
COMMONWEAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "E"
JOINTL V OWNED PROPERTV
(Instructions on Reverse Side)
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Estate of
Lee R. Hollenbaugh
ITEM
NO.
DESCRIPTION
TOTAL
MARKET
VALUE
PE
RCE
NT
VALUE OF
DECEDENT'S
INTEREST
DEPARTMENT
VALUATION
{OFFICIAL USE ONL YI
None - All jointly owned
property was held by decede t
and Thelma V. Hollenbaugh,
surviving spouse, as tenants
by the entireties.
-0-
TOTAL
If additional space is necessary, use BV," x 11" sheets.
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
partyor parties as joint tenants with right of survivorship. Bolll 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-S!8 Fe (7-801
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COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
NOTICE OF FILING OF APPRAISEMENT
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Mrs. Thelma V. Hollenbaugh
113 Hillside Drive
Carlisle, PA 17013
RE: Estate of
County of
File No.
Lee R. Hollenbau~h
r.llmhAl"'l~nd
21-81-0237
Dear Mrs. Hollenbaugh:
You ore hereby notified that the nrigira'
approisement in the estate of 1,,,,,,, llo11eJ:19a"gh
has been filed in the office of the Register of Wills of Cllmh"rl"nd
County an September 2<; ,19 Jll. Said appraisement reflects the following valuations:
Real Estate Nnnp.
Personal Property ?O,"17 87
Jointly Owned NnnA
Transfers Nnp':!'
Total ?n,517 87
As to such tax that is paid within three months from date of death, a five (5%) percent
discaunt is allowable. As to any tax that remains unpaid after nine (9) months (fifteen months
when death occurred from December 22, 1965 to June 16, 1971, inclusive; and twelve months when
death occurred prior to December 22, 1965) from date af death, interest at the rate of six (6%) percent
per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within sixty days
after receipt of said notice as provided by Sectian 1001 of the Inheritance and Estate Tax Act of
1961,72 P.S. 2485-1001, P.L. 373.
Date
Signed~(/d~
Ti tl e Chief Appraiser
September 2<;, lQSl
NOTE: This is not a bill.
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
INHERITANCE TAX
APPRAISEMENT
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REV"4~7 EXt (7"'llOI
[IlORIGINAL
o SUPPLEMENTAL
Estate of
Lee R ..JiQUenball!;!h
File No, _--'!_l&l::9231___
Caun Iy
Cumberlp.nd
Dote of Death
March 9. 19.81
In the ovont that any future interest In this estate is transforred In possession or enjoyment to collateral heirs of the decedent ofter tho
oxplratlon of any estate for life Dr for yean, tho Commonwoalth hereby expressly reservos the right to appraise and assess transfor
Inheritance taxes at tho lawful collateral rote on on such futuro interest.
PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEAL TH
ASSET SUMMARY
DEPARTMENT'S
APPRAISED VALUE
DANNUITY
TOT AL GROSS ASSETS
DREMAINDER
$ NonA
$ ?O,~17.R7
$ None
$ None
$ 20,517.87
,
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2.
1 3.
i 4. Total Transfe.. - SCH. "e". . ,'. . . . .
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I~LIFE ESTATE
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Total Real Property - SCH. "A" . . , . .. $
T4tal Personal Property - SCH. "B". . . . $
Total Jointly Owned Property - SCH. "E" $
Nnnp. Unreported $
?n,~17 R7 Unreported $
Nonp. Unreported $
NOMA Unreported $
$
TOTAL VALUE
$
I do hereby certify that the above appraisement is mode in canf/!1ty with Pennsylvania law and has been filed this
day with the Register af Wills. ~~ k
<;: ~_) ;;;:k~'1't-f}- September 2~, 1981
APP~SER DATE
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REV-4I!4 EX+ 1&01101
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
File Number
?1-R1-0217
III Original
o Supplemental
o Remainder
Estate Name
Lee R. Hollenbaugh
Date of Death
March g. 1981
Social Security Number
?Ol-10-?'5R5
REPORT OF INHERITANCE TAX APPRAISER
I, tho undersigned duly appointed Inheritance Tax Appraiser in and far the County of Cumberland
Pennsylvania, do respectfully report that I have appraised the real and personal praperty as reported In th. foregoing
return at the values set forth opposite each item In the last column to the right in Sched les lfA", "B", "C", and "E"
, ?/,
Dated:
Septemher ?~, 1oR1
ADJUSTMENTS REMAINDER APPRAISEMENT CODE
INVENTORY VALUE AS APPRAISED CODE (HARRISBURG USE ONLY)
Real Property (Schedule A) S No e 00+ 92+
Personal Property (Schedule B) '0+
Jolnt.H.ld Property (Schedule E) 2lH
Transfer. (Schedule C) 30+
TOTAL GROSS ASSETS
Le.. D.bts 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
Tax on $
CODE
COMPUTATION OF TAX
$
$
$
$
$
6%
Tax on $
15%
Tax on $
Tax on $
Tax on $
Exemptions
T 0la1 Estote
TOTAL TAX
INTEREST FROM
BALANCE
TO
$
$
$
Less Credits
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
S
+ $
S
=
$
+
=
BALANCE
TO
$
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~~~!wlft~:t:'!'4,JFFICIAL.RE::I:T~:~r:~~~:~:I~~r~;::~:A~I: ESTATE 'TAX
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~ Thelma V. HOllenbaugh
~I RECEIVED
Jj FROM
>:.. ADDRESS
TAX AT 6%
TAX AT 15%
TAXAT_%
ESTATE TAX
TOTAL TAX CREDIT
f!l7.0S
.-- ES-TATE' INFCjRMATiDN,-
DATE OF DEATH
-- ------ ----- -- -----
FILE NUMBER
LESS DISCOUNT
PLUS % INTEREST
(FROM TO_'
DATE OF PAYMENT
AU U8t 24 1981
NAME OF DECEDENT
m
m
TOTAL AMOUNT PAID
$5 7 . 05
COUNTY cumberland
~------------ ------------------------------
POSTMARK DATE
I REMARKS:
~;
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.' '/ /, 11/ -9 ,,)
/ " ( A,. / '-.:.,.' 'jf I.,./(...;J/
. ! I SIGNATUR"/
~
.PAID ON ACCOUNT"
SEAL
RECEIVED BY
I
REGISTER OF WILLS
---.-.----_-0-_----.----------------.-.----.
"
INfORMATION
To insure proper credit 10 your Decounl, tho nallll} 01 thu 051810 and file number should be clearly prinl-
ed on tho ch~ck or money ordor.
This assessment is made in nccordallC(,! with Section 708 of tho Inheritance and EWHC Ta)!. Act of
1961 (72 P,S, 9 2485.708),
To the Bll:tent that inheritanco taJl. is paid within throu (3) months after tho derllh of tho decodent. a
discount 01 five 151 percent is ellowed 172 P.S. 9 2485.716},
Inheritance Tax, other than tax on a future interest, is due at the date of the decedent's death and becomes
delinquElnt at the expiration of nine (9) months altar the decedent's death (72 P.S. S 2485-711). Inheritance
Tax on a future interest is payable within three (3) months after tho transfor takes effect in possossion and
enjoyment and is delinquent thereaftor (72 P.S. 9 2485.712). Calculale interost from the delinquent date shown
on the lace of this form to the date of actual payment using thu following interest table:
------------ --- ----- - - -------- - - - - ---- --------- - - --- - --- --- ---- - -- - - - - - -- --
1 month .005 4 months ,020 7 months ,035 10 months ,050
2 months ,010 5 monlhs ,025 8 months ,040 11 months .055
3 months .015 6 monthS .Q30 9 months ,045 12 months .060
1 days ,000 17 11 days ,00186 21 days .00352
2 days ,00034 12 davs ,00203 22 dovs ,00369
3 days .00051 13 d.vs ,00220 23 days .00386
4 deys .00068 14 days ,00237 24 days ,00403
5 days ,00085 15 days ,00250 25 days .00420
6 days .00101 16 davs .002,67 26 days .00437
7 days ,00118 17 davs ,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 daVs ,00335 30 days ,00500
-- - -- --------- ------- --- - --- - ---- -- - - - --- - - - --- ---- - - - - ------ --- ------
Any party in interest, including the Commonwealth and the personal representalive. not satisfied with
the assessment may object thereto within sixly (60l days after receipt of lhis Notice as provided by Section
1001 of lhe inheritance and Estate Tax Act of 1961 172 P,S, \ 2485-10011,
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below:
REV.455 EX" 13.801
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF OEBTS
AND DEDUCTIONS
Estate of Lee R. Hollenbaugh Date of Death 3/9/81 FileNo.2l-8l-237
WHEN CLAIMING THE FAMI LV EXEMPTION, COMPLETE THE FOLLOWING:
-- ~--
_. - ----
---- -
-
! Claimant's Address at time of Decedent's Death 113 Hillside Drive, Carlisle, PA 17013
Claimant Thelma V. Hollenbaugh
Relationship to Decedent surviving spouse
liEM DATE
NO,
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NAME OF PAYEE
REMARKS
AMOUNT
Letters
Letters
raisal
35.00
56.00
8.00
2,468.00
26.50
13.00
1.00
18.00
21. 50
50.00
2,000.00
10.50
3.00
1,260.00
Re ister of Wills
Re ister of Wills
Cumberland Law Journal
The Evenin Sentinel
Geor e L. Ebener & Assoc.
Thelma V. Hollenbau h
Re ister of Wills
Bonnie L. Co le
Fowler Addams & Shu hart
Last illness,
Last illness.
Last illness,
Funeral expense
Funeral
Letters
One (1)
Carlisle Communit
Carlisle Hos ital
Carlisle Hos Hal
Hoffman-Roth Funeral Home
Geor es I Flowers
Attorne 's Fees
TOTAL 5
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral
expenses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes.
JeJ~Aslf,;~*~~ 8~~!81
OFFICIAL USE ONL V
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ 1;-'11 tJ. -?7J
,
AT
&
% TAX RATE
/tJ-oP-$1
DATE
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REV. 483.A EX (9.84)
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
P, O. BOX B327
HARRISBURG. PA 1710G
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
ESTATE TAX RETURN
ACN 201
DATE 10-26-85
ESTATE OF
HGLlEN6AUGH
LEE
R
FILE NUMBER 21 81-0237
DATE OF DEATH 03-09-81 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT THE UPPER PQf1Tl0N OF THIS NOTICE WITH YOUR TAX PAYMENT TO
THE REGISTER OF WILLS OF THE ABOVE COUNTY, MAKE CHECKS PAYABLE TO "REGISTER OF WILLS AGENT,"
J(jH~ B FOWL ER I I I PLEASE RETURN THIS
PO eo" 208 ~~m~~~f!JE<;Jm~S~
CARLI SLE PA 17013 AMOUNT "EMITTEO
S
CUT ALONG THIS LINE . RETAIN LOWER PORTION FOR YOUR RECORDS ·
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NOTICE OF DETERMINATION AND ASSFSSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN
ESTATE OF HOLLENBAUGH LEE R FILE 21 lll-0237 ACN201 DATELO-28-85
NUMBER
ESTATE TAX DETERMINATION AND ASSESSMENT
1. Credit For State Death Taxes as Verified 1- .00
2. Pennsylvania I nheritance Tax Assessed 2, 832.05
(Excluding Discount and/or Interestl
3. Inheritance Tax Assessed by Other States .00
or Territories of the United States 3.
(Excluding Discount and/or Interest)
4. Total Inheritance Tax Assessed 4. 832.05
(Line 2 plus Line 31
5. Pennsylvania Estate Tax Due 5, .00
(Line 1 minus Line 41
TAX CREDITS:
Payment
Date
Receipt
Number
Interest i.)
Amount Paid
. IF PAID AFTER THIS DATE SEE REVERSE SlOe
FOR CALCULATION OF ADDITIONAL INTEREST
Totld Tax Credit _ 00
Balance of Tax Due _ 00
Inlel'cst .00
Total Due .00
(If Balance Due is less than $1. no payment is required)
(;VPY 2 - KUjlSI LK VI- WILLS
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Purpose of I~o..ice:
To Remit P,lynwnt:
Refund ICRI:
Interest:
Objections:
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