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21 81 ~~8.1
No, ',"
PETITION FOR, PRQBATE OF WILL AND I.ETTE~S TESTAMENTARY
InthelWlltllteQf_ ~iM^NLJmL, L,,;.. Hurnll~n, (I/k/u 1t:.',_l~:'ol1or
, deoeasecl,
To Register of Wills for the Oounty of Oumberlancl, In the Oommonwealth of Pennsylvania,
"
Petltloner(s) IS'(are) the SKeout 91'
namsd In the Last Will and Testament of
i. .
mMANUJnI,
L, 13Ucl'lImn/k/1:l m, L" 13l!.S!:!~ldatsd May 19, 1975_
Deoedenl was II oltlzen of the United slates and a reeldent of Meol'lfmlcBTJUrg 1301'0
Townehlp (Borough), Oumberland Oounty, Oommonwealth of Pennsylvania,
, '
Deoedent died on S(ll:urday the _ l,fll:h day of ...!'pdl .A,D, 19~,ln the
Oountyof Cu'mberland, ,stale (If _.I'A. al the age of ~ years,
Deoedent has (has notl been married andhae (has not) had ohlldren borntQ him (her) slnoe the eK-
lloutlon of the abovedeeorlbed Will.
Deoedenl was possessed of persohal property to the value of --1lP , 000 . 00
"
and of real estate to the value of
i~I,O, 000,00
as near as oan ba asoertalned: said real estate sltustad as followa dwell J.ng 81 l:uate at
-222 w, Green street; , 1391'0 of Mechanlcsburg, Cumberland Co, I l'A
Thljrefore, your petltloner(lI) respllotful!y IIpply(llIs) for the probate of the said Laat Will and Testa. '
ment and for Lstters Testamentary theron, '
Dated' Aprll 28, 1981
Name and address
of Petltloner(s)
C10M'MON\1Ftl\LTIi NATIONAL, BANK
10 S, Market,Sauare
COMMONWEALTH OF PENNSYLVANIA
COUNTY ~1t<~MR,E.m:~t~
~__-:h<*~e~J, 'I'RUS'I'
.~~~
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MANAamR of Commonwealth NationAl Bank
, Filed:
/Sr:;;
<1/,,11-";')8'1. /;',213-
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named Ih, above applloatlon, being duly.. ,sworn aooordlng to law say(e) ,that the
statements sel forth In thle petition are true to the best of her " knowledge and belief,
.....,Sworn.. and subsorlbed before ~"'-'--r--"--_.
me April 28, 1981 " "
_~~Z~'_~ . --. _ ,1RU;;. MANAU",
COM.MON "AIJI'H NATIONAl", sANK
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COMMONWIlALT1~ OF PIlNNSVLVANIA m
COUNTY OF CUMIlBRLANI)
Before me, the ,Relllster fur Iho probllle of
, ~<:I't;.~~'" ~, .
cumberlandd1enonnllY clImo' he I i3 .
Hank
who, being duly 'sworn ,doea
lis ~nd lIranllltg of ,"etten or Admlnlslrnllonln and forlhe'I=OUl1ty of
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'1'11UfJ'I' MANAOI!:H. COMMoNWmAJ,""\ NA'I'lONAI.,
--
deposo and say Ihllt as
n:xecutor
of Iho lasl Will and Teslnment of mMANUJnt.'" [~lJCHml'l a/k/a 1'1, 1.,. Bucher
dOOOQRod
l.hQ}' will woll and Iruly IId\l1lnlsler the good~ and ohattels. rights and credits of said doc en sod according t,o laW, ,And
also will diligently comply with Ihe provisions of Ihe law rell\tlng 10 Transfer
nr",-f;1- tryn 1-', i 'I~" .", A,Dq 19 Bl
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DECRl~E
Be It remembered thaI on the' ht ,: dnY or..........M~Y
,A:;D,,19Jll-, lhore was probated and
recorded Iho last W\II nnd Tostament of
,
mMANumt. 1.., BUCHml1 , a/kill m.. 1.. Bucher
lale of
322W. Green st., MechanlcaburQ,Soro
Deoeased. Loiters Testamen\;ary WOre granled to
Witness my hand l\nd orrlclal seal Iho day nnd yoar uftJresl\ld,
. ;,.,~ '(
, C;umberland CQlhllY, Pennsylvania,
COMMONWEALTH NA"rIONAL BANK
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. Reglsler
Fjel ,/;' 1'1 '''iil
APPLICATlm~ FOI~ AHD COH5ENT
TO TRANSI'EI< 5ECUlilTIES
lil~OI5TEI~En I~I lilt' tlAME
OF A IHiSllWtH ()f;:C:EDI~,Hr
'*
COMMONW~AI.11I1l1' 1'\iNr1SY\.VANIA
Ilq'ARTMurH (If' RtVf.Nllf '
UUIlDAlI or COUNTY COLLDCTIONS
DATI:.. IWY1.9"li.Dlmn
~ (MUST BE FIL.ED IN TFlIPLICATE)
TO THE PENNSYLVANIADEPARTMEHT OF rlEVENlIi::
Appllcutlon Is liorohymodo fOI C'iAlsont 10 Ih\l Irunslol 01 Iho followlllg socolltlo$ of a Ponnsylvanla
Coqlorutlon or ,0 NutlonulllUllklng ASIIOcllllllln IOC;Ulodlll POlll)5ylvlllllri,
(o).!' O_~h.__~"jb~'!'lIl,Ylv'l'!ta P~r,.. ~.1 ghtC~" (c)pf~t.,..$~(hO.QullrJ"L-..-
(NOTE, In dOll,crlblng uocuritles entor In ((I), 1111 (VO, \lilhor Iho nUll1hor of IIIHlrllS of stock .or tho fllco u,lnount of
reglstorod bonds"ln (h) I tlio 1I0mo 01 llio Issuing C;(lI11pllllY und in (c) Iho cluss of stock or tlio stotod IlIlorest rota
, and maturlt"ldotr of roglstorod honds.) ,
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ISSUED ON !~+J~.~?L.-----, nnd bnvlng (I TOTAL MARKET Y AWE OF L\l,OH:.2_~nH_.n.._____
, (Polo) ,
01 of tho duto uf dooth uf tho docodol!t, ..,l"".nu!l .L. Dl.I~.r .~/aE..h u" , on HunAArH"le.:J.itL-
w""'. 01 Do."'''';'') BUCht" (Poi. o( ,I..th)
who wal lato ofl~_Lw.!l_'L~r!411'1 ,at . .M'ch.nICl.b~ry.
(5trool (Inti Numhor) (r~(J1I1 UfflclI}
c.~~rl'~cL,"Hm" 'm.r-!!l~_"__
(C"uhly) (5tolo)
'rho ucurltlu ora roglstorod us follows:
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(HfIIlIf nF ";H1\r1\ In whIch ctltt\flc:tJ!'(JI UfO ;tl\lhIQrcH~)
I.' L. !IUCht"
~~~~J~1~A TORf~~1 t~H~:~10l\ll1.~tnk,;151 0 lltell" ell f.fD"'I~;I~;~~111"L!.,!_,"L70lL-,__
. NAMF OF APPLICANT ... e~1 t~ u"~~.I~L',~u....._._-_.
CO,UNTYFILF. NUMBERil~Ql~t~I,.u. ADDRESS OF APPLICANT. ~~'L~~Y~"u"T ..~--------
~~~~~~ f:~;:Y ~~,~RT'o"op'iiLY ,1;:CI,O::''vU~;R ~~o~I;;'Li~I~NA~:~I~,I,Ii..,~~",r,
CONSIPERED COMPLIHE AI'lD WILI.,BIl REfURI'lED T.o YOU FOR COMPLETION.
, ___ ____~,.,~._~._',~T--_'-~"--~--~-------..---
'. . . COMMONWE;AI. n.1 Or PE..NN.S.'YL. Y.A. N..IA..."..DEPA. R.'. 'M. ~NT OFREVENUEij}y,
, . , . c:Q!i~g!lTTO'r,RANSFEI\ SECUR.ITIE.? " DA Te9l1i14/.4irllf'!
, I horoby consollt to tho trons.for of Iho \,bovo SII~IIr1lios now loglstorodln tho namo of tho uft~lOld .
Doeodont and wolvo tho IllIn\Jof II cortlflcnto cortllyln\J lutho pllYl110nt 01 tho ,ronslor'lnhorltonco,toxlo which
the properly of sold pocodent Is 1111111.0 sollloct pllrSllollt to tho provisions of tho Act of Juno 20, .1919, P.L.. 52',
OS om~ndodand tho Ad 01 Juno 15,1961, P.L. 373,115 11l110ndrHI. Thl~. Is olso In uccoldonce with tho provisions
.,,,'_____'<___n__.,__'n.~______-'-....__'-
of tho Act nl April 9, 1929, P.L. 3,13.
This Consont to Tfllnsfor .1110 horoln dnscrlbod propnlty ,'porolos only In' rofaronce to tllnostoto..af tho
obove.nomod Docadent.
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CommoJl1\'ealth J~
National 8ank '~
May, 22, '1981
Register ~f Wills. Offico
Cumberland County Court Houso
Carlisle, Pennsylvania
Gent1 emonl
We, as Executor of tho Estate of Emanu01 L. Buchor,' do hereby
personally gUarantlle the payments, wi thin tho time prescribed by law,
of any Pennsylvania Inheritance Tax which may be due on the t"ansfer
of tho security listod on the Waiver form for which a consant to transfel',
is grantad.
THE COMI~ONWEAl TH NAT I ONAl BANK
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By C;v~
Trust Managel'
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Tho Conllnonwoolih NaHanni annk, 10 B'nllh Mnrklll 811I1n,". !'Inrrlnhll'", p", 17108
7~ "JG.?6
17171.(1819688
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omlr:RAL INHERITANCE TAX INFORMATION
,
.
Unsatlsliod Ilabilltlos Incvrrad uy tho dacndant prior 10 hls/har dauth ora daductlblo agalnsl hls/hor taxaulo
calato. In addition 10 llobls Inourrad by tho dacadont or astalo, olhar lIalllS ura cllllmablo Including tho oost 01
admlnlslratlon, attornoy loos, Ild'Jclary foos, lunaral nnd burial exponsUR Including tho cost 01 d burl,al' lot, tombstone
or gravo morkor ond athorrelot,od burial ~xpanaoB. .
All uobls baing clalmod ogalnsl an Qstnto aro subloct 10 tho approval 01 tho Raglstor 01 Will. with whom tho
Inhorltance Tax Roturn 1.010,\1. Evldonoo to support tho docodoht's or tho ostuta'a !iaulllty lor tho dobt. bolng ,
clalmod should bo attached to thl. sohodulo. .
A fall1lly oxomptlon may be clulmod by a spouso 01 a docodont who diad domlcllod In Ponnlylvanla, If ihera Is
no spouso, or II tho spouso has forfoltodhls/hor rlghts,thon any child of tho,docodont who Is n 1I1,01l1110r 01 the,s'oll1o
household con clolm tho oxompllon. ,In tho ovonl thoro Is no such spouse or chlld"lho oxompt,lon can'bo cilalmed by
~ paront ot paronts who ora momllorsnf tho sumo housohold as thedocodent, Tho lamlly exomptlon Is allowable only
ogalnsl assots which paIS by a will or uy Iho POhl1sylvanla Inlestato Laws. '
, ' . .
NOTEI Componsatlon paid to an ostato ropresontatlvo; namoly,. on executor or administrator, lor sorvlces
porlormed In adnlinlstorlng on ostatols roportablo lor Pennsylvonla Income fox purposu, This toxapl, Inoomo
Itom should bo rO'portod on ,form PA.40.lndlvlduallncomo Tax Roturn.
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INSTRUCTIONS FORCOMPLETINGSCHEOULE "F"
1. II tho lamily ox~mption Is uolng olalmod, Indlcatri tho claimant's noma, odd rosa dn~ hls/hor rolatlonshlp to
tho docodont. ,En for "Iamlly oxomptlon" In..tho romotks column and tho, amount ololniod',ln tho amount column.
2. Assign consecutlvonumbors to ,oach Itom Ilstod.
3. Entot tho data on which .oooh,dobt was Incurrod and/or paid.
4. Ent.r t~o nomos 01 oaoh payoo.
,5. Provldo obrlo{ explanation In tho romarks"columnlor oach dobt clalmod.
6. Entor tho amount of. oach dopt bolng clalmod.
7. Tho lotm must be sl9nod by thd parson wha hosassumod tho rosponslblllty lar paying tho dobls. .
IF ADDITIONAL SPACE IS NECESSARY USESVa" x 11" SHEETS.
I'
ftEV.40v l:)(t p,nol
COMMONW~Al Tlj OP PUNN8VlVANIA
OBl'AllTMaNT OP IlBVBNUa
TnANSPUIl INHBnlTAN08 TA)(
nnSIPBNT PBOBP8NT
SCHEDULE /IF" .
STATEMeNT or OEOTS
AND oeDUCTIONS
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."....-- _._~ - --Ill IIlI -~~~.- --
Eslolo of Emanuel l., 'Uuchor _-, _buto of DouthAprll
WHEN CLAIMING THe FAMIL.V EXeMPTION, COMPLeTe THE FOL.LOWINGI
10. 19011110 No,
-,
21-81.2131
Claimant
nullltlollshli) 10 1)1I"IIc1ul1t
Clalmant'a Addru!! attlinu of DucocIQl\l'nl)ulllh
I~g~ PATB NAMa Of fAvna , nBMAnKa I" AMO\INT
,
Reserves: . , ,
22 ,The CO'1111l0nW(lA 1th Na'ti nnA 1 RAnk .~\( I. fnl> , ? nAn nn
23 Jan M. Wll (lV " . , .OM.nn
Attornov's fee
24 , . Closino costs ?nn.nn
26 . , PennSYlVania Dent, of Revenue 19131 Personal Income Tax 7n.oo
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I hereby certify that to the be,t of mYknowl,odgo and ballof the foregoing Is a Ju'st and true statement of debts, (uneral
expanses and expanses of adm:nlstrallon submitted to the astate as doductlons for Inheritance Tax purposes,
, The 0 monweal Nationa
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OFFIO AL SE ONLY .
DEBTS AND DEDUcTIONS ARE ALLOWED,IN THE SUM OP $
AT
%1'AXRATB
nEOI6TllIl p" W'~~B "
DATU
GENERAL INHERITANCE TAX INFORMATION
"
Unsatisfied liabilities Incurroll by tha docodontprlcr to hls/hor doath ora doductlblo against his/her ta~able
O8tato. In addition to dobts Incurrod by'the docodont or ostuto, othor Itonu uro claimable Inoludlng the oost of
administration, attornoyfola, fiduciary foos, funorul and burial o~ponsos Including tho cast of 0 burial lot, tombstone
or gravo morker and other rolatod burial oxponus.
All debts bolno clalmod aoalnst an ostata aro subloclto tho approval of , tho Reolstor of Wllls'wlth, whom the
Inhorltance Ta~ Roturn Is lIIod. cvldoncoto support tho docodont's or tho ostato'sllabllity for the debl. being
clolmed should bo allachod to Ihls uchedulo.' '
A family o~emptlon moy be clalmod hy 0 spou&o of a docodont who died domiciled In Pennsylvania. If there Is
00 .pouso, or If tho spouao has forfO,lted hls/hor rlohta, than any child of the decodonl who Is a member of the some
housohold con claim tho oxomptlan. In tho ovonl thoro Is no such spousoor child, the exemption con be claimed by
o parent or parenta wheore mombo,rs o,f the soma housohold os tho docodol1l. Tho fomlly exomptlon la allowable only
aoolnat OlllltS which p081 by 0 will or by tho Ponn~ylvanlo Inteatat,o Lows.
NOT!:I Compen'soUon pold to an estato roprosenlatlvel namely"on o~ocutor oradmlnls/rator, (or services
performed In odmlnlsterlng on oatote Is reportoble for Ponnsylvonla Income Ta~ purposes. rhls taxable Income
Itom should ho roported on form PA.40.lndlvlduallncomo Ta~ Roturn. ,
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II~STRUCTIONS FOR COMPL!:TING SC~EDULE "Fo"
1. It. tho family okemptlon Is' belngclalmod/lndlcale tho claimant's name/address and his/her rolatlonahlp to
the decedent. Enter "family exel11ptlon" In tho romarks column ond tho amount claimed In Iho amount column.
2. Assign consecutive numbers to oach Item IIstod.
3. Enter the dote on whl!:h oachdobt was Incurrod and/or paid, '
4. flnter the n'OI\108 of each payee.
S. Provide 0 brio! oxplanatlon ,In the remarks column for ooch debt claimed. ,
6,,'Er\ter the amount of each dobt being olalmed. .
7. Tho form must be slgnodby the person who has assumed the responsibility for paying the !lebt..
IF ADDITIONAL SPACE IS NEceSSARV use BW' x 11" SHEETS.
I'
OOMMONWBALTH OP PBNNSYLVANIA
OOUNTY OP QUMBBRLAND
}
III
~he ~~I)nwea 1 th t!.al~l)..~l3a'lh..bJ.._~~!!..B_d~to1.~n.1LIr~~~Ml.!'.il-~
baing duly .... svLQ.!'..o.~__. ftGaardln\l 10 law, dOpOIOI and laYI Ihal ho .__...ElUtC.u.tQL
__ ____. of Iho altalo of __Emanuol L. BJJ..~.lJor'
lal. of Rnl'llll.llb of MAchllnicsburg , Cumborland Counly, Pall dooouod and Ihat Ihe
wllhlri ilan Invonlory mado by .1hfLCaffimonwaa.l.tb.Jlat.J.onal .BanL.--.--,--. Ihe uld-ElI.eCJ.l.tor.
of Ihe ontlra ulale of laid doaodenl, ~onllllln\l of all Iho porIona,l prollurty and ro, a,l cItato, oxoopl roal "hto oUhld,e
tho Commonwealth of Ponnlylvanla, and thai ,tho figural oppollle uoh 110m of Iho Invonlory roprOlonl 11'1 lair valul
II 01 Ihl dato of docodont'l doalh,
sworn to
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_ and lubwlbod bofore mo,
COIIYTlonwelll th Nil \;i onlll Bllnk
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Add,."
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Dato of Paeth --
18
P'Y
May
~-
1981
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INSTRUCTIONS
I. An Inventory mu,t be .flied wllhln Ihroo month. allo, appolnlment 01 pe,lOnolrop,olOntftllvo,
2. A .uplJllmentlnvontory mUll be IlIed within, thirty dlYI of diloovery of additional mell;
3. Addlllonallhoeh may ~e alhohod Q\ 10 pmonally 0, really
4. See AII,lole IY, FlduolarlOl AoI 011 Q4'1.
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(11.0\'1.1 11()hJlu Court/ lltlf'hiHlliJl1blll'CJ/ CIllf,I.I(JI'llll1c1 Cl"UIILy,
flunllo~'tvtlldn/ Jl{tl't:y of thu r,lll\t pill:t
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l!O\llILV. I'lJnJl:JVlv':UIJtl Udl'LV
fI/llff' 1o-"I'IIIIII'lllrt I '-llll hll'h \11,1 II, tllIl1 1111' HlldJ,I/"'" fill h/l/ll'.\1 'I/{lfl, III (lfJ/I...ldcl'cI.
1/111' 01 (/11' /'II/'l/l//11IN /I/Id 1Il!/'I'I'lIil'I//1.'_llndllf/ to 1'llula(lIl.d, /111 {hI' Jlllrl 01 {//f'
fluid 111/1'111 III 1111' 81'l'II//flllfltl 10 11(' ",("d 111111 11I'I'(IIf1I/I'd, hna fI~'I'I'd
1/11" duonJ/l/I'I'1I 1/!}!'f'l' 10 10'1'111/111/ 1'11111"'11 IIl1lu tllf' ,'oldlllll'll/lIf tllf"ll('.('c,,,d 11f' l' I ,
il'-o "l/,~ IIr II,~.~'~'/I,t;, all /1/1' /'/lId ",/1/ 11/'1 I"/~/'/I II/'J'f'I//II/II'~' '11/1,,,1111111'1/ /llId
1/(1/1/ d"/I'/'tIlJl'II, I"r till' /lUIII 0/ (lHf: IlUIWP.IW 'J'lil:NII'Y.'!" [Vg 'PIlOUG/I!-ID ($1 ::!!;, 000.00)
....__...._~......_.._........_........_........~....___.. /J/)/fllfN, 10 /;f' I'l/id f/li 1(IIIll/('fu
11'hJl'tv-iivt! thoUllllllc1 n,vo hllmll;nrl fl[!;'.....ulx ($35,556,00) Doll11ru, 'lIJon I
tho 1~x(.'0\1t1()n of l!l.ifl l\lIf(WlI1ont, thu l'ooof.pl of 'IIhioh _is horubv
(lol:nDwlorhwd. tho htl]l\m~U oC ":lnhtv-l1.tno lhoull/lnd four hllnc1rucl [orl:v..rml1:
($89,444,00) Pol lin'o , nhnll bC' nulu 11"1 I:ho followt.nL1 fMlIlllOL', lnt:.ol~unt:-
uhtll t bo caJnI)u!;od Ill: tho rnl:o I)C fivo (_!i9.) POl' Ctlnt 1)0): unnnrn, cntoul.:\lod
month1v. 'J'11o -fh'l: rHlch in\:(ll'tJal: 1~(l'/mont:. nh.,11 bo cluo I1t1Y 30. 1975. l\ nd
ouch rind nVOl'V month thornidtol' on l:holhil'tioth dnv. On DOOf.w,bflr .\, 197tJ
'J'l.mlvCt lho\HHlnc1lwv(Jn huntlJ.'nd l]ovunl.Y"I1.luht 1$.12,'/78.00) 001101'11 011#\11 bo
,-,n.tc1 on I.ho Pl'inuiur11 n\lm. 'rho nold 'rwolvo I:huul1i1l1d novun hllnr1rod (l(.lVOlllv-
nLol1t 1$12."176.001 11,,11011"., .holl he', In o1ddLUon 1:0 tho lnl:ol"o,t oa (,bovn
Hot~ - (ol'thl and n Pl'lnolnlll UUIn of 'r"f'olvQ t.hOUUflnd savon hundrod DOVOhlv"
oJoht ($12,"176.00) 1>011,"'0, 1'11011 loa duo .,ncll'oYo1blo'oooh onel ~vory
YClnr,dtlm,I';,i1ftl-'/7frrt?1n(ltrli'/fl~4,},1/1~/(}- ',(Ill}}}.Jl) ilV};f~~1I/9P/~fI/ih'nlt\,i7!~ ti9/?/I,f,~ti t'A, J11,y.f,rd ~ , It
, "Imll /-.'I,ld land 1'''11I 11IIt! aflllT Lhn o:-:ocllll.Jon or t.hin ^CJnlQ/IMJ,\Qo AT/'l' 11/t'
1J//1lt1111~N '/'I'rrOl/ 1,,/tun,1I III 1IIf' 1011111 01 Ono Ihlllllrml t.walll:.}'..rlvo l:.ho~lU\llld
($l2r.,OOO.OO)-----....---".....--....-....--...--- '/)'''''''',/,<1/1"/11,, I" 1/11' "11(//",,,//
(II '1/t!/Ir.~/IUlrtlllll/ll(l!f'l'N{ "'''1I11/'I1I'lIr. ,
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,"'lfl "'1011 III(' IIlI/JlI/I,'ni'''1 till' 110M '10"11, tilt' Nold 11(1/'11/ (;IIIII',/Ir/ll Imrt 1/'11" al
I:ho oCI:loo or. JOI\ 1-1. l'Illny, )';"'1)1lro,19'>>. 1I11\)'iIOO"O ~I:'I 011101"1"''11 POl.
1II0A'(', 1',\'('pulll (11111 !I.'III'M Iii 'hi' 111111I11(11'11/ (II till' /11'/'(11/1 I'Vrl, tl f1(1fll u"" /lltll IdCI I-
11I'tullot Iltl';JJrOIIf'r'NIIII'('JJI"j! IIml "/I/lH"'I/~ o/Ihll /lair! 11rl'JIIIHf'I; I" 1I'I'xllllll/l'. {.ffil'
Ihlll! flfll'/("fml'f'fIlH!{: ollrl / (Ill'''', Ilr "Ilhl III rlot/'(',-" 10111111 ('0"""/111111". In,l'll/l filII
t/'C'.'IoI/(I/ l'fJ"f'I/(IIIIN OJ m;tn;nflI4-.......---.........................-..'....--r-...--..--- IIl/Nflltll/'
,'Iud IJIl' 1o'lItd 1lflrlJI II/II/(' /l1'I'oIHI,mr'l, 1I~"'(' t"fth tI/f' .wllt//ulflll (I/lhl'lInl
Imrll 10 JlIfI'I'!tallf1lh(' Jillltll",'ml,Hl." ollflllfltl 1I/1'r.'(o' till' }o1l1H 01 Ono hUllClI'ud
ll<OI1 ty- f Lvo thO\ll11ll1c1 ($\ ~5, 000.00) _ _ ...----- -.. -.. --..-.. - --_.. -- -- - -.. /1"1/,,,,,
III Ih" 1II11/IIInr flllrI lIt tit" 1/III/!H "I"I'/I/l,t'/ort prO/'It/f'rI,
"'"h U \C\ r\l1'I"".1' "~\TtthtlllJ 1/1/(1111'1//'1'('" 1111' /lold Jlllflll''''! t1,,'IIH/,~!lI'lo~/(J1I (II
jllld Ilfl'IIIIHllH 1.1/1111 ,)(, tld(f'/'rl'" tu Ih,' II(lrlll, 0/ I//(' ,\I'NJI/r1 II/Itl, .i ts ,IIr/rx,
ur flN.~'(&!iI,~, 01, 111(1 , "!l1J (II, ",11, /fI 75
III/'" 1I'1t/1'I, IImf' lI/f'/llIfl!' 1I/lIlf' /In/II'llfl "lillll "" I,,,t/lfl'l! 10 IIl1t'I' flllfl tl'l't'I"I' 1/".
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1'1/1' 1or,;I/ IIUII/IlIt'I' fire 11"1>1""1/'11111' 1i/IIIII/'lI:'fH;I; :;'j-:COlfD (11\01;.......-.....-....-....
'..of D,'\lon (7) ~'('iln:l f\'(Jfn t.ho ditto horooC, nt which timo tho lll1[JlIlc1
prJlloil'nl bnllllloo 01101111>0 duo ,'lid P"I'"l>lo in full, with rlco\lrnulal.ocl
illt:oroat tll~l.oon.
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, ggfSTIONS GON91RNINCl PROPEllTY TRANSFERS
I. Old docodont, Y/ltllln. two..yoara of doalh, m~.k~ any. lranslol of allY "\~[Inl pnrt of his osloto without rocolvlng
voluoblo 0[\(\ adoQuolo co!,sldorotlon? (Answor "VOS" or II No" ,) .
2, Old docodonl,wllIllu 11'10 years of doath, trousfer nronur1y !roln hlmsel!l hursoll tolllmaol f/horsnl I nnd onether norty
or partloa (Including 0 SI)OUSO) .In lolnt ownor~hln? (Answor "VOS" or "No",) -0- .
3, II tho answer to onll or two obovo Is IIVos" and \he trans/ers are clalmod to be nontaxable, provldo Iho fol16wlnR
lofo[niotlon:
0, Age of docedonl at tlmo of transfer,
h, Cony of doath corti fI cola,
c. Affldovll hy Ihool\ondlng physlclonlndlcotlaR the slate of decedont's hoallh 01 tllIle of\rnnsfer,
d, All othor Inforlllnllon sunportlnR nontaxohllltyQf translor, .
4, Old docedont;ln,.nls/her lifetime, mnke any Ironsfer of property wllhout rOGolvlng 0 valuable or odequale consldoratlon.
Iherefor which Woslo.toke eHeclln possession or enjoyment alar after his/her death? (AnsY/er IIVes" or IINo",) .l!!L.-
a, Was Ihere ony'posslhlllty that the ploperty transferred might return to transferor or his/her .astute or hesuhloct .
to his/her power 01 disposition? (Answer IIYos" or IINo" ,) .. '
b, What wuslhe trunslereo's age al tlllle of decedenl's death?
6, Old decedent In his/her lifetime make any tronsfer wllhout recolvlng 0 valuable and adequate consldetatlonlherefor
undor which tronsferofexpressly or Impliedly reservlls for his/her Ille or any period which does In fact end beforo his/her
doath: .
0, The possession at enloyment of or Ihe rlRhlto Income Irem the property transferred? (AnsY/ef liVes" or IINo".) NO
b, The rlRht to designate the pllrl~P}1s who sholl posse~s or enjoy the property lransferred or Income therefrol~?
(AnsY/or "Ves" or "No'~!) , '
6, If the answer to five h, o\JJve Is "Vos," slale whelher tho rlghl was roserved Indecodenl alone or others,
7, Old decedentln his/her IIfellme make n transfer, the consldoratlon fn~ wlllFh was transferee's prol\\lse to pay Income
to or for the banefll or ,co[e of transferor? (Answer "Ves" or "No" ,) ~_' i "
8, Old decadent, at anyllmo, transfer property, the bmeflclal enloymenl of which was suhlocl to chonRe, because of
a.reserved power to alter, 'ulIlond, orr~YAke, or which could rovertlo decedenlunder terms of lransfer or by operation of
low? (Answor "Ves" or "No" ,) ....:..--
9, If the answer tooll\ht nhove Is "Vest"wos the power lu alter',amend or revoke the Interest of the beneficiary reserved
In the decedont alone or Ihe decedent and others? (Answor "V os" or "Ne" ,) .
IlIlV.AClIIXI (lO,POI
QOMMONWIA~THO~ l'UNNSV~V^"liII
olMATMMNT Of AIVINUI
TAANa~.f\ INHunlTANau TA)(
nUalOINr OlaUOINT
SOHEDULE "p"
IlSNIlPIOIAIIlIlB
(llIltrllllf/nllS IlI/lloVUfll1 Slclo)
Eatlto of
to',"" nl,It.' I. lllJrdtAr-
BBNEP10IARleB ANp Al,'IoAeBbBB RBLATIONSHIP 8UIWIVSO DA'tS,OP INTBRll8T OF BENSPIOIARV
, DllOBOllNT ' BIRTH
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The Ibove"'neflolarles wore living at tho tlmoof tho dooodllnt's deAth O)(oopt for the followll1g:
NAME
DATE OF DEATH
,~
,
I~ Iddlllonalspaeo I, nooollary, Ulo'QW' x 11"1110011,
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INPORMA TION
Thll dooumln\' I" Ihe Nollol rlqulred 10 'be given under Seollon 70eol Ihe Inherll.noe .nd SIl.le T.~ Aol
of 1 a6 1 172 P,S, lIollon 2486),
If Ihe I.x II p.ld Wllhln thr" (3) month. ,aftet Iho deoldlnl',. d..lh, . dlloounl of 5% of Ihl tax paid II allowed,
Inh.rl"no. TI~ bloom.. dlllnquenl nln. 191 month I Ifllr thl dloedlnl'l dl.llh. Inll"ll II charged II Ihl
r.tl of .Ix 161 Plrelnt Pit Innum on Ihl, amounl of unp.ld tax, Isse eXAMPl.e ael.OW)
SXAMPl.e, If. blllnol of lax dUI of $2,000,00 II In, a dlllnqulnt IIIIUI from 3~3-80, and paymlnl II mad.
on 5_23-80, Ihl Inllr"l II olloull,"d II Indloalld bllow:' "
Sirup I
Oller mine Ihe till of
Inllrhl !rolll Ihl tabll below,
ST~P a
Multiply the bll.noe of,
lax dUI by the rail of
, Inlltll\.
STEP 0
Add Ihl Inlerell
'0 thl b.lanoe of
lax dUI.
Inllr.11 ftom 3-30-80 10 5-23,-80
~"uIII hI!
, 2 Monlhl. ,0 1 0
20 OayI . + '%9~35
RaIl of Inler..1 ., " 315,
,';j
8.lanol of Ia. dUI
l~atB of lntotstt
INTeReST
$2,000,00
~ ;0 I 335
S 26,70
aalanoe of tl~dUI
I'IUI Inllr,I'to
_D.lI! of PaY~"nl 1+1,
'i'O'fA lax In
InllrOlt 10 Oa'l
of Paymlnt
$2,000.00
$ 26,70
$2,026.10
--.-""----.... -_......;. --....... -.... -- - - -.... -- -..... - - --......- ...-....-.... ....'..~ ...._'...._---.- - - -....... ....-... ....---_.... --- - -~-
, . . I'
11 d,YI
1 2 daya
13 daYI
14 daYI
15 daYI
16 daYI
17 dlYI
I 8 daya
, 18 daYI
20 daYI
~-----------~---------~-----~---~~-~~-----------------------------~----
I monlh ,005
2 monlhl ,010
3 1lI0nlhl ,016
1 day ,00011
2 d.y. ,00034
3 dm ,00051
4 deye ,OO06e
6 d.ya ,00086
6 d.ye ,00101
7 ,d'YI ,00118
B daYI .00136
9 dm ,00162
1 0 d'YI ,001ee
4 monlhl ,020
S motllhl ,025
6 month I ,030
7 monlhl ,036 10 'inonlha ,060
8 monlhl ,040 11 monlh. .065
9 hlonlhl ,046 12 menlh., ,060
,00186 2 1 d.y. ,0036~
,00203 22 daYI' ,0036 '
.00220 23 day" ,00a8e
,00237' . 24 dlV' ,00403
,00260 26 d,YI ,00420
,00267 26 d.y. ,00437
,002S4 27 daYI .00464
,00301 2 S daya ,00471
,0031S 29 daYI ,00488
,00336 30 day. .00600
Any party In "nlelh', Including Ihl Commollweallh snd "he perlonal raprl,lIntSllvl, nOI ullefled wl\h Ihl
appral.,menl and aueum.nl msy obJlol wllhln ,tlXty 160) dlY' .fllr r,ollPI of Ihlt Noliol .. provldld by
$eollon 1001 of Ihe Inh.rllanol .nd Selall Ta~ AOI of 19S1 '(72P,S, 110. 2485 - 10011,
MAKI QI'IIOK' OR,MONIY OROBR MYAB~E TOli'RBQIST8R OP Wl~~S., AQBNT" .
" ., .';
DSTACH THE .TOP PORTION OF THIS FORM AND SUBMIT WITH YOUR PAyMENT TO tHE R~GIST8R, OF WII.LS FOR
THS COUNTVSHOWN ON THE REVERSE, SEE THE INHSRIT ANCE T AXINSTRUCTIONaOOK FOR ADDRESS,