HomeMy WebLinkAbout81-00293
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COMMoNWIlALTl1 011 PENNSYLVANIA SRI
COllNTY'OF C:UMIII!RLANI}
, Iloforo 1110, tho l~o"lstor I'or tho prahlllU of Wills IIl1d grnntlug or Lollol'S of Al/1l111118trlltlon IUllud for tho Coullly of
" CUll1borlnud, Ilor8011ll1l)' ~/llil\L......I-\~'\'nc.s:..-.J;!.J"-Q,^t:. L:"y\ ~
, ".;J' ,
who, boJusl/uIY_<;;'wul'\'.. , do!:.\>__dorI080 /lnd sny thnllls f',x l:..l.:i.ill.'Il:L-
of tho Inst Wlllnnd'l'oHhllilont Of-\?v.\t, W, ~C"Y'M. w; ~ (~"-1 doconsed
lAeo ,will \yoll lImi truly ndl11lnlslor Iho goodsllnd chllllols. rights lIud credlls of slIlddocOlIsod lIooordlllglo IIIW, Alld
b
IIlso will dlllsonlly c0ll111ly wllh tho provlslolls of ,Iho IlIw rolllllllglO Trllnsfor IlIhorlllllloes, "'1...10' '" IInd subscrlbod bof~to mo,
May '3, ,0\.0.. 198). 1.\..",,, f'Y'dL f.~..:,. "
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cq. "
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m ,;'~ ~ <Xl
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Bo,1I romemborod thllt 011 tho
13th dllY qf
D f;CREIt
Ma,V
,A.0..19_~, thore WIIS probnlodllnd
11110 of
rooqrdcd the Inl! Will Md Tostlllnollt of
Oarlisle
Ruth W. Krumwiede
pooonsod. (,olloi'1 lJ'estamentary wore 1I1'lIl1lod to
Witness myhnlld IInd orrlclnlsQlI1 lhe dny nnd yellr nforesnld.
. C~mborllllld County, PQnnsylvlIllln,
H9r~ce Eugene Ervin
~~"9 '
'-~'H'r OILr C ,
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6~./J'i-J./.>. J (f,al...
. '"". ROIlIIIOr,,"~
. (\;1:;;~
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INPORMATION
'Thla dooumenl la the Nolloe .equlrea 10 be given unaer Seal Ion 709 of the Inheritanoe ana aat.le TI~ AOI
of 1961 172 P.S" ..ollon 24851. '
If thl I,I~ la pala within Ihr.,(3) montha afllr Ih' aeoedenl'adeath, ~ alaoounl of ,6% of Ihe IlK paid la IlIowed,
; ,'"
Inherltlnoe Ta~ blloomea dellnquenl nine (9) monlha ,Ifler the deoadenl'a 'deallh, Inlereal la oharged It the '
r'le of elx (6) perolnl per .nnum on Ihe ImoUl11 of unp.,a I.~, ISaE EXAMP~E BE~OW)
EXAMP~EI, If e balenoe of I'~ due of .2,000,00 la In e dellnquenl elllua from 3. 3~80, .nd paVment ,a m.de
, on 5~23~80, Ihe Intereal la o~loul.led .. Indlo.led pelowI '
Inlereal Irom 3~30~80 16 5~23-BO
Rllulla In:
2 Montha. ,010
, 20 Dava . + .%O~~f>
R.teof Interll' . ,13 5
aalanol of I.x due
R_t.- of Int't811
INTaREST
.2,000,00
l,01335
26,70
BTBP G
Add Ihe Intereal
10 the bll.noe of
I'~ due,
a.l.noe of t.~ due
~Iua Inlereel 10
,.Mt of p.vwonll+l
I'~ .n
Inlerut to p.le
of P.vmen'
.2,000,00
. 26.70
BTlP'1
Dllermlne the 'lie of
Inter, It from thel.bll ,below,
STIP 2
Mulllplv Iheb,'anoe of
, ,.~ due by the rill ,of
Inlerlll.
.2,026,70
-------------~-"------~------~~-~--~---~-----------------~~---~--~,---
1, monlh .006 4 month a ,020 7 monthl ,035 10 montha ,060
2, monlhl ,0\0 6 monlh' .026 B month a .040 11 month' ,065
3 month I .016 6 montha ,030 9 mOntha ,045 12monthe .060
,00017 ,
1 dav 1 \ dive ,001a6 2 1 deYe ,00352
2 diva .00034 \ 2 deVI .00203 22 diva .00369
3 daVI ,00051 13 daye ,00220 23 daYI ,00386
4 daVI ,0006a' \ 4 aaVa ,00237 24 daVI ,00403
II daVI ,00085 16 d.ya ,00250 211 dave .00420
6 aave ,0010\ 16 dave .00267 26 dlvl ;00437
7 dlvl .00118 17 daVI ,00284 27 daVI .00464
8 aava ,00136 18 daya ,00301 28 dava .00471
9 daVI '80162 9 d.ve ,0031a 29 ,daVI ,0048e
1 0 daVI , 0169 20 daya ,00336 30 daYI .00500
------------------~.-------~-----------~----------~-~---------~~------
,
Any Pa'ty In Inlerell, Inoludlng Ihe Commonl'oleallh 'and, the perlonal fepteaentatlve, not tlllefled wllh the
appr6laem.nt .na a..llemenl mav obJeol Wlthln,lIxty 1601 daye .fI., reoelpl of Ihla Nolloe II provided bV
S.ollon 1001 of Ihe Inh.rll.noe and Elllle,Te~ Aol 01 1961 (72 P,S, leo, 2486 ,~10011,
MAKI CHleK DR MONIY OROIR PAYABLI Tql IIR.QUTJR ,OF Wl~LS. AQIN1'''
,
OeTACH THE ,TOP PORTION OP THIS PORM AND SUSMIT WITH YOUR PAYMSNT TO THS REGISTSR OP WI~~S POR
THSCOUNTY SHOWN ON THE ReVERSS, SSE THE INHERITANCE' TAX, INSTRUCTION SOOK POR A,ODRSSS,
nl!V.lb<1(I fiX' ({"fll") .
IIUHBAU o'p eXAMINATION
P~NN8V~VANIA ORPARTMPNT OF RellfiNUP
1',0, 1I0X 8317
HARRI8IlURa, PA 1710B
INHERITANCE TAX RETURN
RESIDENT DeoEDENT
FlloNumbor ~1l
-
o~c , t's Namo (LollI Firs\, and Ml~o In\tlpll i, , OQQQilont's Adilrm
OECMSED _, __t.lil'n..vJjiliJ-~' 18 "J)O~Qrai Court
, Snclal ocurlty Numbor , D~ta of Doath I
___ _~)'.1.eIJ~.g1LlL olf.SDfil ~ CAd~-l?a_\:::LQ\}
OHECK 1. Orlolnol Ralurn [K] 2. SUPlllamental Roturn 0 3, Romoludor Rntum 0
, . ' Q, Fodoral Eltata Tax 0
Roturn Roqulrod,
BLOOKS O. Oooadant diad tallata ~, v 7, ,Oaoadant malntAlnad 0 living ,0 o. N,umber of safa dloosll
(Attaoh oallY of Willi ,,. " 'trust (Attaoh 00 of trulll baHas Inventoried
--
Ail corrolPon~anoo ond oonfldonUal tax Informellanlhould be dlroot,d to!
~~:~~NT "Nama 0' ", . ~~
~O'otr~ I...l~)'~dt.l'l~~_. .' " r.\lt ~,
"".~".N", ~ .. ~ -:-: :\~.~~ ~~~,.. '.
16, Amounfof line 14 toxAble et 0% rete
,1InQludevelu81 framSohedule K)
10, Alnaunt of line 14 texable et 16% rate
(InoludeYAlues from Sohedule K)
17, Prlnolpal tax duo (add tax from line 16 olus taH from line 10)
10i Totel Prior oeyments! '
(a) Amount peld
(b) plIII Dlsoount ,
(0) Mlnuslntetult
" 19. Oelenoe Due (line 17 mlnuI line 10) ,
Make Oheek Feyablo to! Register of Wills, Agent
.. · PLEAse REOHEOK MATH · · ·
APPRO,
PRIATE
A.Llfe 8state D
Reoeplluletlan
REOAP1T,
ULATION
AND
I. Real 8state (Schodule A)
2, Stooks and BondI (Sohedule 0)
3, Olajely Hald Slock/Pertnotlhllllntorelt (Sohedulo 0)
4, MartoogOland Notol (Sohodule D)
6. Oalh & Mlloollanoaul Petlnnal Property ISohedulo E)
0, Jointly OwnodProperw (Sohedule F)
7, Tranlferl (Schedule 01 .
O. Total Or!!1I Allotl (tolal lines 1,7)
0, Funorel ExpenlelAdmlnlltretlvo OOlll/MllcollaneauI
EXOOnlel (Schedule H)
10, Oabu/Mllttgagol/Llonl (80hodulo II
11. Totol OedlloUonl hatalUnol 9 & 101
12. Not Veluo,af ElIata 1Il11O 0 mlnuI line 111
13, Ohorltoblo OequelU (Sohedule J)
14. ~et Vellle lubleot to tal< Wne 12 mlnull1no 13)
TAX
CALCU.
LATlON
Oomputatlon of Tax
.-...;
~
Zip
-
(1I~I~ltlltl'lb
( 21
1 3)
( 4)
(.6) l.\~,,=,,~(),PSI
1 01 '
(71-~
(Ol~
( 01
'1101
(111 l,~~tml'~
(121~' .,
(13) "
(14) :.xwlb~,,"
(16) _n~...5L~-'"o-
~,ad.9.16
r ."
x.oo-
(10)
x.16-
117l~~16
(18)
(19)
- - '
Undor peflaltlol of \I11t/uIY, I deol~re thall havo exenllnod thll totllrn, Inoludlng eooompanylng Ichodulel and uatementj, and to the heu of my knowlldgo
and bullef, III! \lUO, 0 eot. and complete. Oonlaratlon'of ,Unparer other thon the pellonll repreaontltlve Is bOled on all Information 01 whloh pra~aror hDI
ony knawledgo.
~
------.-.-
'81ciNATURO OF .PR'arARiiRoTHaR THAN RaPRaSQNTATIVa
AODRasa
OATS
AODRa88
DATa
A.
_____......~."=~.'_T_~..,~__....,....;.'_.~...__""'~#*."""'..,';;_o~~~~~.~..,,_'~"O"_,~o",,~__._<. ----,--. , -
U,B. OEPAflTMiNT OF HOUSiNG AND UIlMN DeVll~oI'MeNT
" 8eTTL.EMBNT STATEMGNT
, , .
CUMIIUIA,ND VALI.~ til\,\I1NGS AI~D I.Q^N ASSOCIAtiON
, 16 wt,,. HtOH rmrr
CMWIJ, 'NHHaV\YANlII 11'(111
_ ., _;~'~~1~,_.f~~~' ~nrr9_~~~!!~~_9-~-p~:n:l~PJ
I, TVPB Oil LOAN
II..
l'lJIIIlA
,8,1::1 IIMIlA
3. KI CONy.\lNINI,
q IYA
,., J CONY, lNG,
IT. LOAN NUMUURl
I
10, FILU NUMIIUAI
I
! I. MOAT, INI. OAlPNO"
NOTII Th18 10,,11 18 lurll18hod '" 'IIVU you 11 SIIl\01l101l1 olllolulIllIlllIl'l/I11J1'1 llollla,AIIHlll/1\a paid 1001111 hy IhoallllloO\onlllUlllI1 lira uhown,
IIOII11IIIU'Ikod "Ip,o.o,)" wow plll\ oUlaldo IhO "lollII1UI IIIIlY IIlu IIhOWIIl,ow '01 I IIlorl/lll II 01111 I PUlp,,""a 11m' 010 1111\ 11101lldodlll Ihu 101als.
D. NAMU Oil IIOAAOWBRI
WU1ar" L. oX'i~and,JJ:.
.1.11I\ ^ ,Od c!U.1II\4
II!, NAMP Oil Bl\LLUAI
I
! Ruth W. KJ:umw1de,
I
I
i
! Il, 8IlTTLl!MPNT MBNTI
0, PRClPBR'rv LOCATIONI
18 J)cNQ1.. Dr1"
ca.r:l1l11., PA 17013
.1ames 1)., Flower
ALAce Oil BBT1'LBMaNTl
c.v.S. & L.
I 16 W lii.gh lit:., oal:'1181e" PA
~. 8U"''''A~Y OF BORRoweR'S TRANSAOTIONI .: K. SUMMARY OF SEI.I.I!R'S TRANSACTION! I
100. OR088 AMOVNTPUBFR(1UORROWBR : 400,' ORoSS AMOUNT DUB TO SBL~BR' 'I'
101, Conlrllol 1I11,IOS prloa ' \ 401, Contmol .11108 prlDo ' la6, 900.00 ,
102, Porsonal propotly 402, 1'0lSOMI proporly
103. Bolllomsnl OhlllOSS 10 borroW or (IIno 1400) I 403, I
104; 404, I
106, I 40B,
Adlust",snts lor I\sms pnldtiy sailor, In advnnoo
CllY/tOWn',tllxss to ' "
CO\lnly Is~S8 10
ABssU8msnl8 10
106.
107,
lOB.
109.
,1.10,
1.1\,
.,m,,,,
200,
201,
202.
203.
204.
20B,
200.
207.
2.00,
209,
120.
ORQSS A"'OU~T pue PROM BOAROWB,R
AMOUNTS PAID BY 0" INBB\lAL:P 01' BORFloWllR
DsposHol dUrnest monsy I
PrlnolPflI .mounl 01, now loon(s)
Exlsllno loan(s) takon subloollo
210.
211,
212,
213,
214,
21B.
210,
217.
210,
219,
I
i
AU)uslrnOIlIIl lor 1I0ms ~npald by sollol ,
~IYA~n~~s ~
Counly laxos 10
A8808smonts 1,0
.
I
I
, I
TO:,A~ pAID BV 11'0/\ 1l0RROWBR ,\
CABH,AT ,SBTTLBt.\IiINTPROM OR TO BORROWER
moss ornoonl duo 110m horrow'on1In" 120) J '
~bsa'i'1l10\'nt8 f,uld 'bY, "Ifor borrowo,' (11110 2211), (
QAS~, (J.J PRqM) ([,:]TO) 1l0RROWllR
M.. ; - "-,~d"""",,,_~',,'F'__"_"~'=~~~"''''~--''' C'_'L~""""~" ."-;.~;,,.~.,o
220,
,3,00,
301,
302.
303,
1446(203) 61/a'
HUO.IA SETTLEMENT BTAl'IlMENT
m.tae.
n. NAMa 01' LaNOBRI
C\.Unbedand Valley'
Savi.nge &. Loan AellClO1at1o
ii, BQTTLBMBNT OATS I
I
'Jan. 3.4, 1982
400,
407,
400,
409,
410,
411.
412,
AdllIBtO\onlB lor Iiams Pfll<t "pollOI In advllnos
Olly/loWn laXUS 10
CoUnlY IsxoS to
Assossmonts 10
School Taxes
307.82
420.
BOO.
601,
602.
B03,
604,
006,
BOO,
a07,
600,
00ll.
OROSB AMOUNT DUB TO SllLLl!R
RBDUClTIONS IN AMOUNT PUll TO Bll"!.,ll
Exo." dopohlt (.00 Insllllotlons)
Soltlomonl oho,oos to 80llar (!lno 1400)
ExlsllnO loan Is) Inkon BubloOI 10
Pllyoll 01 ,flrs\ morlonoo losn OVSL
poyoll 01,8900nd O\ortgngo losn
86,207.82
(i,Q3.3.90
20,53.6,08
Adl\lslmOllls fo"lIoO\s unpaid by so'flol
Clty/lown laxos 10
Oounty taxss & noro. 10
Ae80Bomonta to
610.
011,
612.
613.
614,
f.lli,
I 6111. \
101'1,
I 618,
I (ill1. "I
: 020, TOTA~ RBbUOTION AMOUNT DUB SBI.I.BA 26,541.12\
I 000" ClASH AT SETTLllMllNT TO Oll1'ROMSl!l.l.IlFl' "," I
j,~~~~~;:;~~:,:~~;~:;~~~!:!~~
1~.()4
{
'.
:',!III:I(:,(OI'Y
SA F 8Y~lor'" &, F'brms
(AmOlloon llRvlnlJll & Aooounllng Supply, Illu,l
QU~STIONS CO.t'lct:RN.lliQJ~.Q!:f:RTV TnANSfl~R~
1. Old,docodent,wllhln two YO, ars of doolh, mllko ony IflInslur 01 OIly mlllorlolllnrl 01 lils oslalo wllliollt rm:olvlr\R
vnlllnhlo and adequate conslduH1Uon? (Alfswur II'(OS" or IINo" ,) ~~ '
2. . Old decedont" wllhln two yums 01 dooth,l,ronslor IIrollOrly from hlmsol fI horsoll to hlmsulf/hQ[Bolf ond onothor pmty
or portlos (1lIcllldlnR 0 SpOil so) In lolnl ownorshlll?(Answur II'(OS" or "Noll,) ll'?..._
3, Ifthoonavler to o,noor two alXlvo Is II'(OS" LHHI,t11o translors mo clalnll1d 10 ho nontllxllhlo, plOvlllo Iho lollowlng .
" Information: .
n, Ago of docodonl at time of trOl\slor, ~--
h. Copy of death cortlflcote,
c. Affidavit by the ot\enc!lnR Ilhyslclnn Indicating tho stole oldocodont's hoolth at tlmo of trans for,
d. All other Information slIpportlngnonlllxahllltyof transfor, '
4. \lId docodont, In his/her II fo\lmo,mako any transfor 01 prollorty wllhollt roc:olvlnr. 0 volllohlo 01 ndoQU1110 c0l1sldflll1t1011
therefor which was 10 .\akooffec:llo Ilossosslon oronjoymont at or ollor Ills/hor dooth? (Answor "'(os" or "No" ,) no
n. Wos there ony posslblll\ylhol the prollorty tronslerrod might rotulIIto ltonsforor or hls/llof oslolo 01 ho liUhjoot
to his/her power of dlsposltlo~? (Answer II'(us"or "Nu" ,) ,.
b, What was the trarlsflHeo'S ,ogo at lime of docodenl's doath?
5, Ol~ dooodentln hls/hor Ilfollmo moko ony transfor without rocolvlnn 0 valuablo 110\1 odaquoto consl(lorotlonthorolor
und~r whloh tronsfororexprossly or'lmpllodly rosorvos for his/her life or ony porlod which doos Inlncl end beforo his/her
death:
a, The possesslonoronloyment of or tho rl ghl.to Inoon\e from thoproporty transferrod? (Answor "'(os',' or IINo" ,) no
b, 'rho right to deslRhote tho porsons who sholl possoss or enloy tho proporty ,tronslolfod or Incomo lh.orolrol1l?
(Answer "Ves" or "No" ,) ,
6. If th,e onswer to IIvo b, o\XlVe Is "'(as," wns lho rlghl roservod In docodonl olono ( lor docodont and olho,rs ( ),
1. Old decedontlnhls/her lifetime make o'tronsfor, tho ,consideration for which wns trans(oroo'splomlso to poy lucomo
to or for the boneflt or caro of transferor? (Answer "V os" or "No".) no" '
8. ,DId decodent, at any lime, transfer Ilroporty, t1\n baloflclol enloyment 01 which was subject.lo chango, bocnuso of .
a reserved power tool tor, amend, or revoke, or which oould rovort to docodoot IIndor torms of transfer or by Ollerollon of
law? (Answor "Ves" oIIlNo",) 110
9, If the answer to Qlght above Is "'(es," wos tho powor.to allor, amond or rovoko tho Intorost of tho bonoflclary ,reserved
,In tho decedo\lt olano ( ) or doco(lon\ ond othors ( ), ' f
,
, ;'
~,
I.Ml'I' WII.I., ^NIJ 'J'I':H'I'MH~N'I'
01"
IlU'l'lI W. KIH1MW,lIWI~
I, Illlt:hW. Kt'llmwlede/ 01' 1~"Ir.fi,:< (':1'1111]11', Vln,llnil1, no
'hereby m,'lkl', pUb.llnh a,nd deolill"o tl1lll to Ill1 IIII' 'ImlL will I1l1d
t.ellt,all1ant:, IIProby ~"(!vokil1g 1111 fnl:IIH1I: willl1 and ('rHl)ollf.l h13~'etofOl'()
. nillc1e by niP.
AH'l'lCl.,E I
1 d trect pl'ompt Payment oCII11 illY jurI!: dobtll exoluaiva
of ,thoso rHWllrl9c1 by,onol1lnbt'llncos upon l't'lal prCIW'I't:y, tho Uxp(lnaes
of last stnknoss, furioral and Ildministt'ation of IIII' untata.
AR~'TCLE lr
I cHl~ec,t t.hat all estate, aucue'H\ion, IU<)IICY, inheri~
tanoa or other tranHfertaxes, howover dallignatorl" t:hat, Ilhall
,
be payable by rbason of my death, whother aSBeas~1 with re~poct
to property pllflsing llnqer this Will or ot.1Hlt'wisll, aha1l be 'Pllid
out of."and' be Ohal"gflll against the principal of my I:olllduary
estate, withoqt railnbut:lloment fr.om any p!'!t'flon, <HI 11 C<,lllt of the
adminJs~t'at:jon of my estate.
AR'l'ICL,1D III
All ,a premillo and cri~erion for interpreting this wiil,
I ahno,unce it; to be lilY wish and intent thill: any porllon desig~
n~ted as the bonefi~iill:Y or reoipient Of /;Iny bequoflt: Ol' devise
h"H'oin who in tlot llvln\1 on t.he thirty~fil:nt (31st) rl/1Y foJ1Clwing
the date of IOY do"th, ahlHl be oonsidered to have died prior to
my de~th (11I1I:oln sometimes refert'ed to as haYing p~'odooeased me),
~a POR OOMPLETING SOHaDU~e "B':
Sohndulo "E" must Inolude all property, 1'001 andllorsonol, ownod by the deoodan!lolntly with another'
party or'pertlas ilslolnt tenents with rloht of ~\lrvlVorehlp, sothtanglble and Intenglble property are to be
Inaludarl, List 1'001 ostate first,
,
1. Deuarlboell reel proporty as Indloatotlln till! l118truotlol1s (or Sahedulo /lA," Desorlbo 011 por80nal propel:tY
OK Indlooted In the Instruatlons forSaheduln "B," Inqludo the nomo,addross and relotlonshlp to the
deooden,taf the oo,ownar!s] and the date the lolnt ownership was ostabllshad, '
2. Indloato the total,l11arket valuo 01 the 'Jointly owned property,
3,' Indlaate the poroentaoe of tho deoedent's Intorost.
4. Indloa'!o tho marketvalue of the dooedont'slnterest,
~ ~ ~ ~ ~ ~ z ~ z ~
~ t:l I
~ ~ d P
z z ~ ,
0 p
, 0
z 0
0 'T1 '11
"
g
Z
,
.,
id .
\, ~\, ,
'.j
.i'I':i
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COMMONWIAL TH OP PINNBfLVANIA
olPAATMBNT OP AIVaNUI
TAANIPIA INHIAITANoB TAl<
AUloINT olCBDINT
SCHEOULl1 "F"
STATEMeNT OP DeaTS
AND,DeDUOTIONS
~ f Iluth w, ,t{rUllIwioclo ,'" 4;30/fli
"atata 0 _, ' -' ' _ Date of Death '
WHEN CLAIMING, THE FAMILV 'EXeMPTION, cOMPLeTe TH~ FOLLOWINGI
Fllo No,
Clnllllnl11
Rulnllol1ahlP toPor.orl/lrll
, CIIIII)1onl'8 AcldrlllR at limo of Oooodonl'" DOlllh
'~~~ DATI NAMa or PAVBB , , AIMAAKB .-;; AMOUNT
, "
1/15/02 , , 144.00
24 J. l\o~Qr Clrnt~ " npprnilln1 foo for Iltllmp oolloction
25 1115/82 uorough of Carlilll.e , Clewer and wntor 72.22 :
26 1/15/lJ2 call1ia1e Communi tyAmbu1allco Ambu1nno9 CallY ioo " 45,OU
,
8/13/a2 cumber land , Mvertiain\l , 10,00 i
27 , l.nw Journal
9/14/81 cumbarlnnd Valley' 8avings .. , 1414.00
28 and 1,( nn Mortgllgo pnymonta
10/8/81 kvsning 8entinal , 25,39
29 AdvortiaJ.ng
12/9/81 " lawn oore on Docodont's ron1 olltate 30,00 I
30 Marty Cummings
31 8/13/01 Mary Ann porwnrt Airline 'ox1'on80 for IJocedent 'II daught r 278,00
32 F'Lshman " Ilells Attorney'a feo 2587,50
33 Hornoa Eugene Ervih EXoO\ltors feo ' 'I!\o.o"
34 Social 80curit:v Refund due for ovarpa ""'ents , 1193.00
, Register of Wills , 00 for filing of t:nx return nod
35 12.00
first and final aooount ,
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,I hereby certify that to the beat of my knoWledge and belief the foregoing Is a Just and truo statement of de6ts, funera
expenles and expenses of a,llmlnl$tratlon aubmltted to tho estate QS deductions for Inheritance Tax purposes.
j' , 810NATuRll Of' ['II)UCIARV
OFF CIAe DaB ONL \l ,," ,.
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OAT~
DBBTS AND Dl!DUOTIONS ARE ALtOWBD IN THE SUMOF $
AT
% TAX RATe
nUoI8T~A of' WI~~g
DATU
Q.5.Ji!:RAL INliERITANCE TAX INFORMATION . .'
Ulla 1I.f1od IlabllltlOl hlcurred by Ihe decederll prior lohls/hor ,Ieoth lIrododucllble uualolt his/her tlikablo
ostatll. I adllltloo lodllbts IncIHtod by Iho docodol1t lIr osloto, olhor ltellllllrO clollllOlllo Includlog tho cost vf
admlnlllr Ilonl altornoy fOol,fldliclary feul funoral llnd burial uxponsollocludlou tho co.I of a burial 101, tombatol1o
or grave markor'ol1dolher rolal'" burial OXllel1Ses. ' ' ' p. ,
, '
All debts boli,U c1dlmod agalolt m1 oltato aro RublocI to lho approvol of tho RbglBtor of Willa with whom lho
Inherltaoce Tax Re,lurn II f1lod. Evldonco,Io'lupport Iho dllcodllrll'.,or Iho lIatalo'a liability for tho dllbta bolog
claimed should bo attached 10 thll achodulll,
A familyexompt!on may be clalmodby a spouso of a declldoot whadlod domlcll,lId.lo POntllylvanla. If thorola
110 IpOUIIII or If thl! spouse hOI fo'rfoltod hla/hllr rlghls, Ihon any child of Ihe decodent who ,Is a member of the sarno
houlehold can claim the exemptioo, In tho ovent thero Is no auch SPOUSl! or child, I~O OMIIl11,ptlon coo be clolmed by
a parent or parents who are;memberl of the samllhoulohold aa Iho docodent, Thll family exomptlonl. allowable ooly
ogaln.I oallll. which pass by a will or by Ihe Pennsylvania lotostate L.aws,
l'lOTEI Camponsatic)rl paid to 00 eatllte IlIpruontallvo/ nllmely', anexeculor oradmlnlatralor, for services
performod 10 administering 00 oslate Is reporlable for Penoaylvanla Income Tax purpOIU, This taxable locome
Item ahould,be reported on form PA.40.lodlvlduallocome Tax Return. . '
.
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INSTRUCTIONS FOR COMPL.ETING SCijgDU\"E "F'i
1, If the family exemption Is being ~Ialmed, Indicate the cl,almant'a lIome, address aod hll/hel relationship to
the decedeol, Enter IIfamily exemption" 10 the remarka column and the amauntalolmed In Ihe amevnl column.
2, Asslgo ciiolllcutlve numbers 1,0 each Item listed,
3, Enler Iho dale 011 which oach'debt was locurred and/or paid,
4, ent.r the names of each payee, i '
5, Provide a brle{ explanatloo In thore01atks oolumn for each debt claimed.
6, Enlor. the a!l1ounl of each ~ebt being claimed. . ." ,. " ,
7, Tho form musl be signed by tlie person who hal assvmed the rOlpunalblllty for paying the debt".
IF ADDITIONAL. SPACE is NECeSSARY Use 8W"~ 11" SHEETS,
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