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OATH OF I'ERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ss:
COUNTY OF CUMBERLAND
Before me, the Register for the Probate of Wills and granting of Lellers of Administration in and for the County of
Cumberland, personally came J:1Y r.. r.h:lmhprl in :'lnrl Hplpn '<1. IHnl(lt:>
, do
depose and say that as
F.xPl'lltOl"!;
who, being dulY....JLwnTn
Bf'lrnnrn \~. Chambp-r] in
deceased
of the last Will and Testament of
thpy will well and truly administer the goods and ehallels, rights and credits of said deceased according to law. And
also will diligently comply with the provisions of the law relating to Transfer Inheritances. Sworn and subscribed before me.
A.D., 19..!ll-
April IS .
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DECREE
Be it remembered that on the_.2l5.t....-day of
April
,A.D.,I9~, there was probated and
Bernard W, Chamberlin
recorded the last Will and Testament of
late of
Borough of Shippensburf(
,Cumberland County, Pennsylvania,
Jay C. Chamb~rlin and Helen J.l. Hinkle
Deceased. Lellers Testamentrv were granted to
Witness my hand and official seal the day and year aforesaid.
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Register
4. Life Ellele D 5. Federal Estale Tax 0
Return Required.
6. Decedent died testata fX1 7. Decedent mainteined a living D B. Number of safe deposit D
(Attach copy of Willi ~ trull (Attach copy of trusll boxes inventoried
All correspondence and confidentialt.. information should bo directed to:
REV.1500 EX + (9.81)
t;UREAU OF EXAMINATION
PENNSYLVANIA DEPARTMENT OF REVENUE
P.O. BOX B327
HARRISBURG. PA 17105
INHERITANCE TAX RETURN
RESIDENT DECEDENT
/ cJ.3& - .;:1
Decodent's Nama (Lell. First. en
DECEASED . l'0bQ.X"\'~
Social Secunty Numbor
~Q~. 41~
CHECK 1. Driginel Return W
APPRO.
PRIATE
Middlo Initiall
tmll.f'O W.
Date of Daeth
-Ol.~l
2. Supplemontal Return D
BLOCKS
CDRRE.
SPDNDENT Name
Recapitulation
1. Real Estote (Schedu!e A) (11
2. Stocks and Bonds (Schedule BI ( 2)
3. Closely Held Stock/Partnership Interest (Schedule cl ( 3)
4. Mortgages and Notes (Schedule 01 ( 4)
5. Cash & Miscellaneous Persona! Properly (Schedule E) ( 51
RECAPIT. 6. Jointly Owned Property (Schedule F) ( 61
ULATIDN 7. Transfers (Schedule G) ( 71
8. Total Gross Assets (total lines 1.7)
AND 9. Funeral Expenses Administrative Costs/Miscellaneous
Expenses (Schedule HI ( 9)
TAX 10. Debts/Mortgages/Liens (Schedule II (10)
11. Total Deductions (total lines 9 & 101
12. Net Valuo of Estate !line B minus line 111
CALCU. 13. Charitablo Bequests (Scheduie J)
LATIDN 14. Net Value subject to tax lIine 12 minus line 13}
DOl,C>OO.D~
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3, (" S O. 5C\
Computation uf Tax
15. Amount of line 14 taxable at 6% rate (15) 51.\ I DO a .\ d....
!include values from Schedulo KI
16. Amount of line 14 taxableatl5% rate (16)
(include values from Schedule K)
17. Principal tax due (add tax from line 15 plus tax from linol6)
lB. Total Prior payments'
(a) Amount Paid
(b) Pius Discount
(cl Minus Interast (1BI
19. aalanceDue!lino 17 minus line lB)
Make Check Payable to' Register of Wills. Agent
... PLEASE RECHECK MATH...
File Number J, I - ~ I. 0 do SO
11 d. 5'7
3. Remainder Return 0
State
Zip
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(191
Under penalties of perjury. I declare that I have examined this raturn. including accompanying schedules and statements. and to the best of my knowledgo
and belief, it is true, correct, nd complete, Declaration of preparer other than the personal representative is based on all information of which preparer has
any knowledge.
ADDRESS
SIGNATURE OF PREPARER OHlER THAN REPRESENTATIVE
ADDRESS
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PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
I. 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 knowl edge;
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 penally 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. AI! 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. FILlN GO F FALSE RETU RN
Any person who willfully makes ~ 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 bOU1.
NOTE: Compensation paid to an estate representative; namely, an execulor or administrator, for services performed
in administeling an estate is reportable for Pennsylvania Income Tax purposes. This taxable income item should be
reported on form P A-40-lndividuallncome Tax Return.
REY-4!'lO ~xt (to-SO)
COMM'OHWEA~ TH OF PENNSY~ VAWA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEOENT
Bernard W. Chamberlin
SCHEDULE "A"
REAL PROPERTY
(Instructions on Roverse Side)
ITEM oESCRIPTIOH ESTIMA TED oEPARTMEHT
NO. MARKET VALUATION
VALUE (OFFICIAL USE ONL YI
I. Residence, 10 South Washington Street, Shippensburg, PA 32 ,ODD. 00
17257
TOTAL 32,000.00
If additional space is necessary, use aW' x 11" sheets.
1. Did decedent, within two years 01 death, make any tmnsfer of any nwterial pari of his estilte wilhout receiving
valuable "nd adequate considemtion? (Answer "Yes" or "No".) no
2. Did decedent, within t\lll years of death, Iransfer property from himself/ herself to himself/herself and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) ...ill\-.
3. If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxahle, provide the following
information:
a. Age of decedent i1t time of transfer.
b. Copy of death certificate.
c. Affidavit by the attending physician indicilting the state of decedent's health at time of tmnsler.
d. All other information supporting nontaxability 01 tmnsler.
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 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 vaiuable and adequate consideration therefor
under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end belore his/her
death:
a. The possession or enjoyment of or the right to income lrom the property transferred? (Answer "Yes" or "No".) M
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. above is "Yes," was the right reserved in decedent alone ( ) or decedent and others ( ).
7. Did decedent in his/her lifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefi t or care of transferor? (Answer "Yes" or "No".) nO
8. Did decedent, at any time, transfer property, \he bmeficial enjoyment of which was subject to change, because of
a reserved power to aller, amend, or revoke, or which could revert to decedent under terms 01 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 ( ).
QUESTIONS CONCERNING PROPERTY TRANSFERS
,REV,453 EXt (3,80)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "D"
BENEFICIARIES
.
(Instructions on Rev<,'rsn Side)
Estate of
Bernard W. Chamberlin
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE 0 F INTEREST OF BENEFICIARY
DECEDENT BIRTH
-
Jav Chamberlin ves . 1 nf 00'0'0
son
Helen Harie Hinkle dauohter ves 1 of estate
.-
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------ -- ---- -
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-
-- --
. I
Tha above benaficiaries are living at this time except for the following:
NAME
DATE OF DEATH
P
TOTAL E VALUE OF DEPARTMENT
R
MARKET. C DECEDENT'S VALUATION
VALUE E INTEREST (Offic;al Use Dilly)
N
T
5,329.85 50% 2,664.92
1,971.33 50% 985 .67
REV.454 (lotIO)
.CDMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
(InstructiO/lS on Rfwcrse Sic/a)
Estate of
Hnrnn~~ W ~hnmherlin
ITEM
NO.
DESCRI prlON
I.
Savings account, Peoples ~Iationa.l Ban:,
2.
Checking account, Peoples National Bank
l
TOTAL THIS PAGE
3,650.59
.'
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 (or 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 (5) 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.455 EX+ (3.80)
COMMONW.EAL TH OF PENNSVLVMllA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
Estate of Bernard W. Chamberlin Date of DeathApri 1 I, 1981File No.,) / . 2/ ..,)5'0
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant
Claimant's Address at time of Decedent's Death
ITEM OATE
NO.
I
2
3
4
5
6
7
NAME OF PA YEE
Co.
11.0.
J. Paul Fogelsanger Ins. Agency
Penna. Electric Co.
Ortho edic Associates
Fa Ison er Funeral Home
o.
d. Tax Collector
15 Boro of
16 Fete's
.enna. Electric Co.
18 Penna. Electric Co.
19 Penna. Electric Co.
20 aker & Russell
21 Forest N. M ers, Esquire
Relationship to Decedent
REMARKS
AMOUNT
Water & Sewer
Telephone service
Professional services
Fire Insurance
Electric service
Professional services
Cleanin furnace
Professional services
Electric service
R -ir of washer
67.75
6.33
294.00
81.00
13.74
15.00
87.27
200.00
19.77
10.00
of a
Real Estate Taxes
Water & Sewer
Service call
Service
Service
Service
Fuel Oil
At torney fees
2.82
5.50
5.45
116.00
1,250.00
TOTAL
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 ~~i. ~r,a,te.)) ~ed_Yy'!~~~~;~.lnheritance Tax purposes.
'J. r' (.l,. '}..,L.. 11/17/Rl
II , SIGNATURE OF FIDUCIARY DATE
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $
AT
% TAX RATE
REGISTER OF WILLS
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxable
estate. In addition to debts incurred by the decedent or estate, ather items are claimable including the cast 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.ta 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 same
household can claim the exemption. In the event there is no such spouse or child, the eXlll11ption can be claimed by
a 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 Intestote Lows.
NOTE: Compensotion poid to on estate representative; namely, on executor or administrator, far services
performed in administerir,g on estate is reportable for Pennsylvanio Income Tax purposes. This taxable income
i tern should be reported on form P A.40.lndi vidual Income Tax Return.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the family exemption is being claimed, indicate the claimant's name, oddress 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 an 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 far paying the debts.
IF ADDITIONAL SPACE IS NECESSARY USE B%" x 11" SHEETS.
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INFORMATION
This document is the Notice required to be given under Section 709 of the Inheritance and Estate Tax Act
of 196 I (72 P.S. section 2485).
If the tax is paid within three (31 months after the decedent's death, a discount of 5% of the tax paid is allowed,
Inheritance Tax becomes delinquent nine (9) months after the decedent's death, Interest is charged at the
rate of six (6) percent per annum on the amount of unpaid tax, (SEE EXAMPLE BELOW)
EXAMPLE: If a balance of tax due of $2.000,00 is in a delinquent status from 3-3-80, and payment is made
on 5-23-80, the interest is calculated as indicated below:
STEP 1
Determine the rate of
interest from the table below,
STEP 2
Multiply the balance of
tax due by the rate of
interest.
STEP 3
Add the interest
to the balance of
tax due,
Interesl from 3-03-80 10 5-23-80
Results in:
Balance of tax due
Rate of interest
INTEREST
$2.000.00
x .01335
$ 26.70
=
Balance of tax due
Plus Interest to
Date of Payment (+)
TOTAL tax .nd
interest to Date
of Payment
$2.026.70
$2.000.00
$ 26.70
2 Months =
20 D.ys
Rate of interest
.010
= + .00335
.01335
---------------------------------------------------------------------
, month .005 4 months .020 7 months .035 1 0 months .050
2 months .010 5 months .025 8 months .040 , 1 months .055
3 months .015 6 months .030 9 months .045 1 2 months .060
I d.y .00017 " days .00186 2 1 d.ys .00352
2 days .00034 12 d.ys .00203 22 d.ys .00369
3 days .00051 13 days .00220 23 d.ys .00386
4 d.ys .00068 14 d.ys .00237 24 d.ys .00403
5 d.ys .00085 15 days .00250 25 days .00420
6 days .00101 16 days .00267 26 days .00437
7 days .00118 17 days .00284 27 d.ys .00454
8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 days .00318 29 days .00488
10 d.ys .00169 20 days .00335 30 days .00500
---------------------------------------------------------------------
Any party in interest, including the Commonwealth and the personal representative, not satisfied with the
appraisement and assessment may object within sixty (60) days after receipt of this Notice as provided by
Section 1001 of the Inherit.nce .nd Estale Tax Act of 1961 (72 P.S. sec. 2485 - 10011.
MAKE CHECK OR MONEY ORDER PAYAaLE TO: "REGISTER OF WILLS. AGENT"
DETACH THE TOP PORTION OF THIS FORM AND SU8MIT WITH YOUR PAYMENT TO THE REGISTER OF WILLS FOR
THE COUNTY SHOWN ON THE REVERSE. SEE THE INHERIT ANCE TAX INSTRUCTION 800K FOR ADDRESS.
REV'1500-EX+ !g.ell //-c./3 {-3
BUREAU OF EXAMINATION
PENNSYLVANIA OEPARTMENT OF REVENUE
P.O. BOX 8327
HARRISBURG, PA 17106
Decedent's Name I Last, First, and Midd!e Initie!!
Chamberlin, Bernard H.
Social Security Number Date of Death
180-05-7413 4/1/81
DECEASED
CHECK
APPRO.
PRIATE
BLOCKS
CDRRE.
SPDN DENT Name
RECAPIT.
ULATION
AND
TAX
CALCU.
LATION
INHERITANCE TAX RETURN
RESIDENT DECEDENT
File Number
21 81-0250
Decodenl's Address
South \;ashington
Shippensburg, PA
Street
17257
1. Original Return D
2. Supplemente! Return D
3. Remeinder Roturn 0
4. Life Esteto0
Forest N. Myers, Esquire
Talephono No.
532-9046
Recapitulation
1.
2.
3.
4.
5.
6.
7.
8.
9.
Real Estate ISchodule AI
Stocks and Bonds ISchedule B)
Closely Held Stock/Partnership Interest (Schedule cl
Mortgages and Notes (Schedule 01
Cash & Miscellaneous Personal Property (Schedule E)
Jointly Owned Property (Schedule F)
Transfers (Schedule G)
Total Gross Assets (total lines 1.7)
Funeral Expenses Administrative Costs/Miscellaneous
Expenses ISchedule H)
Debts/Mortgages/Liens (Schedule !!
Tota! Deductions (tota! lines 9 & 10)
Net Value of Estate Uine B minus line 11)
Charitable Bequests (Schedule J)
Net Value subject to tax Uine 12 minus line 13)
5. Federal Estate Tax 0
Return R,quired.
6. Decedent died testate D 7. Decedent maintained a living D 8. Number of sefe deposit D
(Attech copy of Will) trust I Attach copy of trust! boxes inventoried
All correspondence and confidential tax informetion should be directed to:
I Computatien of Tax
15. Amount of line 14 taxable at 6% rate 1151 56 ,77 I .00
linclude velues from Schedule K)
16. Amount of line 14 texeble et 15% rata (16)
(include vaiues from Schedule K)
17. Principal tax due (add tax from line 15 plus taxfrom line 16)
18. Totel Prior payments'
(e) Amount Paid $ 3 ,000.00
Ib) Plus Discount
(c) Minus Interest I1BI 83.000.00
19. Balance Due Uino 17 minus line 18)
Make Check Payable to: Register of Will" Agent
... PLEASE RECHECK MATH'"
10.
11.
12.
13.
14.
Addre"
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City Shi ens bur
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( 3)
I 4)
( 51
( 61
17)
34,769.00
22.658.81
3,650.59
I 81
60,317.09
I 91
(10)
-0-
4,307.28
(11) 4,3n7.?R
(121 56.771.00
(131
(14) 56.771.00
x.06= 3.406.27
x.15= -0-
(171 3,406.27
(19)
406.27
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer other then the personal representative i. based on ell Informotion of which preparer hes
any knowle gr. \) ,I).
\.' ,_; '" _ . rg, PA 8/5"/8?
SIGN~T OFPERSONALR PRESENTATIVEISI AOORESS 17257 DATE
'r-&----..-\- lJ ly..-- P.O.
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Box 695, Shippensburg, PA 17257
ADDRESS
8/::'-/82
OATE
.
IlIV,l~llC+I',llJ
SCHEDULE "A:'
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FI LE NUMBER
21 81-0250
Bernard W. Chamberlin
(All propertY Jointly-owned with Right of SurvlllonhlP mu.t bl dl.clo.ed on Schedule "F"I
ITEM VALUE AT DATE
NUMBER DESCRIPTION ASSESSED VALUE OF DEATH
1. Personal residence located at S. Washington St.,
Borough of Shippensburg I Cumberland Co., PA $37,200.00
TOTAL (Also enter on line 1, Recapitulation) $ 37 200.00
(If more .pace 1. needed lnurt IIddltlonal ,h..tl of sam. Ilz.)
REV. 1547EX 11-82)
I
BUREAU OF EXAMINATION I NOTICE OF INHERITANCE TAX ASSESSMENT
PENNSYLVANIA DEPARTMENT OF REVENUE APPRAISEMENT ALLOWANCE OR OISALLOWANCE CONTROL NO. 101
P.O. BOX B327 .
HARRISBURG. PA 17105 I OF DEDUCTIONS. ANO ASSESSMENT OF TAX OATE
J ___.. __ Q1l-27.-!l~
ESTATE OF CHAMBERLIN BERNARD W FILE NO. 21 B1-0250
OATE OF DEATH 04.:::QJ, -B_1_______ _ ___._______.___.___________~Q]JNTL_CW<l6ERk8KD
NOTE, TO INSURE PROPER CREDIT TO YOUR ACCOUNT SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS OF THE AaOVE COUNTY. MAKE CHECKS PAYABLE TO "REGISTER OF WILLS.
AGENT." IF TAX PAYMEN1.S ARE MAOE WITHIN 3 MONTHS OF THE OECEDENT'S OATE OF OEATH. A 01SCOUNT
OF 5% OF THE TAX PAlO MAY BE OEOUCTEO.
FOREST N MYERS ESQ
9974 MOLLY PITCHER HGWY
PO BOX 695
SHIPPENSBURG PA 17257
CUT ALONG THIS LINE
PLEASE RETURN THIS
PORTION TO REGISTER OF
WILLS IF PAYMENT OUE
- - - - - - ,- - - .- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR 01SALLOWANCE OF OEOUCTI0NS ANO ASSESSMENT OF TAX
ESTATE OF CHAMBERLIN
BERNARD
W FILE NO.21 81-0250
OATE 09-27-B2
ACN 101
TAX RETURN WAS: I X I ACCEPTED AS FILEO I I CHANGED
.---
APPRAISEO VALUE OF ESTATE,
1. Real Estate (Schedule Al
2, Stocks and Bonds (Schedule B)
3, Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages and Noles (Schedule D)
5. Cash & MIscellaneous Personal Property (Schedule E)
6. Jointly Owned Property (Schedule Fl
7. Transfers (Schedule Gl
8, Total Gross Assets
APPROVEO DEOUCTI0NS ANO EXEMPTIONS'
9, Funeral Expenses/Administrative Costs/Miscellaneous
Expenses (Schedule HI
10, Debts/Mortgages/Liens (Schedule II
11, Total Deductions;
12, Net Value of Estate
13, Charitable Bequests (Schedule Jl
14, Net Value SubJect to Ta)'.
ASSESSMENT OF TAX:
\5. Amount of tine 14 taxable al 6% rate
16, Amount 01 tine 14 taxable at 15% rate
17. PrinCIpal Tax Due
TAX CREOITS,
\ PAYMENT
. DATE
I 11-18-81
I
L
RECEIPT
#
DISCOUNT (+1
INTEREST 1-1
069819
.00
i
THIS ASSESSMENT IS BASED ON: 1 SUPPLEMENTAL RETURN
NO INTEREST IS DUE IF PAlO BY 01-01-82
IF PAID AFTER DATE INDICATED SEE REVERSE FOR INSTRUCTIONS
111
I 21
I 31
I 41
I 51
( 61
I 71
34,769.00
.00
.00
.00
22,658.8.L
3,650.59
.00
( BI
61,078.40
I 91
1101
.00
4,307.28
1111
1121
1131
1141
4,307.28
56,771. 00
.00
110,773.12
1151
1161
110,773.12
.00
6,646.40
.00
6,646.40
X.06=
X.15=
1171
AMOUNT PAlO
3,000.00
I TOT AL TAX CREDIT
; BALANCE OF TAX OUE
tlf Balance Due is less than $1,00 no payment IS required)
3,000.00
3,646.40
RET AIN THIS PORTION FOR YOUR RECORDS
REC':,!; c'
Rr~:r
'S') IJr'r
.. .', .-f) n!!
INFORMATION
This document is the Notice required to be given under Section 709 of the Inheritance and Estate Tax Act
of 1961 172 P.S. see lion 24851.
It the tax is paid within three (3) months after the decedent's death, a discount of 5% of the tax paid IS allowed,
Inheritance Tax becomes delinquent nine (9) months after the decedent's death. Interest is charged at the
rate of six (5) percent per annum on lhe amount of unpaid lax. (SEE EXAMrLE BELOW)
EXAMPLE: If a balance of tax due of $2,000,00 is in a delinquent status from 3-3-80, and payment is made
on 5-23-80, the interest is calculated as indicated below:
STEP 1
Determine the rale of
interest from the table below,
STEP 2
Multiply the balance of
tax due by the rate of
mterest.
STEP 3
Add the interest
to the balance of
lax due,
Interesl from 3-03-80 to 5-23-80
Results In:
Balance of tax due
Rate of Interest
INTEREST
$2.000.00
x.~~
$ 26.70
Balance of tax due 52,000,00
Plus Interest to
Date of Payment (+) $ 26,70
TOTAL tax and
interest to Date
of P.yment $2.026.70
2 Months =
20 D.ys = +
Rate of interest =
.010
.00335
.01335
--------- ---- -- - - - ~---- --- -- --- ----------- -- ------------ -------------
1 month .005 4 months .020 7 months .035 , 0 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 day .00017 11 days .00186 21 days .00352
2 days .OD034 12 days .00203 22 days .00369
3 days .00051 1 3 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 .D0101 16 days .00267 26 days .00437
7 days .00118 1 7 days .00284 27 days .OD454
8 days .00136 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
appraisement and assessment ma\' object within sixty (60) days after receipt of this Notice as provided by
Section 1001 of the Inheritance and Estate Tax Act of 1961 (72 P,S, sec, 2485 - 1001).
MAKE CHECK OR MONEY OROER PAYABLE TO' "REGISTER OF WILLS. AGENT"
DETACH THE TOP PORTION OF TH!S FORM AND SU8MIT WITH YOUR PAYMENT TO THE REGISTER OF WILLS FOR
THE COUNTY SHOWN ON THE REVERSE. SEE THE INHERITANCE TAX INSTRUCTION 800K FOR ADDRESS.
BUREAU OF ItI01VIDUAL TAXES
INlIeRI rANce TMC IHVI5IOtl
DEIlT,28DuDl
IlARRISaurm, PA 171i!8-0601
com10NWEAL TH OF PENNSYLVANIA
DEPARTIIENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
...~ '9>. "'.
,.~ ",.If;,(i'J't:P
IIYJkl,',''-''.:'\'l r;;;~..
fii,-,'C;Q.t;<.;,\'"
11('t:~)."~.r::;~,,~:~J
H;"~,~ ,ir~'...;~'.
J[~.IUl [X UP eel.'"
FOREST N MYERS ESQ
9974 ~10LL Y PITCHER HGWY
PO BOX 695
SHIPPENSBURG PA 17257
DATE
ESTATE OF
DATE OF DEATH
FILE NUI1BER
COUNTY
ACN
00-05-96
CHAf1BERLIII
04-01-81
21 81-0250
CUMBERLAND
101
W
BERNARD
At:lount RCl:li Bed
MAilE CHECK PAYABLE AND RE~lIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit tho upper porHon of this 101'111 with your tax paYlllent..
CUT ALONG THIS LINE l> RETAIN LOWER PORTION FOR YOUR RECORDS -<I
ii'{\i:i&OTEX-iiFP-(f)3":!i&Y------iEiiiE--ij:ii-i.riiTANCE--;:i>.TS;'ATEfiENT"o-F";IC-couN"T--il-;iE---------------------
ESTATE OF CHAMBERLIN BERNARD W FILE NO. 21 81-0250 ACN 101 DATE 08-05-96
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF TilE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, TIlE CURRENT DALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT:
04-07-83
PRINCIPAL TAX DUE:
3.240.13
PAYMENTS (TAX CREDITS),
PAYI1EIH RECEIPT DISCOUIIT (+) AMOUNT PAID
DATE NUMBER INTEREST (- )
11-18-81 XE069819 .00 3,000.00
04-06-83 XB070713 58.00- 297.60
08-03-96 \IRITEOFF .72- 1.25
TOTAL TAX CREDIT
3,240.13
.00
.00
.00
THE DEPARTMENT HAS WRITTEN OFF THE
BALANCE DUE AS U~COLLECTABLE
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE