HomeMy WebLinkAbout81-00274
oATH m' .,.':RHONAI, RIWRWn:N'rATln:
COMMONWDALT1! OF PHNNSYLVANIA SMI
COUNTY OF CUMIIURI"ANI>
lleforq me, Ihe (IORlsler fnr Ihe I'robllle uf Wills IIl1d llrllnlhlQ of Lellors ofA,lIilln\strn(\on In ,lIlId for the County of
CUlllborlnl\dl pqrsonlllly CII1110___'
wlHl, being duly ,flworn I do sa
of tho IlIst WIII/lnd rosllllllenl of
H_ ms_ther In. Long
doposo /llId SIlY thlll'l\S
Forrest D. 'Long
Executrix
deeensed
she will wellllnd trllly ndnllnlsler Ihe gondsllndohnllols, tlllhts IInd orodits of snld deceased accordlnllto law. Al)d
also will dlllgenlly Qomply with the Iltovlslons of tho'lnwrolntlnglo Transfer (nherltnnoos,
.' I
h.
lIpr'i 1 29, A,I)" 19~ 'I, 1'/
and subsorlbod beforolllo,
r"',
Roglstor
1 d
01
u.. ~
lI:j'I 0 l!l <71
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mCCREE
llo it tomonlbore,d Ihat on tho agt.lL..:..dllY of
April
,,\,0..1981 ,thoro ,Was probatod and
late of
recordod Iho Insl Will and,Tostamont ot
Forrest D. Long
--
,aamo,Hlll
, Cumberlalld C\lunly, Ponnsylvunlll,
Esther E. Long
t;locollsod, I"ollers , Teliltallento'ry worq llrRnlod to
, Witnoss my hnmlulldofflcl/ll sOllllho day aud yonr MOrORald,
S~8
~,~~c?,~
, Resistor
~ (MUST Be FILED iN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE,
Application Is horoby modo for CORsont 10 tho Ira~s/or of tho /ollowlng socurlll08,0/ 0 Ponnsylyonla
Corporollon or a Notlonol Bonking Assoclollon loco lad In Ponnsylyonlat
(0) 22 4 sharE!..~b)-1..:t'J!!l!!.~rioeL~~EI2..!.-~______.._,m_._,__.__. (c).$Qll1.ID!?.!) .-..:...-____
(NOTE, In doscrlblnp socurltlos ontor In (0), ob 0/0, ollhor Iho numbor olshoros 0/ stock ,or tho loco ol11ount 0/
roglstorod bonds, In (b), tho nOl11o 0/ tho Issuing cOl11pany and In (c) Iho closs of stock or tho ,stolod Inlorost rota
and moturlly doto 0/ roglstorod bonds,) 2/5/69, 5/29/69, 6/5/70 and 9/4/72
ISSUED ON 1/30/67,5;27/681, and having 0 TOTAL MARKET V AWE OF $.4 i6!~..9L..:.........__
(Do'")
os 0/ tho dotll 0/ dooth 0/ tho .~ocodont, , For~Bt D, LO!}51___. ,0n~E.dl.:. 14, 1981
(Nom. of Docodon') (Dolo 0' d..",)
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
. no ......" ,... ....... '" .. .. t::"':.il.... ..-,.",..-,.-.,...".,--.. ...
DATe _"V\lll!fi.~.LJ. 911J..
'*
COMMONWEAL TIi or rBNNsnVANIA
DePARTMeNT or RRVENue
DUREAU or COurlTY COL~BCTIONS
who woslotll 0/ 624 Devon Road, Camp Hill, __ Cumber1~nd ,_..Er:!!!...na.__
(51..., ond Number) (f'o.,Olllco) (Counly) (51010)
'rho socurltlos ora ronlstorod os /ollows, Forrest n. Long
11 _____....~___.-___-_---...
(Nom. or nom.. In which cOlllllco'.. % ,cpl,'er.d)
AOMiHts=r-RM'o&R-) Esther E._Long 624 Devon Road, Camp Hill, Pa.
EXECUTOR r (Nom.) (Add.o..) .
, NAME OF APPLICANT Esther Ill.:- LonCjl __
62ifl5EiVon Roaa
COUNTY FILE NUMBER ,~ /,.\'/ n '1 'I'! ADDRESS OF APPI.ICANT Camp Hill_l_ Pa. 17011
BUREAU FILE NUMBER SIGNA TUR E OF APPLICANT' ,.I
NOTICEI IF YOU PAIL TO PROPIlRI.Y PII.l.IN ANY PORTION OP THIS APpi:TCATION,'IT WII.I. NOT B
CONSIDIlRIlD tOMPl.eTli ANDWIl.l. BI! RETURNIlD TO YOU FOR COMPI.I!TION, "
COMMONWeALTH OF PENNSYLVANIA- DEPARTMENT OF REVENU;-' - --=I
. ,fQ.~seNT TO TRANSFER SECURITIES. DA'rE~~fI'.P-.
I heroby conso'nt to the trons/or 0/ tho oboye socurltles now raglstorod In the noma 0/ the a/oruold
Docedont ond wolve tho /llIng 0/ 0 certlllcote corllfylng 10 the poymont 0/ tho trans/or Inherltanco tax to which
the propllrty a/said Docodent Is modo sublect pursuanl to tho proviSions ,0/ tho Act 0/ Juno 20, 1919, P,L. 521,
as omondod ond the Act 0/ June 15, 1961, P,L, 373, os amended, This Is also In accordoncll with tho provisions
of tho Act 0/ Aprl.l 9, 1929, P.L, 343,
This Consont to Trons/or tho horoln descrlbod properly operotos only In roferonco to tho ostoto of the
oboyo.nomod Docodont,
~~~.
'~~
SUP, 3
Md Ihe Inlarul
10 Ihe blil.nca 01
I.x aua.
B"'noa qH.x aua ,O~,OOO.OO
PrU8"1Ii\ir"1"To-."-'-~---
,.t,.~t '?~/:~;Pl!nLi!J~_L.l~J1
InlOlul 10 Oale
pI P.vmenl 02,02~, 70
RtCO;'I"1
nr'H~ "
'n;1 1l1~T 1: II! 1
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"
INFORMA 1'I0N
Th'o aooumanl,'o li,~' Nolioe lequllea 10 be Ulv~n undor $0011011 70B 01 Ihe InnOlllonoe .na EBII\e TI' 'Act
I B61 172~,S, seollon 24651.
If Iho, lax II pOld, Wllhln ,We' (3\ 1110n\h., al\er Ih. aeoedeni'o OOllh, . dlooounl of 5% of "Ihe tM; plld IS .1I0wed,
Inharl'anoe Ta. bacomos dellnquenl nine (91 month. Illar Ihe deoedent's oo'lh, Inl",,1 10 ohsruad al Ihe
r.ta of el> 16\ per,cenl per aMum on Ihe amoUnl 01 unplld la., ISEE EXAMPLE BELOWI
"EXAMPLei If 0 b.I'noe 01 t.. due of $2.000,OO,1b In e dellnoual\1 IlalU& from 3_:1:.~_0, 'ndpavmenl I. made
on~.:Q7~0, lha Inlar"t I. o.l,ulated.. Ind'ollod below:
STeP 1
Delermlne ,Ihe ,.Ia 01
Inlorall 110m Ihe I,blo below,
STEP 2
Mulllpl, Ihe b.llnca of
la. due bYlhe TOto of
!~teren
Balance 01 tax due $~,OOO,OO
B41u.l'/nJrm~IREST-t"O'~ff-6' .
Inle"ll Irom 3-03-80 10 5-~3-80
Rasultl In' -----
~ Montho .
" ,20 Dav' .
R'le of Inlarall .
,010 ,
.:L-..JJ.ll:l.aJi.
,01331i
..'... .. .. ... _ ... _ _ _'" .. .. . .. _ '''' .. .. _ _ . . . ,< _ _ ~ ~ ~ .. 0- .. _ .. _ r,~ 0- ~ T ., ..
"
_ .. .. _ .. " ~ .. h .. ", ..... .. _,,_ .. _ _ ...
1 monlh ,005
2 il1\lnlha ,010
3 month. ,016'
1 d.v ,00017
2 deve ,00034,
, , 3 diva ,00061
" 4 d.va ,000e8
5 daya . ,00085
6 d.y. ,00101
7 d.y. ,00118
8 day. ,00135
9 day. .00152
10 d.y." ,00169
10 monlh.
11 monlh.
1,2 mOhlh.
4 monlh.
5 monlh.
e monlh.
,O~O
,0~5
,030
7 monlh.
a monlh.
9 month.
,036
,040
,048
11 day.
1 ~ d.v.
1 3 dayo
I 4 dava
I Ii d.vo
16 dav.
17 d.v.
18 d'VI
19 d'YI
20 day.
.00186
. ,00203
,00220
,00237
,00260
,00267
,00284'
,00301
,00318
.00336
2 1 dev'
22 dlVl
23 d.y.
24 day.
28 d.V'
26 d.Y.
27.dav.
28 'day.
29 daVl
30 day.
,050
.055
.060
,U0352
,00369
,00386
.00403
.00420
.00437
.00454 ..
,00471
.00488
.00500
.. ..... ':'. .. .. -- ... "-", -." "L ,",: ," ... - .. .. .. .. -:,.. .~ .. ~ ....i ... .. .. .. .. - "'._ - - ., ..,. ~ - " .. ,,' '. - ,. .. .. - ~ ... .. _ .. .. .... Or' .. ... .. .. _ .. .. .. .. .~
AnY parlv In '"\lreet, Inoludlng Ih. Commo"\IIeallh and Ih. par.onal repro"nlallve. nol ..llIfl.d Wllh Iha
.ppraluf1lenl and a,Btaem.nl f1lIY objeol Within 8lXIY (60) daVB after ro9e1pl Clf Ihl8 Nollo" 'a. proVld.d bv
5'0110" 100 I of Ih. Inharlllrloe .nd EOI.I. T.x Aol of 19a 1 (72 F.S, .ao. 2486 ., 10011,
MAKe CHeCK OR MONey ORDeR PAYA8~e TOI "1\BOlSteR OF Wl~~S: AoeNT';
. ,
PETACHTHE "!'aPPORTION OF THIS FORM AND SUEMIT WITH YOUR PAYMENT TO ,THE REGISTER OF WI~~S pOR
THE OOUNTV SHOWN ON THE, REVERSE, s~e THe INHeRITANOE TAX INSTRUCTION aOOK FOR ADDRESS, '
" ,,!'
COMMONWIALTH OIlPINNSYLVANIAJ'
COUNTY Oil '''''''I"Wltll)~..L ,.' ."
mS',l'HER m. LONG
__,.___._-->.__..............~~_____~.~__~~._____________->--"-+"~;_='r~~~o'~...,_._._-.----;,---.,,_..--0........_____ ...~____T._~__...
beln9 dulv . SWQ1;:l1:_.....___. ~ooordlng 10 laW, depoltl ~nd uYlth~t she __U-_________..__
_._.___..JllKe.g~trlJl~_._.._...__......_ of the Elhte of . 11'n~~~at. n. I,on~
late ,of __..:,..........Q~mp,ll~,l,.;Lm.L ' ,,"q'___7"_.__,Cumberl~nd Oounty, P." deou.ad and th~t the
within' lIen Inventorv mado bV ._..........._n_""'.. . '. . .,. ._.__,~_"._., the uld . '
of.the entlr.o 811~te o. f I'ald dooldlnt, oonllstln9 of ~II thl pDrlonal prop'ertv and real eltetl, IHOlpt realelt~te outsIde
Ihe Commonwulth,of Ponnlvlv~nla, end that Ihe fl\lural oppollte oeoh 111m of the Inventorv repre"nt It'l faIr value
II of Ih. dall' of deoedlnt'l doath,
.s~lJ"l'\ ~Q ,
andlublorlbed bofore ma,
~7\::~\ul'_,~'~+-- )
........"'-~......-, f\
Esther E.. Long/ Exeoutrix ~~
I_lli-Co"""-.Boad
.'
.....:
'J... n.. .1., 19..a.J----:
'~~ (~.m~f-d
~OTf\RYp(1l1L\C '(j
My Opmmlssliln ExplrO!, Juno 5, 1985
~.~rrlsburH, 1'0: Oilupllin ouunly
Camp Hill, PA 17011
.'~_._,.+-.._'._-_.......-
Add,."
Data of Death
14j:.1L_____ April,
Diy Month
198:),
VII'
INSTRUCTIONS
I; An Inventorv mUlt be. fllld withIn throo monthl alter ~ppolntment of perlon~1 repr8lenhtlve\
2. ^ lup,plement Inventorv mUlt bo flied within thlrlv dav~ of dlloovery of eddltlon~1 81"11.,
3. Additional ~h8eh may be attao.hod uto pOtlOMItV or reallv
4, See Artrole IV, Plduolerl8lAot of 1949,
'cd
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Inv.nlory ~f Ih. r.ol ond ptrsonal ,.tal' of
FORMS'l' P. LONG
---
.~-
dlOla..d:
.224 Shares Gol)U1\on Stook.-'l'ranumedC?,a Corp. at $20-7/8'
.1 diamond ring
3. wrist watohes
Ie'
Misoalbneousolothing and personal items
Automobile . aUiOK . appraised value
\1,
l'
"
$4,~76 00
,200 00
210 00
500 00
200 00
" "
"
'UPI JO 1~0l1 .to ,tlOII '~,l\1PIl~\I(lq
1.1ll11pOJ~ au 01\11110 01111 "I 1110,I:'1I'! 11'\"111"1'0 ,HI Oh\lIl \!'
jlI'11\11\000\l 0111"111.'.'01111 1101,; ",,' , '1" ,1.W,Ii> 01 !'"
IIIIIIIIIIIPPI'HIUI\ ,\,lp,I,) "1 1l,'.\P' , "II '1111\DOoV !
III (1I1('lIo"f'l" UOIII,I,,\ "11.1 II) \,\ "! '1\0 Jll pll\lli"'~ I
. '1ll,lli"lJ~ "",11,111";.) i'\l1 11,\ 1"'Hlll ' ',I '''I 111M n\\lr,Q n\l'
1I1)1I,'.\ Ililtlld IHIII ,HlIJ;~ 'IljUP ~'.l ",1 \,tdl l'l\IllO;.1ny "ltP
i" rtllllll 0111 JlI O,'llu(I 1I01il,I,1I 1\>1(1 ,1J11.,na ^qaJOII I
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AflfllDAVIT OF
FIDUCIARY
(In.\r,,"t1f/nl tIn Rev.r.. Sid,)
.!t$
10\ V.440 1'.ftOI
COMMOHWBA~'rH OF P8HHIVI. VAHIA
OUFARTMIHT OF HIV8HUG
TRAHlflR IHIIORITAHce TAX
R"IOIHT OeceDeHT
, ~ t.:.~~..pm_~_
-T
-
Eltal' 01 D'OHRl!ls'r D. LONG .'
.---.._..._...,,-..-,....<<......0 n._~ ,~~" ,.~~,,~,"-,_.,. .-,'-' ""'." -,,-.,......-
I..oal Add rm _6 24-_~e,y~~. .~P~.c?~:..~____H~--:-
Camp Hill, PA 17011
---------~~, '..~~~,...,._~----.-'_.._-_....._.......-
Dolo of Dao~\ APdLJ..4.,._ljUjL_--.;~.---
,
SlIclol Socu rlly Nu, ..l1.2.::.llJ.~.1.5 J, B
--.,-.-
({ill vI
(!ITA' HI
Ill!'I'
Buroau File No, _,..:_~____'"c.____.~~.---
. CU\lnly Fllo No, ._~.~:.~~:!!L._;__......,.,....__.._._
,1. Decedent dl~dl
( ) Inleltoto(wlthoul a will)
( x) Toslate (Ioovlng II lost wlll--eopy tdtaehod) OOpy Ol~ wnL ATTACl1l!lP
2, I, th.llling of a Fodural Estnle Tall Rolurn renulrod lor Ihl8 ollato? YaLX-....... No ......,-
3, ( 1<) i~llfO.flExecutrlx ) Admlnlstrator/ Admlnlst(utrlX
Namo Ill~t.her..JD.~_,~g._,.._.,H.H._.__...~ .......--.----.....,
Addrea. il~Y.9.n_nQ.is.L...--"...._-_...._c-._-_..-.._-
Camp Hill, PA 17011
-1O,rVl..-'---..~....jiiT^l.if't"...-.,.._....~~'-(1iiii......--..-
4. All correspondonQo sholild 'bo mallod to ( X) Attornoy
) Flduel my,
5. .1/ an attorney II roprnentlnutho utnto, IndlQatal
William .H. Wood, Esq..
Nome ~J!.fe~ Wooq.,_ AJ,.~,lm_Ji; RaJU!!.....___
Address il~.J,nut ~j: .J_.J'..,..g_,_J~Ql:lJ..~.~,~-,._.-
!:!arrisbur.lJ, PI\.___;L 71.0B__._...___
ICITYI (",.AH\) (Zlltl
. 1..1 It al1.afe.dopqll'bo~oa rOIlI.tor.o.dlh tho dllChodllnl'.n IndlVlduql nomo, or lolnlly wllh, oras on nuontordepUlY
'01 another, or In dOQedont'. Inillvldu.ol,name wit right of .oecoss by onatnor aa ogont or donuty, InQlud~ Iho name
and addr"u'ol ,~o ban.k or othor Institution Vlhora tha aolo deposit boll I, looolod,lha nome W In which tho box
la regl.tered ond the rolotlol1.hlp 01 tho lolnt huldera to tho docodonl,
,.< .' ,. ".-' I
~''''~-'!Ar7'-''-~' .-....~ -. ~"....'r..-'-'~.~ :.;.,...'-~
HAMIl'AHDAODRUlOF' BAHK OM alHaH IHITITIITIUH IIAMft OR HAMnllH WHICH
IH .WHICH DeCaoaHT MAIHTAIHllfA SAPa DHPOIIT aox SAPU onf'oslT POX IS "ClOISTUROO
. _ . _''',,~ ,...._* . _. .... ..il.:;m.~~--"
C011\l11(:mwea1th National Danlt ~OE~~llt 'Po Long and 8 "'''
...,._____.,.,......--..-"..... _h~LJD..J,......LQng_.---....--- _pOU5llil-____"'~...
Hampden Dranoh
_________,------- ..............~__.__ ._____........._ ___.....".-.-.......-.-- ..__........._ ....i.....
4101 Carlisle Pilte,Camp .Hill,Pa.
...,__....""'_._____-; .."".-__............_.._..oi...._._..........__ ..-
--
Under ponolllllol por.\ury, I dflcloro Ihol I'IHlvo oxnmlnad this retUrn, Including aQoompanylnl1 sQhedulea and.
'Iotements, ond tn tho best 01 my knowludgo ond uollof II Is huo, corrool and OOl1lploto,
k~...___...._~_.--c....~-,_._.~~
/I';',;<I(;,:'/' - 1
MGNATlI"F. OF PIDlIclARY
gO ESTION S CONCERNIN 0 PROP ERTY TRAN SE.lli!A
1, Old, d,ecedent, within ,two years of death, make aay transfer of any matorlnl part of his os tat 0 without rocolvlng
valuable andadoQuato consideration? (Answer "Yes"or IINo" ,) _-1i!L. ' ,
2. Old docodent, within two years o,t daath, transfer property from hlmsel f/ horsol f tolllo\sol f1horsulf nnd unoUlor POfty
. or parties (Including a spoUse) In lolnt ownership? (Answer lIyos" or "No",) ..J.iI.L.
S. If the answer to one or two ,above Is "Yes" and the transfers aro clalmod to bu nontuxoblu,llfOvldo tho follClwlnR
Information: . .
a, Aae of decedent at time of transfer, .
b. Copy of doathOertlflcate, , ' .
c.Affldavlt'by the attending physician Indicating tho stato of decodont's hoalth at limo ollranslor,
d, All other Information supporting nontaxablllly oftransfor,
4. Olddocedont,ln his/her lifetime, make any transfor of proporty wlthollllocolvlnR n vulllublu III Illloqllnto OOtiyldorallon
,'therefor which was to take eHect In possession or enjoyment at ornftor hla/hor dUllth? (Answot "Yes" or "Noll,) No
a. Was there any possibility that tha property transferred mlRht rotll!lllo lrllnslerm or his/bur ostllloOI be Guhloct
to his/her power of disposition? (Answor "Vea" or '.'No ',) ~_
b, What was,lhe transferee's age at time of docodent's doaUt?
6: DIP, dl1cedent Inhls/her,llfellme make any transfer wltltou! r,ocolvlnr a valllahlQ,and adoqualo conaldorlltlon Ihorofor
"under which transferor expressly or Impliedly roservos for hlslhor I fo or nny period wtilch do09111 fact ond holoro Ills/hor
, death: '
a, The possession or enloymenl of or tho rlRht to Incomo from Iho prollUrlY translOlrod? (An9wor"Vea" or'INo" ,) .~
b. Tile right to doslllOate the persons who shall possess or onJoy lhoprOllorty Iranslmred or IncolIlO thorofrom?
(Answsr "Ves" or lINo",) No .
6, I f the' answer to II ve b, above Is "Yes," was tho rl gh I resorvodln !IoclIdllnt alono ( ) or doeo(lonl nndlllhor s ( ),
7, Old decedenlln hiS/her lifetime makoa transfor, tho consl(\~rallon for which Wl19 trnnsforoo'sprornlse 10 pay Incomo
to or for the benefit or care of transferor? (Answer "Yos" or '!Noll,) Nn . . ,
8; o.ld decedent, al any ,time, \ransfer property, the bmoflclal onjoymonl 01 which Wll8 sublect to chango, bocauso ot
a.reserved power to alter, amend, orrevoko, or which cou,ld rovOII,to dacedonlundor lorm9 oftransfor,or by opetatlon of
I,aw? (Answer,IIVes" or "No" ,) No '
9. 11,'thaanswer toolght above Is "Yes," was the power 10 aller, amond or rOVQko tho Interost of Iho boneflclary reserved
In Ihedecedent alone ( lor decedent and,others ( ), '
I, I . I'
IWV.4U3 10<1 (3.AO)
OOMMONW8AL TH OP rPNN8VLVANIA
D8PAIITM8NT ClP n8V~N1J8
TIIAN8P8R INH8RITANOe TAlC
R8810RNT DeOAOeNT
RCHF.PULE "0"
Ill!NI!PICJIARIH8
'*
I!stata of, ~ORRIJJST D. LONG,
,
(1I/.YI/'lIc/llln'lIn flavorlo Sldol
DeoeaseCl
-~---., -
, BP.NllP,qIARIEs ANDADDRHS81!1l , RIlLATION8HI~ =1' DA.~a_~p INTEAUT 0/1 BBNEPIOIARY
BIIITH
" Yes
Ee the \ lll~nq _.J. SP9.lUl.fil.__.____ -- , , m",.. ~ ra ~a""J't""A
6240evon R()aCl , "
...;... .. . ,
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Camp Hill, PA 17011 , ..
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The above beneflul.rllls pre IIvlhl/ et thl. tIme except (or the follow/fll/l
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DATIlOP DIlATH
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~IONS FOR COMP,~I!TING SOHI1DULB "E"
Soho(lulo "E" n,ustlnoludu ull propul'ty, ruulunel porsonul, ownuel by Iho dooodontjolntly wlthol1othor
parly or patllos as Joll1,t tnl1unt& with ,'I\lhl of ullrvlvorshlp, 130th lun\llhlo und Inlnl10lblo proportv aro to bo
hl\lludoel, List rual usta III first,
1, . Oosol'lbo all roal proparty 08 Inellolllodln thllln9trllotlol1s for Buhoduln"^," Dllsorlbo oil pOl'80nol property
as Indicated In Ih8 Instruotlons lor Sohneluln"B," Include Iho numc, ndelros81111d rolatlon.hlp latho
eloootlont of tho oo.ownadslund tho duto tho lolnt oWl1olshlp wasostabllfthod,
2, Indicate tho totnl markot valuo 01 tho Jointly owned property,
'3, Indloat8 tho poroontn(lo of tho doocdont's Intorost,
4, Indloato tho markot value of tho dlloodont'slnterost.
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~m~eRAL INH~"ITANoe TAX ItlI~QRMAT~
Unsatl.f1ed lIabllltlos InourrudlJv the deoodent prior to his/her daeth ara deduotlbluagalnst hls/herta)(abIO estate,
In addition to dobts Inourrad by the (Iaoedont or ostata, othor Iloms ara ololmoble Inoludlng tho ooslof ildrnlnlstrotlon,
attornoy foes, IIduolary (eos, funaral and burial e)(pensos Inoludlnll tha oost of a bllrlallc)t, tomhstona or grave marker,
All dobts being olalmed IlgalnBtlln estate ora subjoot to tho approval ollha Register of Wills with whom tha
Inherltanoe Tux ROt\ll'I11s f110~1. F.Vldonoe to support the,deoadent's or tho ostllte's liabilitY for tho debtB baing olalmed
should be attaohed to this sohedule, '
A fernlly,oKernptlon of $2,000 Imly ba olalmed by ft spollse of a deoedent who dlod domlolled in Psnnsylvanla,
If thero Is no 8pOU80, orlf the spouse has forfeltad hls/har rights, than any ohlld Ilf the decedeht who Is a member of
the 88me household Oan olalm the exemption, In tho event thore 18 no suoh spoUse or ohlld, the e)(emntlon oan be
ololtTled by n parent or paronts who aro members of tha same hOllseholcl os the deoedent, The family oxemptlon Is
allowable only aualnst assets whloh pen by ft will or by the Pennsylvenle Intestate Laws, .
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INSTRUCTIONS FOR COMPLETING SCHEDULE"F"
1,
If the family exemption lsbelnu olalmed, Indloato the olalmant's nama, addren and hls/hor relationship to tha
deoadent, Enter"fomlly exemption" In the remark,S oolumn anel the amount ololmed In the amount, oolumn,
Assign oonseoutlva numberBto, eeoh Item IIstad,,' " i
Enter the date on whloh eftoh debt was Inourrad and/or paid" '
Enter the nomos of aooh payee, , '
Provide 0 brlof e)(plal1atlon In the rem~rks oolumn for aooh debt olalmed,
Enter tha amollnt of eooh debt being olalmed,
The form mllst be signed by the person who has eBsumed tha responsibility for pay InO the debts,
2,
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