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PLEASE RETURN THIS PORTION WITH YOUR PAVMENT
ESTATE Of
KELSALL OOR IS J
FILE NO. ' 21 131-07.40
COUNTY CUMBERLAND
DATE OF ASSESSMENT OQ-25-81
ACN 101
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!:.as AS (3.81)
Commonweal\h 01 hnnsylvonla
ti.po.rtmenl 01 Re~enue
Sureau 01 Accounlt Se"lem",,1
P.O. \\OX 2055
l\arrl$bur9. Pennsylvania 17105
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\'Irs. \'Iary C. \..el'f\S
Reg'i ster of \1'i1'\ s
Cumber'\ and County courthOUse
Car'\ 'is,\e, 1')1. '\70'\3
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:-<0. 21-81
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PETITION FOR LETTERS OF ADMINISTRATION
IN THE ESTATE OF ...()Nzis......J.j(e/....:s.t;ut........... DECEASED.
To ....,IlJII.t?.y.....g .,. .~. ~ .l4!!.>..... ... ...... ...... ........... ............... ............ ..... ... ....
Register of Wills 1'01' the Count,\' of Cumhel'ialld. ill Ihe Commonwealth of l'enlls,\'I\'allia.
The Peli tion of ... AJ((. ll..ffl.I.9.... ,./..:... /(e.../... .S/I t../,.....'k...... Do.. J/ ./0.. .I??~..t:'e. /... .S.d.??...........
.......................................................... respect full,\' showel h I hat ..[)t?ft..i5......J...,../{eJ..S.);-/..LJ....................
E L IMsT.\'!' }'
was a resident of ..............ll!.(I......s...v.J:~I?!~b.::n,yB~;:~:~I~P ,Cumhel'iand County, State of Pennsyl-,
vania, and a Citizen of Unit~d States, and d~llll'ted Ihis life intestate in the County of (),t9..(.(.f1..d.uJ
........M~dK..... and State of .........;.{..8....... ...:...,....................;,........:.............'...................................;..
on .......~i........ the ..........-.3..0..................... d,l; of .....I?7.'l8...clJ...................... A. D., 19..r......,
at the age of ....i?.r. yeal's. ,
. That the said ......O'C!.4.1..5....J.....k.'e.lSJI..t..L................... deceased, left sUl'viving the following
named widow 01' husband, heil's and next to kin, to wit:
Name
Helatiollship
Hesidence
,.'i./.~/(;;.8.IJ.ld1:f.<V;lZd~w..GI/(/ 61' t' M
&...f:. (() I.i.. f: r.t:'.iJ.l(.e. 'J{!,; ikr;.(!,?J.I. a.t ~
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;.1;.0.dr.n.ll....J,... }(e.L.SA.t.L..
.O"t1.y.J..D...../J.1....ke..J.,$d.fl....
............/2?r:.T!J:f.I.::.....
........ ....r/.1./.'A.e..r:........
................................................................
......,.....................................
................................................................
................................................................
......................",.."........'......
................................................................
..................................................,............. ,............",.................,.......,.. ................................................................
........................................................"..,... ..........................."............... .........,......................................................
.......................................................,........ ........,..........................,........ ................................................................
................................................................ ............................................ ................................................................
................................................................ ........,...""............................ ................................................................
That those above named include all of the next of kin, so far as known.
The said decedent was possessed of pel'sonal propel't,\' to the estimated value of $.la;l.'O,c.'.D.....~i.c:i...
and of Real Estate. Icss incumbrance, to the estimated valne of $..3.:0rO,C.Cl.<.!:'!.Cl... as near as can be
ascertained.
That the said Real Estate in so fal' as is known is located in .JJe..:j.i.?~!.(,!O'.D...)!r.i./..I.I.f'.e?.....
........E...I!J..O,/..,,/J..,...?4........................... ....... .............. ............ ........................ .......... ...... ..................,.....................
Therefore, your petitioner(s) I'espectfully apply(ies) fOI' Leltel's of Administration in the above
named estate.
Dated ........~p.):;.:j)....}........... ............. A. D.. l\l..El.~"
Slgnature and Addr"ss
A/ c?;~ /
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....1!\4.!.;-:.,,:,/....Pf..;,~~-.!...4....................
of PetitiOllt't'(~)
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L-:---
COMMONWEALTH OF PEi\':\SYL\'Ai\'IA
I
} HH:
COUNTY OF CUMBERLAND I
........:...... ........ .VQf!../1( ./1... J,...kr:.. /...5)1/,./..,..'1:....1)111/ 1.D.. .//1! .lre,.l~:Il?l..... ......... named
in the above application being dul)' ..........;?.!:~/.(!.!:?..lJLJff...,... according to la\\', Ha,' that the facts set
\C /I'
forth in the above application are tl'110 to the best of ...1...... .... knowledge and belier.
~~;~;~..~~.......... ........ ............... ........... and Hn bSCl'ibed] ..'?~.. .:.... .:........)2;:. ... ..;.~....... .... ........................
..A..f)~J,.I(..Z:;.;~;...<f'Zt~.."....t7..:;;;........................
lI._p l"'J. 1 ':! A I) 108' /..,...-.......-~~, ~...--:-~l"-t:....--'
........"',."....".................................;....... . " J....;,.... .. .""''-...,. ......................................... ..........................
...//21.&jl..(!.:..,;:~~;;::.~.~.':~/.....:..........
(~' tI 7"'" Register
Filed:. .......April...14....B8L..........................
....,...."...................................,........................................
OATH OF
All(JI'ne)' :~f~jf~.f.,<.a.!...~...:t2.<J.u:L~~J /-
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.cddazt;.upu A(,llt>S7
PERSONAL REPRESEN A TIVE /
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} ss:
..f.I0.l!.lJ1.s...J!...ke..i5.IJ..U...~...D..I.1..I!..iI)..Jl1.!..&..J.Sf.l..t..t......,........................., petitioner(s)
being duly .........._,K2&c.~,!:z'!;;!<.q,.t.,(,............. aecording to law do ............ depose and say that as the
., ,!1om/l,)1'::o7RIiIOe f)' J f,,/L L
adnllmstra~/.}...!'l,....... of the estate of ............U~'>.~/.J..............l.l.e...,...~I.l.t.,................................................
~~~~~~~~. ...,y.I..~....~i.......... .,;~.;;; ..;~;;. .~.~~.. ~.;~ ;;.. .~~.~;~;~~~~. ;.~~. ~~~~~' ~~~' .~~~.~~.~;'~:. .;;;~ ~.~..,~.~~.~;~~.;~~ .~~. ~~;~
deceased, according to law. And alHo will diligently comply with the provisions of the law relating
to Transfer Inheritances.
..............$.~9.+.D.......,....,................... and subscribed
before me.
......,:b.P.d.L,..~.....................,..... A. D., 19...l'U..
{/;? 2 )-X!. I
R~.~!f;f....(~:.....6y,e.t.::,:~r,'~:...........,.........
.../!<.rI.7ML);:.,.."~n.,.,eg"',...........................
.d..4.?:.?:/:ft...&~c.L/:......,..........,.....,.......
DECREE
Be it remembered that on the ......J.1:.\:.h............... day of ......!W.+.,U............................. A. D., l~l.....
Letters of Administration in the estate of .....,!;lp,ris...J.....Ke lsa 11.................................,....................... ....
......... ...........'...................,.............. ........................... late of .... ...Eas.t. ..P.ellos.bo.ra ..Xo.WIl ship. .....,............
Cumberland County, Pennsylvania, deceased, were granted w ....!':l:9~mi\..,.7."...K'?ll'!i:\:\..:I....i\n9...p.;;w,i.d M.
...... ....!S~JJ?;;\ J;\'.. ...........,.... .............. ..,....... ............ .......... .. ......,.............. ......... ,.................., ................... ........... ..........
Witness my hand and ofllcial Heal the day and yeaI' aforesaid. I .', .
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........................,(.."ft.;{..y....n....'.!,1;,i~j~~:~::......
21-81
No."......."........,..........,.
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Renunciation and Request
---------
In the Matter of the Estate of ::..JIl.f}::.~....(j......*d,:L!J.,i!..~.I""''''''''''''''''''''''''''''''''''''''''''''''''''''''
\... ~,)
To ......,..1.'l.(zlr,.t,;/(.t{..d..f,.<..u,........,......,.............,.............................., Esq., Register for the Probate of
Wills and granting Letters of Administration for the Cou nty of Cumberland, in the Commonwealth of Pennsylvania.
..........,', the undersigned, being the ....h_:a.?:i./...............................................................................................
..................................................................................................................................................................................................
..................................................................................................................................................................................................
...... ..........................................................................................................................................................................................
..................................................................................................................................................................................................
doefiereby reneunce ......,~L.L...........................right to have Letters ....f."f.....tldZ!.u~~~
....... ...................... ...... ..... ........ ....... ... ................ on said Estate issued to .. ... .......~-:... .............................. ......................
................................................................................................. .................................., and do.,fiereby request you to grant
the same to .t;l~2cV.9.,..';1{.!.u.Lt:....(M.?i..df2.t.~c.C?.../2Z...&.~.d.......
'cL
Witness....mt.hand................and seaL...6.1Jthis..............G.....................................u..........................,......
day of .........ar1..,f.............................A. D. t9.fS..!
Sealed and delivered in presenee of
~2(ddL1lL~dm....
.......-........................................................................
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l.../I./.i. ({.-/J...;.,:....,1..(/,l6: L............. (L. S.)
.............................................,..................(L.S.)
...............................................................................
....,........................,.....................,..,.........(L.S.)
................................................................................
........................................................,.......(L.S.)
~~~:::::.:...::..::.:.:::::....::..:::::::::::.:::::..:.::'::::::::::::,::::::'.::
.........................................................,......(L.S.)
.........................,.......,......,...,....,.......,...,..(L.S.)
................................................................................
.......................................,........................(L.S.)
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J~%~:;n~~,Ef't;r:'<':;;',""'" .. ....COMMONWEALTH OFPENNSVLVANIA . .
~;~:g;K':0'~"477:0F~ICIAL~ECEIPT , PE~::~~~:~~~FI~~:~~;ANCE AND ESTATE T. AX
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TAXAT 6%
David N. KllI.11
RECEIVED" iI..... .anneybak.r
FROM .
TAX AT 15%
& 1.880 .... '.C.
IAXAT_~o
4000 Vinl st.
Middletown, PI. 17057
.desTAi'EINFCiRMAi'iCiN:--it'Uh-io-,--i9SC-------
DA TE OF DEATH
ADDRESS
ESTATE TAX
TOTAL TAX CREDIT
$9.38
DATE OF PAYMENT
21-81-240
May 1, 1981
!)Od. iI. Kels.ll
Cumber 1.nd
tESS DISCOUNT .47
m PLUS % INTEREST
(fRDM__ TO_I
m TOTAL AMOUNT PAID $8.91
FILE NUMBER
NAME OF DECEDENT
COUNTY
--------------------------------------------
POSTMARK DATE
I REMAR. KS:
"PAID ON ACCOUNT"
SEAL
RECEIVED BY
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SIGNATURE
REGISTER OF WILLS
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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David H. Kelsall and ~c>E~l!!_~~~!'.1.L.
b.ing duly "\{QJ:1l__ according 10 law, d.po... .nd s'y~ Ihat t h.Y---LlI.c.-L!J~
administrators of Ih. E.lal. of Doris J. Kelsall
1.1. of _.._.....__Eno1a -.' .._____, Cumberland Counly, P.., d.c....d .nd that tho
wilhin i. .n inv.nlory m.d. by ~hem .__ _. ., Ih. ..id administrators
of Ih. enlir. ..lale of ..id d.c.d.nl, con.i.ling of .lIlh. personal propdrly .nd r..1 e.lal., .xc.pl r..1 ..t.le oulsid.
th. Commonwe.llh of Penn.ylvania, .nd Ihallhe ligur.. oppo.il. .ach il.m of Ihe Inv.nlory r.pr...nt it'. f.ir v.lu.
a. of the d.l. of d.c.d.nt'. d.alh.
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19 S/
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D . d '1 K lX~~XAdm;n;lt..lo. s/i J KIll
av~ I.'. e saTr- Norma .. e sa
and .ub.crib.d before m.,
~
NANCY ,t!RHD. Notary Public
Middletown, Dauphin Co.. f-la.
My Cnmmi.~~i()f". E!(oires Oct, 17, 19A3
65-College A"p
~1~ H~rrling Street
Co1legevi11e, PA
19426 Add....
New Cumberland, PA
1/070
Oat. of O..lh
30-
Day
Harch
Month
1981
Vur
INSTRUCTIONS '"
,"
I. An inventory mu.t b. fil.d wilhin Ihr.e monlh. aft.r appoinlm.nl of p.rson.1 r.pr...nl.tiv.~~;
2. A .uppl.menl invenlory mu.1 b. filed within Ihirly day. of di.covery of addition.I....Is. fg~:
;n.vo
3. Additional .h.els may b. attach.d a. 10 person.lly or r..lly '';. ,~;
4. S.. Articl. IV, Fiduci.ri.s Act of 1949. 6';'
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REV.455 (1.00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEOENT
SCHEDULE "F"
STATEMEfJT OF DEBTS
AND DEDUCTIONS
_ .._.___ _.nn__ ..~_____'" ~.-
. ___....________ ______.u___
-_...__-:.,---,--,---,~--
File No. 8. /oJ" /-.:J!:IiJ
Estate of Doris J. Kelsall Dille of Death ~I~rch 30. 1981
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant
Claimant's Address
ITEM
NO.
DATE
NAME OF PAYEE
A.Z. Ritzman Assoc., Inc.
Tristan Associates
Philadelphia National Bank
Bell Telephone
P.P.&L.
East Pennsboro Township
Stone Funeral Home
Register of Wills
Kenneth H. Ginter, Treasurer
Commonweal th National Bank
Pannebaker and Associates P.C.
Mis
a
a
Harrisbur Hos ita1
Bell of Pennsylvania
Holy Spirit Hospital
Hess's
Phi1adel hia National Bank
PA Department of Revenue
Westwood Villa e
Cumberland Law Journal
Evenin Sentinel
Holy Spirit Hospital
Relationsllip to Decedent.
REMARKS
AMOUNT
X-rays
X-rays
VISA - final bill
Final bill
Electric bill
Sewer bill
$
Cremator ex ense
124.85
4.66
156.98
39.00
837.00
44.00
99.26
11. 46
Short certificates
1981 Real Estate taxes
Check printing charge
Le a1 fees
'ng fp-p-!=i
Medical ex ense for 1as i
Pa ment b decedent
Payment by decedent
Payment by decedent
Pa ment b decedent
1980 PA Individual State Tax
Deb t of deceden t
Estate Ad
Estate Ad
Medical ex ense for last illness
1
18.00
50.00
$32,045.47
TOTAL THIS PAGE
1 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,
SIGNATURE OF ATTOHNEY/FIDUCIARY
DATE
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S ~)I tJ1 !J-. '17 AT
.
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~ _GISTER FILLS
(p
PE RCENT.
Iii -5-f/
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedenl prior to his/her death are deductible against his/her taxable estate.
In addition to debts incurred by tile decedent or estate, other items are claimeble including the cost of administration,
attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone or grave marker.
All dehts being cluimed against un estate are subject to the approval of the Register of Wills with whom the
Inheritance Tax Return is riled. 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 of $2,000 may be claimed by a spouse of a decedent who died domiciled in Pennsylvania.
If there is no spouse, or if the spouse has forfeited his/ller rights, then any child of the decedent who is a member of
the same household can claim the exemption. In the event there is no such spouse or child, the exemption can be
claimed by a parent or parents who are members of the same household as the decedent.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the family exemption is being claimed, indicate the claimant's name, 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 has assumed the responsibility for paying the debts.
.JMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*
COUNTY FltE NO:
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DATE
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FltE NO.
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ESTATE
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DATE OF DEATH
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Appraised Value of Estate:
Real Estate
S;j'<1 ,/. (/ ({I
Personal Property
+..-.: ~;- I.. :5,:'''7 ,~.;;
Jointlv Held Property /Transfers
+
/ / ;~' 0
I
. / "", 'I;
. :,~'."
-
s
I
Tolal Gross Estate
Total Approved Deductions
., ' '/')
:. "'"J..l ,-, /i '; 'f I
/
Clear Valua of Estate
$ -I / /;':/) ,;;}
,
'-'-"~---- ------.-.-.
Less: Appr;:,ved Charitable Exemptions
Clear Value of Estate Subject to Tax
$1/ '7 /.,:,- ) /.;4.
/
Amount Taxabla @ 6% Rate
$ .1-/ ? ! ;"/ ~) :,,)-/./
/
tax due
re. -j / ',-
$ "', ~ "J . {?J -"
I
Amount Taxable @ 15% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
.-' :;: -j I -
$..../ v,;:', . (O~
/
* '* * * '* . A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
1)-_/, Y I
/..//-91
..
AMOUNT PAID DISCOUNT INTEREST TAX CREDIT
$ '/'1 + ~~ - $ $ I ;-: r"
.' / = -~ ,.::
,
'-7dd It- + //1 ;; II = ""//'/ --;; J
~ I
J
+ =
Interest accrues at tho rate of Six (6) percent par 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
.......',
$l /,,/
,.
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;J~J/..-
, ',,' /- ('/
Asselsed by: '. I' I "I,:i ;t; t
See Information on Rel/erse Side Ag.nfl~rlh.Commo{/ 1~.lth
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INFORMATION
To insuro proper credit to your account, the namo of tho estate and file numbor should be cloarly print-
ed on the chock or money order.
This i.lssossment is made in accordanco with Sl!clion 708 of the Inheritance and ESlillO Tax Act of
1961 (72 P.S. 9 2485,7081.
To the exlent that inheritance tax is paid within three (3) months ofter the dellth of tho decedent, a
discount of fiye (5) percent is allowad 172 P.S. 9 2485.716).
Inheritanco Tax. other than tax on 8 futuro interest, is due at the date of the decedent's death And becomes
delinquent at the expiration of nine (9) months after the decedent's death (72 P,S. S 2485- 711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer ti:lkes effect in possession and
enjoyment and is delinquent thereafter (72 P,S, 9 2485-712), Calculate interest from the dolinquent date shown
on the face of this form to tho date of aC1Ual payment using tho following interest table:
--------------------- - ----- ---- --- ---- ------ --- - - - -- - --- -------- -- -- - - - -- --
1 month .005 4 months .020 7 months .035 10 months .050
2 months .010 5 months .025 B months .040 11 months .055
3 months .015 6 months .Q30 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 '3 days .00220 23 days .00386
4 days .00068 14 days .00237 24 days .00403
5 days .00085 15 days .00250 25 days .00420
S days .00101 16 days .00267 26 deys .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 per!)onal representative, not satisfied with
the assessment may object thereto within sixty (60) days alter receipt of this Notice as provided by Section
1001 of thalnherltance 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:
COMMONWEALTH OF PENNSYLVANIA l
COUNTY OF CUMBERLAND J
55:
David M. Kelsall and Norma J. Kelsall
__.____._n~.._... _.. _"_______
----------------
being duly
sworn
according 10 law, depo... and .ays Ihal they. are administrators,__
Doris J. Kelsall
of Ihe E.lat. of
lal. of __._ _._.. ....nE:ll.().!.a...._......_ , Cumb.rland Counly, Pa., dec....d and th.1 the
within i. an inventory mad. by them __ ._____., the said administrators
of Ih. enl;r. .,Ial. of said dec.denl, con.i.ling of all the personal prop.rly and real .stat., .xcept r.al estal. outside
Ih. C.mmonw..lth of Penn.ylvania, and Ihat Ih. figur.. oppo.ile .ach ilem of Ih. Inv.ntory repr...nt it's fair valu.
a. of Ihe dal. of dec.denl'. d.alh.
C
..6..tlf--Cl~.,
)x&rtl}. ~#b'L. ,7~~ :I(,~'./I
Dav~a 1ft!- ,e ~Q r . Adminhtra~p.cIII u. ~1
.65 College Avenue 515 Harding Ave.
and .ub.cribed before me,
'1/20u- 1 G
'~,-12 Cu.'J..lU'-
(lml! ,I, CUSlE1l. HOIAllT PUllUC
WESl H!N~'.ER lWP., (),\"P~I~ ~OllNIY
1011 tfl'l!AISS10N E~PIRES JUN, A. 19d3
,,,,,,,Ile<, p",~I,"Ja ~~\llci'l~n .1 N.I"~
19 S'I
--
collegeville
New Cumberland
Address
PA,17070
PA, 19426
Dale of Death
30
Day
March
Month
1981
Yoar
INSTRUCTIONS
I. An inv.ntory must b. filed within Ihree months after appoinlment of personal r.pre..ntative.
2. A supplement inv.nlory mu.t b. filed wilhin Ihirly day. of di.covery of addilional a..ets.
3. Addilional .h..I. may b. attached as to personally or really
4. S.. Article IV, Fiduciari.. Act of 1949.
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SUPPLEMENTAL
Inventory of the r.el and personal e.tote ~f
Doris J. Kelsall
d.ceosed.
Real Property
Condominium, 818 Charlotte Way, Westwood Village, Enola,
Cumberland County, PA 17025 as recorded in Cumberland county
Recorder of Deeds Office 12-2-80, Book F, Volumn 29, Page 652
Sale Price
Previously inventoried
$ 48,400.00
35,000.00
Additional Amount
$ 13,400.00
13,400 00
, .
Personal Property
Tax Refunds - Florence Stauffer
Refund of county Tax
Refund of School Tax
$ 22.84
335.85
$ 358.69
358 69
TOTAL
13,758 69
I
/
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
'l
J
ss:
David M. Le1sa11 and Norma J. Kelsall
being duly __~~_____ according to law, depo... and s.y. th.1 they._ arc~<!mini~.!:.~t~.r.~__.._._
I h E I Doris J. Kelsall
_____. __ 0 I e .Ial. 0 __ ._______._______
1.1. 01 ____.Jno1a.__ _..._._.__._._____.____._, Cumb.rland Counly, P.., d.c....d .nd Ihellhe
'th" . I d b them th 'd administrators
WI In 15 an Inven cry ma c y _ __ H_ ----.-, e sal --------------
ollhe .nlire ..Iale ol.aid d.ced.nl, con.i.ling 01 al1lh. p.rsonal property and real ..lal., .xcepl r.al ..Iale outside
the Commonweallh of P.nnsylvania, and Ih.llh. ligur., oppo.if. e.ch ifem of Ih. Inventory repr..enl il'. f.ir value
a. of Ih. dale of deced.nl'. d.alh. ..1 ~ / // I- ... /// aT'-
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1llJ,.J0/~}1 and subscribed before me, '-j/ . /~.1
/f-ov;U,tL- 0., xi~- <<.!tl/(/
( Davia 'M;' KerialTe,......'o-r 'A-d';;-;,-'-,-'Normlr"J';"Ke1s-all
19 _6_~_ CIJ . mlrlll ra or
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9
5 College Avenue
~~ !? G.Uitvc-
EilHH R. CU~1ER, ~r.L\RY. r'c.BlIL
WEST HMWVER lWP.. OloliPllltI I,D,INTY
MY COMMISSION EXPIRES JUNla. \983.
Memoor, P~"nsylvanii! Association 01 Not3fles
Collegeville, PA 19426
New Cumberland, r
... ..... .17.070
Addt."
Dale of Oealh ___ __.....3_~___._._........._.__._._MaE.~~.m _..._._____~.flL__u._.__. ----.
C'Y
lJ.onth
Yur
I.
2.
3.
4.
INSTRUCTIONS
An inventory must be filed within three months after appointment of persol1al reprcscnfatiYe,'
n
A suppl.menl inv.nlory mu.1 b. fil.d within thirty day. of di.covery of additional ....h. '!::;;
~-o:r
Additional ,he." may b. allach.d a. 10 personally or r.alty 3.jf
See Arlicl. IV, Fiduciari.. Act of 1949. j:~
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S UPPLEH!'NTAL I [ f
Inventory of lie real and personal estate 0
Doris J. Kelsall
Personal Property
PA. Blue Shield, medical payment
Erie Insurance Company, insurance premium refund
Internal Revenue Service, income tax refund
U.S.News, subscription refund
E.I.DuPont Company, stock dividend
Berg Electronics, credit union and life insurance
E.F.Hutton & Company, interest on cash management
Dauphin Deposit Trust Co., overpayment of interest
deceased
'-
$ 867 48
484 00
258 00
L8 00
80
358 22
407 L2
- 37 2L
$2,43L 83
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
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COUNTY FILE NO:
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DATE
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FILE NO.
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DATE OF DEATH;<'~(S.:- / :::;, /:iff/
Appraised Value of Estate:
Real Estato
Personal Property
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Total Gross Estate
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Total Approved Oeductions
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Clear Value of Estate
$ ,I '; /i. /:./'
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Less: Approved Charitable Exe,mptions
- .--.------
Clear Value of Estate Subject to Tax
$ ;' ~J ii/.. ,I) :;"J
$ /<: (1(/, .. :/</ tax due $ 1.~) ~ 1/'1
Amount Taxable @ 6% Rate /
- " , ' ,-" ,
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Amount Taxable @ 15% Rate tax due
TOTAL PENNSYtVANIA INHERITANCE TAX DUE S //";/ ;:.J /)'7
""" , - ,
'* '* '* '* .. '* A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
/1.- If/_PI
;.... ....
AMOUNT PAID DISCOUNT INTEREST TAX CREDIT
S /. "-'-}/f /1,. + $ $ = $ " -,,< i't) .F"v,
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Interest accrues at 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
$ i/~!'
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BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
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Assassed by: . /
S~8lnformlltion on Reverse Side Age 10 thecom7"llh
(..-
jJ'!FORMA TION
To Inliuro prapor crodit to your UCCOUnI, tho nruno of the t!state and file number should be clearly print-
od on tho chock or Inanov ordor,
This nnSUS!H110fll in m,l(lo In Ilccordanco with Section 708 of the Inheritance and Estate Tax Act of
1961 (72 P.S. fI 2405.7001
To 11m 0.-.1001 thnt lnhoritn"co In>:. is paid within three (3) months after the death of tho decedent, a
dlscellnt oil,," ([,1 porcent is nllowed 172 P.S. S 2405.716).
Inhfttilnr1CfI TOll, olhor than tox on a future interest, Is due at the date of the decedent's death and be conies
duUnquunt 01 tlw fJJ(plrllllon of nino (9) months after the decedent's death (72 P,S. 9 2485.711), Inheritancil
1'nll. on n 'utlHlJ intOlos! is payablo within three (3) months after the transfer takes effect in possession and
onJoYlllont ond is clollncluont lhorealt'er (72 P.S.!1 2485-712), Calculate interest from the delinquent date shown
on Ihll fucu 01 tlll!llorm lQ thl) clllto of actual pnyment using the following interest table:
---------..-- --- ------ - --------- ---,------------- - - ------- ------------ - - -----
1 monlh .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 doy. .00017 11 dnys .00186 21 days .00352
2 dnys .000:14 12 days .00203 22 dnys .00369
3 dny. ,00051 13 dnys .00220 23 days .00386
4 dny. .00068 14 days .00237 24 days .00403
6 days .00085 15 days .00250 25 days .00420
6 doy. .00101 16 days .00267 26 days .00437
7 doy. .00118 17 days .00284 2" days .00454
8 dnys .00135 18 dnys .00301 28 days .00471
9 dny. .00152 19 days .00318 29 days .00488
10 dny. .00169 20 dnys .00335 30 dnys .00500
.. - - -- ------ -- ------- - -- - -- - - - - --- -- - - - --- -- - --_._- --- - - ---------- ------
Any porty ill irHOrtHit, including the Commonwealth and the personal representative, not satisfied with
tho nS!i05Sn1l1nt Olny objllct thereto within sixty (60) days af:er receipt of this Notice as provided by Section
1001 ollhn Inherit.ne. nllll Estat. T., Act of 1961 (72 P.S. S 2485.10011.
Make check or money order payable to:
"Register of Wills. Agent"
Mail 10 the address listed below:
REV.4SS EX+ (3.eO)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER' INHERITANCE TAX
RESIDENT DECEDENT
SUPPLEMENTAL
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
~,
.
Estate of Doris J. Kelsall Date of Death 3/30/81
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
File No. 21-81-240
Claimant
Relationsllip to Decedent
Claimant's Address at time of Decedent's Death
ITEM
NO.
DATE
NAME OF PAYEE
REMARKS
AMOUNT
Jack Gaughen Realtor
East Pennsboro Township
council of Westwood Villag.
Settlement charge
Pro-rated Sewer Bill
f'ro-rated Maintenance Bill
4,115.00
3.39
9.29
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TOTAL 4 127.68
I hereby certify that to the best of my knowledge and belief the foregoing is a just and hue statement of debts, funeral
expenses and expenses of administration submitted to tba.estate as ded~uctio s f~r Inhe, 'tance Tax purposes.
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DATt'
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ .1/ /,f{ 1. ~ l' AT
/
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t+~REG'STER~~
C; % TAX RATE
/-//-/":2..
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsollsllod Ilohilitios incuned by the docedenl prier 10 his/her deolh ore deductible ogeinst his/helloxoble
051010, In addition to dehls incurred by the decedent or ostete, other ilerns ore c1oirnoble includiog the cost 01
odmlnlstrollon, otlornoy foes, fiduciory fees, lunerel ond buriol expenses including Ihe cost 01 0 buriel 101, tombstone
or grovo marker and other leloled huriol expenses.
All debh heing clolmed egainst an estate are subject to the approval 01 Ihe Register 01 Wills wilh whom the
Inhorltonco Tax Relurn is Iiled. Evidence to slJppurl Ihe decedent's or the estote's liability lor the debts being
claimed should he attached 10 this schedule.
A lomlly oxemption mey be clnimed by (I spouse 01 e decedenl who died domiciled in Pennsylvenia. 1/ there is
no spause, or il the spouse hos lor/elted his/her rights, then ony child 01 the decedent who is 0 member 01 the some
housohold can clnim the exemption. In the event thero is no such spouse or child, the exemption can be c10imed by
o poront or poronts who oro members 01 the some household as the decedent. The lomily exemption is allawoble only
egalnsl ossots which pass by e will or by the Pennsylvania Intestete Laws.
NOTE: Compenselion peid Ie an estale representelive; namely, an executor or administrator, lor services
porlormed in odministering an estate is reportoble lor Pennsylvania Incame Tax purposes. This toxeble Incame
Itelll should bo reported on lorm PA.40.lndividuallncome Tax Return.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. 1/ the lemily exemptien is being claimed, indicete the c1aiment's name, oddress and his/her relatianship to
the decedent. Enter "Iamily exemptlan" in the remerks calumn and the amount claimed in the amount calumn.
2. Assign cansecutive numbers ta each item listed.
3. Enter the dote on which each debt was incurred and/or peid.
4. Enter the names 01 each payee.
5. Pravide a brief explanation in the remerks calumn for each debt claimed.
6. Enter the amount al eech debt being claimed.
7. The lurm must be signed by the persan who has assumed the responsibility lor paying the debts.
IF ADDITIONAL SPACE IS NECESSARY USE 8h" x 11" SHEETS.
mjr
REV-4d EX+ 10-80)
COM.~O~WEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
STATEMENT OF
FIDUCIARY
(Instructions on R.vers. Sid.)
*
Estoteof OoriR.1. KplRol1
Dote 01 Deoth
M:lrf.h 10, lqRl
Last Address 818 Charlotte Hav
Westwood Village
Eno1a, PA
(CITYl (STATE)
Sociol Security No. 203-38-3234
Stote File No.
County File No. ;) / - Ii' 1- ,;)'1 D
17025
(ZIP)
I. Decedent died:
(xx) Intestote (without 0 will)
( ) Testate (Ieoving 0 last will--copy a"eched)
2. Is the filing of a Federal Estote Tox Return required for this estate? Yes_ No l(
3.
) Executor
(1) David M.
NOme(2)NQtl''' J
(xx) Administrotors
Kelsall
KQlr?ll
o:l
~
202-18-2689 (1)
Social Security No. 19) 2Q 1255 (2) :'"
""'
(2) 515 Harding Street ;;~
fr'J,,'J
New Cumberland. PA 17070;'1;;
(ZIP) ..:_J
5~;
Address (1) 65 College Ave.
.
;-~
C011egevi11e. PA 19426
(CITY) (STATE)
~
:)0
4. All correspondence should be mailed to (XX) Attorney
Fiduciary.
}.-:
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5. If an attorney is representing the estate, indicate:
..,
Name Pannebaker and Associates.P.C. Telephone No. (717) 944-1333
Address 4000 Vine Street. P.O. Box 510
Mi,1,11ot-nt.ln
(CITY) .
17nC\7
(ZIP)
Ph
(STATE)
List 011 safe deposit boxes registered in the decedent's individual namehar jointly with, or as an agent or deputy
of another, or in decedent's individual name with right of access by onot er as agent or deputy. Include the name
and address 01 the bank or other institution where the safe deposit box Is located, the name (s) in which the box
Is registered and the relationship of the joint holders to the decedent.
NAME AND ADaRESS OF aANK OR OTHER INSTITUTION
IN WHICH DECEDENT MAINTAINEa A SAFE DEPOSIT BOX
NAME OR NAMES IN WHICH
SAFE DEPOSIT BOX IS REGISTEREO
RELATIONSHIP OF JOINT
HOLDERS TO DECEaENT
None
Under penalties of perjury, I declare that I have examined this return, including eccampanying schedules and
statements, and to the best 01 my knawledg~_and belief it is .tr,u~~ cart.ect and complete.
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SIGNATURE OF FIDUCIARY
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PENNSYLVANIA INHERITANCE TAX GENERAL INFOBMATION
1. PERSONS RESPONSIBLE FOB BETURN
Section 701 of the Inheritance and Estate Tax Act of 1961 provides thatlhc followinl~ persons shall prellmc and file
a retnm:
.
a. The personal representative of the estate of the decedent as to property of the decedent administered by him
and such additional properly 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 trusl, provided that no separate retum 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 montlls after the decedent's death, unless an extension for filing has been applied for and
grante~ 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. PAYMENTOFTAX
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.
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 imprisonment not exceeding one year or both.
NOTE: Compensation paid to an estate representative; namely, an executor or administrator, for services performed
in administering all estate is reportable for Pennsylvania Income Tax purposes. This taxable income item should be
reported on form P A-40.lndividuallncome Tax Return.
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QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any material pari 01 his eslate without receiving
valuable and adeQuate consideration? (Answer "Yes" or "No".)
2. Did decedent, within two years of death, transfer property from 11imsel II hersell to himself/llersel f 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 certificate.
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 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".)
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".)
6. If the answer to five b. above is "Yes," state whether the right was reserved in decedent alone or 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".)
8. Did decedent, at any time, transfer property, the brneficial 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".)
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 the decedent and others? (Answer "Yes" or "No".)
R~V-4t13 E>P (3.80)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIAR IES
'*
(Instructions on Roverse Sir/oj
Estate of nnric 1 J(nlQ:111
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY
DECEDENT BIRTH
n.u,~ M Vale." 7/25/55 50%
65 College Avenue
Collegeville, PA 19426
-
Norma J. Kelsall morhlrr.- uae 111710< <"./
<;1 <; Hardina Srraar
New Cumberland, PA 17070
--
.
.
The above beneficiaries are living at this time except for the following:
NAME
DATE OF DEATH
mjr
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 ioint 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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PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritancc and Estate Tax Act of 1961 providcs that the following persons shall prepare and file
a return:
a. The personal representalive of the estate of tile decedent as to property of the decedent administered by' him
and such addilional 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 Ihal no separate fetum 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 montlls 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. FP.ILURETO 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 pcrsonally 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 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 llle 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 ilaye 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 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 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 P A.40-lndividuallncome Tax Return.
INSTRUCTIONS FOR COMPLETING SCHEDULE "B"
Schedule "B" must include all tangible and intangible personal property
owned individually by the decedent at the time of death. Property owned
jointly with another party or parties should be listed on Schedule "E" . . Jointly
Owned Property. Intangible personal property titled In the name of the decedent
but payable at death to another party or parties, including but not limited to
P. O. D. U. S. Savings Bonds and Tentative Trust Accounts, must be listed on
Schedule "B."
Tangible personal property should be listed first. Examples of tangible
personal property are jewelry. wearing apparel, household goods and furnishings,
books, paintings, automobiles, boats, snowmobiles, aircraft, etc.
Intangible personal property includes cash-on-hand and in the bank, stocks,
dividends, bonds, mortgages, treasury certificates, notes, tdgether with accrued
interest, salaries or wages, insurance payable to the estate or fiduciary in said
capacity, partnership interest. etc. An interest in any undistributed estate or
income from any property held in trust under the will or agreement of another
even though located outside of Pennsylvania at the time of death should be;::,:
listed on Schedule "B." "-;
A completed Partnership Interest Report (REV.894) must be attached for
each partnership or joint venture, and a completed Closely Held Corporate Stock
Information Report (REV.893) must be attached for each closely-held business
interest or sole proprietorship reported on Schedule "B."
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REY....'" EXt (&-80)
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
File Number
21-81-0240
GJ Original
o Supplemental
o Remainder
Estate Name
Doris J. Kelsall
Date of Death
Harch 30, 1981
Social Securi ty Number
203-38-3234
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser In and lor the Caunty 01 Cumberland
Pennsylvania, do relpectfully report that i bave appral..d the real and personal property as reported in the loregolng
retum at the valuel ..t forth oppolltlt each Item In the last column to the Ight In ~edules "A", "B", "C", ond "E"
Dated: Januarv 13, 1982 .....:J&/~ .~
RITANCE TAX A RAISER
AaJUSTMENTS REMAINDER APPRAISEMENT CODE
INYENTORY VALUE AS APPRAISED CODE (HARRISBURG USE ONLY)
Real Property (Schedule A) $ Hone 00+ 92+
Personal Property (Schedule B) 2 431 83 10+
Jolnt.H.ld Property (Schedul. E) 2lH
Tran.!... (Schedule C) None 30+
TOTAL GROSS ASSETS 2,431 83
Leu D.bts and Deductions 40- 93-
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Eltote RATE FACTOR PRINCIPLE VALUE CODE
--
o Annuity
EQJUISE OF REGISTER ONLY 9ll1.E. COMPUTATION OF TAX
Tax on $ 6% $
!
I Tax on $ 15% $
Tax on $ $
I
.. Tax on $ $
1
.,
I Ta~ on $ $
I Exemptions
I Total Estate
j TDTAl. TAX $
I INTEREST FROM TO $
I
I BALANCE S
I
I less Credits
DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST TAX CREDIT
I S + S 5 = s
I' + =
BALANCE 5
INTEREST FROM TO S
BALANCE DUE S
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PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 oi the Inheritnnce i1nd Estate TilX Act of 1961 provides thill the lollowing persons Sh,lll prepilre and file
a return:
a. The personal representative of the estate of the decedenl as to property of the decedent mlministered by him
i1nd such i1dditional property which is or milY be subjecllo Inheritance Tilx of which he/she sllilll hilve or
acquire knowledge;
b. The transferee of property upon the trilnsfer of which Inheritilnce Tax is Of milY be imposed by the 1961 Stiltute,
incfuding a trustee of property (rilns(erred in trust, provided Ihalno separale relum need be made by fhe tfilnsferee
of property included in the return of a personal representative.
2. PLACE FOR FILING
The feturn 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 monUls after the decedent's death, unless an extension for filing has been i1pplied for and
granted by the Secretary of Revenue within the nine-month period.
4. FAILURE TO FILE RETURN
Section 791 of the 1961 Stillute provides that" . . .any person who wiltfully fails to file a relurn or other feport
required of him. . .shall be personally liable. . .to a penalty of 25% of the tilX 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
taw."
5. TAX RATES
Inheritance Tax is payable at the rate of 6% on transfers to lineal descendants, such as father, mother, husband, wi fe,
son, daughter, grandchildren, graudpilrent, son-in-law and daughter-in-law and at the rate ef 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 unti I payment is made. All payments received are fi rst appl ied to any
interest which may be due with i1ny 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 againsl.any property belonging to a transferee liabte 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 imprisonment not exceeding one yeaf or both.
NOTE: Compensiltion poid to an estate representative; namely, an executor or ndministrator, for services perfonned
in administering nn eslilte is reportable fOl Pennsylvnniil Income Tax purposes. This tnxilble income item should be
reported on form PA-40-lrlltividunllncome Tax Return.
,~
"
SUPPLEMENTAL II
REV.451 EX+ (3.S0)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*'
(Instructions Oil Rovorsc SidoJ
Estate of
Doris J. Kelsall
I
I
!
I
I
I
, I
I
I
I
I
I
.1
ESTI MATE D DEPARTMENT
ITEM DESCRIPTION UNIT MARKET VALUATION
NO. VALUE VALUE (OFFICIAL USE ONL YJ
Personal Property
PA. Blue Shield, medical paymen t $ 867.48
Erie Insurance Company, insurance premium refur~ 484.00
Internal Revenue Service, income tac refund 258.00
U.S.News, subscription refund 18.00
E.I.DuPont Company, stock dividend 1. 80
Berg Electronics, credit union & life insurance 358.22
E.F.Hutton & Co., interest on cash management 407. 12
Dauphin Deposit Trust Co. , overpayment of inter st 37.21
',' ,.
'- .. o.
I
,
I TOTAL THIS PAGE $2,431.83 A', 1.-1/ $;1 .11
,
I
I A'l-'
REV-S18 FO (7.80) "
",1:
'r,;~~
NOTICE OF FILING OF APPRAISEMENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
Ms. Norma J. Kelsall
515 Harding Street
New Cumberland, PA 17070
Mr. David M. Kelsall
65 College Avenue
Collegeville, PA 19426
RE: Estate 01
County 01
File No.
Doris J. Kelsall
Cumberland
21-81-0240
Dear Ms. Kelsall and Mr. Kelsall:
You are hereby notified that the original
appraisement in the estate of Doris J. Kelsall
has been filed in the office of the Register of Wills 01 Cumberland
County on Januarv 13 , 19!!1.. Said appraisement reflects the following valuations:
Real Estate S 13.400.00
Personal Property 358.69
Jointly Owned None
T ranslers None
Total S 13.758.69
As to such tax that is paid within three months from date of death, a five (5%) percent
discount is allowable. As to any tax thot 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 of death, interest at the rate of six (6%) percent
per annum is charged.
Any party in interest who is aggrieved by this notice may abject thereto within sixty days
after receipt of said notice as provided by Section 1001 01 the Inheritance and Estate Tax Act of
1961,72 P.S. 2485-1001, P.L. 373.
Date
January ~3, 1982
S;"., ~<,d'r"'-
Title Chief Appraiser
NOTE: This is not a bill.
REV-U4 EX+ (HO)
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
FII e Number
21-81-02'10
GJ Original
o Supplemental
o Remainder
Estate Name
Doris J. Kelsall
Date af Death
March 30, 1981
Sacial Security Number
203-38-3234
REPORT OF INHERITANCE TAX APPRAISER
I, tho undorlignod duly appointod Inhorltonco Tox Appralsor in ond for ,ho County of Cumberland
Ponnsylvania, do respoctfully roport that I havo appraisod ,he rool ond porsonal proporty os reportod in tho lorogoing
return ot the valuo. ..t forth opposite eoch Itom In tho los' column 19 the rl ht In S~ules "A", "B", "C", ond "E"
Doted: Januarv 13, 1982 .....:...0 I%r.-t 4-vt-'
ITANCE TAX APP
VALUE AS APPRAISED ADJUSTMENTS REMAINDER APPRAISEMENT CODE
INVENTORY CODE (HARRISBURG USE aNLY)
Rool Property (Schedul. A) S 13 400 00 aa+ 92+
Porsonol Property (Schedule B) 358 69 1a+
Jolnt.Hold Proporty (Schodulo E) None 2ll+
Tronsf.rs (Schedule C) None 3a+
TOTAL GROSS ASSETS 13 758 69
Len D.bts and Deductions $ 40- 93-
(SCHEDULE F)
CLEAR VALUE OF ESTATE
OLlie Esta,o !!ill FACTOR PRINCI PLE VALUE CODE
o Annuity
FOR USE OF REGISTER ONLY
Tax on $
CODE
COMPUTATION OF TAX
$
$
$
$
6%
T ox on $
15%
Tax on $
Tax on $
T aX on $
$
Exemptions
Total Estate
TOTAl. TAX
INTEREST FROM
BALAtlCE
TO
$
$
$
Leu Credits
DA TE OF PAYMEtlT
AMOUtlT PAID
TAX CREDIT
5
$
, ~
INTERlST FROM
BALAtlCE DUE
'"
'M
.<::
W
~ >, ~
~ ~ ~ 0
.... III W '" 0'1'
.... :3' bO lD
Z >>l >>l III nl 0
0 >- >- W .. .... H
.... +> .... 0
>>l .. +> 'M ,Q
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H 'tiP '" III '"
...l r, III 0 ...... N
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- W U ..
U Z 'M +> +>.0
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~ 0 .... ~ nl ;;l ....
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0 ~ ci
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-
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"
1981 Ford Escort, Per Appraisal
1980 Kawasaki Motorcycle, Per Appraisal
Household Furnishings, Per Appraisal
Erie Insurance Company, Insurance Premium Refunds
Internal Revenue Service, Income Tax Refund
PA Blue Shield, Medical Payment
Florence Stouffer, Refund of Property Tax
U.S.News, Subscription Refund
TOTAL PERSONAL PROPERTY
AFTER ACQUIRED PROPERTY
Commonwealth National Bank, interest on Trust
Account 92445-01-4
TOTAL AFTER AQUIRED PROPERTY
TOTAL DEBITS
CREDITS
YOgR ACCOUNTS CHARGE THEMSELVES AS FOLLOWS:
Cumberland County Register of Wills:
Stock Inheritance Tax
Inheritance Tax
Filing Fee
Commonwealth National Bank:
Check Charge
Trustee Fee
David M. Kelsall, Short Certificates
Norma J. Kelsall, Various Bills of Decedent
Tristan Associates, Doctor Bill
L!:~R 100 i'~;t 598
$ 5,900.00
1,170.00
710.00
484.00
258.00
867.48
358.69
18.00
$45,949.12
$ 2,003.06
$ 2,003.06
$96,352.18
$ 8.91
3,423.93
6.00
11.64
18.20
4.00
582.00
15.60
A.Z.Ritzman Associates, Doctor Bill
Holy Spirit Hospital, Hospital Bill
PA Department of Revenue, Individual Income Tax
PhiladelphIa National Bank, Visa
Bell of Pennsylvania, Telephone Bill
P.P. & L., Electric Bill
East Pennsboro Township, Sewer Bill
Riverton consolidated Water Company, Water Bill
Dauphin Deposit Trust Co., Mortgage 010121214915
Kenneth Ginter, Real Estate Tax
Council of Westwood Village, Condo Maintenance
Erie Insurance Co. Fire and Owners Liability
Jack Gaughen, Realtor, Settlement Charges
Pannebaker and Associates, P.C.:
Costs Advanced, Probate Will, Estate Ads, Filing
Attorney Fees, on Account
TOTAL PAID CREDITS
Reserved to Pay:
$ 1.60
50.00
28.43
124.85
4.66
208.00
81. 39
19.84
21,359.74
550.89
233.29
90.00
4,115.00
94.00
2,000.00
$33,031.97
pannebaker and Associates, P.C., Balance of Fees $ 2,788.18
Misc. FIling Fees and Taxes 200.00
TOTAL RESERVED TO PAY $ 2,988.18
TOTAL CREDITS - RESERVED AND PAID $36,020.15
USER 100 r~~[ 599
RECAPITULATlON
BALANCE FOR DISTRIBUTION
$ 96,352.18
36,020.l5
$ 60,332.03
TarAt DEBITS
TOTAL CREDITS
BALANCE FOR DISTRIBUTION CONSISTS OF THE FOLLOWING:
1981 Ford Es cort $ 5,900.00
1980 Kawasaki Hotorcycle l,l70.00
Household Furnishings 710.00
E. 1. DuPont DeNemours Co. Common Stock 148.50
Cash 52,403.53
TOTAL FOR DISTRIBUTION $ 60,332.03
Respectfully submitted:
hfZ/~&J~
David M. Kelsall, Adminis trator
~~lU- () xit~ tlLJK/.
Norma J. ~~lsall, Administrator
Dated:
)
{lfbC 4.19f'1
L!)~R 100
;Hr~,
jj./,vl..
GOO
J
REV. 1593EX 111-a2)
PENNSYLVANIA DEPARTMENT OF REVENuj
BUREAU OF ACCOUNTS SETTLEMENT
P.O. BOX 2055
HARRISBURG. PA 17105 _ ._._~~~~..~~~___ DATE _~..:.Q.4.-~~
EST,~TE OF KELSALL DORIS J FILE NO. 21 8l-0240
DATE OF DEATH o.l=lO.::fl.1 C;:Jl.UIIIT..'L._ GUMB.ERJ"l\lm
NOTE: TD INSURE PROPER CREDIT TO YOUR ACCOUNT sueMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS OF THE ABOVE COUNTY. MAKE CHECKS PAYAeLE TO "REGISTER OF
WILLS, AGENT."
INHERITANCE TAX
ASSESSMENT
CONTROL NO.
lOl
JAMES B PANNEBAKER ESQ
4000 VINE ST
PO BOX 510
MIDDLETOWN PA l7057
PLEASE RETURN THIS
PORTION TO REGISTER OF
WILLS IF PAYMENT DUE
~1:J'r: _A.!-9~~ _ -r:Hl~ _L!I'!.E_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .
"INHERITANCE TAX RECORD AOJUSTMENT"
ESTATE OF KELSALL
DORIS
J FILE NO.2l 8l-0240
ACN lOl
OATE 03-04-83
ADJUSTMENT BASED ON:
ADMINISTRATIVE CORRECTION
VALUE OF ESTATE:
1. Real Estale ISchedule A) III 48,400.00
2. Stocks and Bonds (Schedule B) I 21 .00
3. Closely Held Stock/Partnership Interest (Schedule C) I 31 .00
4. Mortgages and Noles (Schedule Dl I 4) .00
5. Cash & Miscellaneous Personal Properly (Schedule E) ( 5) 46,230.25
6. JOintly Owned Property (Schedule Fl ( 61 l,133.28
7. Transfers (Schedule G) ( 71 .00
B. Total Gross Assets ( 81 95,763.53
OEOUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Administrative Costs/Miscellaneous .00
Expenses (Schedule HI ( 9)
10. Debts/Mortgages/Liens (Schedule I) ( 101 36,173.l5
11. Total Deductions 1111 36,173.15
12. Net Value of Estate (121 59,590.38
13. Charitable Bequests (Schedule Jl (131 .00
14. Net Value Subject to Tax 1141 59,590.38
TAX:
15. Amount of line 14 taxable at 6% rate (15) 59,590.38 X.06~ 3,575.42
16. Amount of line 14 taxable at 15% rate (16) .00 X.15o .00
17. Principal Tax Due (17) 3,575.43
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+1 AMOUNT PAID
DATE # INTEREST 1-1
... SUMMARY OF1 ALL 05 PAYMENTS **.
Dl-21-B3 070547 l42.58 3,665.75
. IF PAID AFTER OATE INOICATED SEE REVERSE FOR CALCULATION
OF ADDITIONAL INTEREST
RETAIN THIS PORTION FOR YOUR RECOROS
TOTAL TAX CREDIT
eALANCE OF TAX OUE
INTEREST
TOTAL DUE
3",JiQ!
232.90CR
.00
232.90CR
(If Balance Due IS less than S 1.00 no payment IS requIred)