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HomeMy WebLinkAbout81-00313 l'f ", ,,' " " ;,- I ~-, I' ,,_,-, , " ,,' .j\, I I, " !' "1 I' 'I I' , , I, , I, I " , I " , I, " " ;, I oJ" : "I, , , l. " I , , I' , j. . " , " " " I I , , " " , "I t" , "i , , , I, , ", I , (! '\. ;, , " ,j" ", If! '" j' -',I ,: , ;', il_ " , ,I" , " .j,' , I, "',' "II " ~, J' " " " till ~ I, " I' ,., " ", " " " I, " ,I ", ',I) , I' " , I, .I' " , " , " " , , , " , " " " " I',' I ~ , I' I' , " " ,- " , i , .,. , ~ " .. " " , " , " 'I I' " '" i, 'I I fl. ", I' " " I -' ~ - " , " '\ " ,,, Ii " '" " " , " I ", 'f .. I , I: .>!. .. " , ,- ",J, " " " "I' .;,' I, " , : " I' " " ,I " " " I " " " '/,'1 " ,,, " I' I" " 'I'" ,!-' ,I I,' I, , , , , " '.I, ," "jll -I.' .f;/d'u,I-'/ n,~ V.4~lJ 1'-801 r.OMM(jHWU~ TIf Of peHHlnV~HI~ OIPARTMltlT Of ReVIHUe TRAHlflR INHeRIT~Hce TAX RIIIOIHT DeCeOeHT AflFIDAVIT OF FIDLlCIARY (Inltructlcnl en Rov,,,.. Sl~o) '* -..."".-,..- --- 'I!:El:llIltY....-u..'=___~"F.t~~r~'ft.U:t - 1,,,,-~ eltnto of -11lU.y":,S-\u'.D_'lJlJal1~___.."_...,,._-_ Last Addr..s -1\.1) .JI.!!J..lloK.J.n'_'______ __. ah iIlP!l.!J.l!lHB'.ll".J'./I_,LZllL (CITYI !'HAltrl 17.IPI Onto of Death ....JI.Q.lll<ult~I.l!LZ.o-lJl6Q Soclnl Socurlty No, _J!;i(lw36w?.M.2.___ Buruoll Fllo No, _______.__.___._____..... ... -......., County File No, _..:i?.L~'.L_:.._~~___,.._ .. ,1. Decedent dlodl ( ) Int..toto (wlthouta will) . ( 1I) TOltate (leaving a lost wlll~-copy attached) 2. Is the filing of o. Fodoral eatato Tax Roturn rOllulrod for Ihls aLtaiD? Yus..__ No ...JI_ 3. ( ) Executor/Executrix ( ) Admlnlstrat~rI Admlnlstratrl x (x) I''..lor Namo Alico AJ,llJUlJ!lL-.____.."..,_.....______ 4. All corrospondonco ahuuld bo mailod to ( 1I) Atiornoy 5. ,If an attornoy Is roproaontlngtho oatato, Indlcato: ) Flduclqry, (, 2l rf:) i1f~ ,J" rn' , I,' t;),l, ~ '.<l, ,... ~I~ ,t: '" , '''I t....r" - ," :'I.i,. 00 ":\ ~;} ,-, 'I :: , '0 " :-, "'..J , "11 ',) ()' Addrflla _-1L..lLJl..6.. ShippensburB. l'A ICITVI 1125'l IBTATllI {"llltl Name }Iorost N. HYara _ Addreaa ..J.!L~.t;.lJ....fR..I1!1 StroQ.L._ --4*wrUSD"l'R. 1;~rAT~1 lU..S3---- (~Ir'l List all safe depa'lt'box~s relllstered In tho doeedo~t's Indlvlduql nnmohor lalntly with, or no" agent or doputy of another, or In decedent I Indl.vldual nal110wlth right of'neceoa hy anat or as agent or doputy. InClude tho nllnln and addre.. of the bank or other Institution whoro the aafo doposlt bQX I~ loentod, the name (a) In which tho bOK Is reglltered .ond the relationship of tho lolnt holdera to the doeodont. -' NAMS ~Ha ~DDRBlI Of BAHK QR OTHER INSTITUTIOH IH WHICH DsceDSHT M~INT~IHSO A SAFe OBPOllf BOX ...... -. - HAMB OR HAMEl III WHiCH lAPS DepOSIT oox 'I ReolSTERED - Nono ..__.._"...-.~------ ~. --_._---.-~--- , - Under penaltlos of perlury, I doelaro that I hove Qxamlnod tllis return, Including accomJlUnylng achoduloa and ItQtomentl, and to tho best of my knowlodgo ond bollof It la truo, COrloct rInd completo, . a \} . ,/'.' , '\$ ...) 111_ , ' ~', ' / / r' .,' (;. /,. ., ,,", A 1~_~~__.::.;.....:.._:_"..;...sL.:...~_:..._/_..__...,__ IIOH~TURE OP PIDudARY DATU RETURl'l COMP\..ETEO ,.,PORMSTO \...OCA\... COUMTY IMHi:RITAl'Ice TAX OPFICE' 11..29..'78 ~ll'JlI 0 lCCOUH.. ... ...'" ~7:'O'f(n.n.... ~lS.Qe ~JlIIut!l\ Or O~o~~~,tM~IBR\OI B s 0 011 0 eB'" 010 ItlPo1\M~TIOtl RK"~TIOHSHIP Tb o'd'i:o~i.1' H~Mf. ~ aerQvel.ns.k. ,n.D 6 \1Jo,: l\9~ 'Jld,PP.~"llUl'I.h · clTV Sb1l'pen,b11'1.1 ,.,2S'7 H~MlI . AU.o~~ ^1)11 ~oORllBl , ..Il. 16 lox 1193 8b1PplMl'~'Pa. 1'72~ a~H~. ItlsTITUT\.2H ~OORoBl C__1a-' "U" Sa"""" .114 'Loa" 49 llllllt nlll Iltrll0t'. 1Io1l ,,4 fblwen,WllI.P.. ''7Ii1,'' a~"~HCIi o~ ~ccOUHT ~T 000 IHTORIiOT ~O<\RUBO AHP oa""BCTlP"" AT 000 , OTA" o Z~T 0 I HBRBav CBRTI~V THAT THBIH~ORMAT oH caHTAlH H RU >1'0 CORRKOT .BPROS.HTATIOH a~ IHrORMATIOH IH OUR ~I"osIH AceoRU '/11TH tIlCTIOH,<I pl' Il T~~ ~CT M,\OI\, IlaHATURK o~ ~IHAHC,^" HVIlBTlaATOR ., " , j UfiV.I1!i4'(t',UO) cOMMONWUAL TH O~ I'F>NNUVLVANIA DfiPARTMUNT Pf RUVuNUU TRANSPUR INHUIIITANOS1'AX RSSIDSNT peaaDeNT ,. 13stalo of Bury .JilL~!?Y.9.!iJ.lik ~""..- ~. ITEM NO, OUSCIIIPTION ..--- SCHEDULE "13" ,lOINnV OWN~P PfiOpg;nV (lmlmet/oIlS 011 Rovorso 5/(/0) 44aa M':'_.._.~" . TOTAL. MARKET VALue =a='\Z .-;;"4; .- ~~ umblHlllrld Vlllloy Bllviniju & Loan Aaaodation Account 11148197 Certificate 005~6?617~ Certificate 005~696172 Certificate 008~684027 cortificato 008~697818 ", VAwn OP DnCEOENT's INTIlI1EST 4.039.61 50% 2,019.80 10,120.36 50% 5,060. III 5.0~0. 11 50? 2,530.08 10,133.80 50% 5.066.90 10,133,80 ,50% 5'066.90 TOTAL THIS f1AGe 19.743.06 * DEpARTMENT VALUATION (Off/ola! URSOII/yl , I I I )~ ,!<fJ. r~~ I ~' ; " " i ~ ~. . ~ ~ ! 'I '.~ J .:t Z r- "I ~ S- III ~ i ~ ~ d ~ .~ ~ d i i :z: :z: i 1:1. . ~ ~' ~ 8 Il< " '; ,. ~FV,~~., 11.00) COMMONWEA~ Tit OF rUNNSnVANIA DEPARTMENT 01' RUVENUS TJlANQFUR INflERITANOS TAX ,RESIDaNT IlEQapaNT SCHEDULE 'fF" 8TATnMnNl or DEDTS AND DEDUCTIONS . ~ _ '. ~_~_, o~~,"-"-~""'0<~-_"'~.uJ''lr-~.';E,.-t4,'icjillW'''~-''',,,,,;,.,~ ""i'iil.-~'''''''~'t'''''~''' .'.','=".'" "-,,,,_-_"'",,".E,,,,,",~.._..+1if'-""-"""'- -~ - .- Estate of IlatY fjgtOVQtllil1 Dulo of Dnelh AO\ltumIJoc 2, 1980 WHEN CLAIMING THE FAMILY EXEMPTION/CoMPLeTE THE FOLLOWINQI . Clalmun t Atiuo Alpl\llllh _-:.;.... Rulullonshlp to D~codont IlOlll1htOl: Clulrnunt's Addrm HIIl,fln, 1101< 2\13, HhiooOllslJucn, 1'1\ 172~7 - _. -.---.... ~ ~--- - . ......,.,..__.,.._..~.n_'T ~~~ __ _._~u .... " - I~g~ OATS NAMa OF PA VU E " REMARKS AMOU~T --~ - I, _QLoL....P..!JlJ.\9..I\____..~____~.__. .I"llDocul Q I .335,00 ~.....-.---._---------_---.__. '. 11ll..t..WLQ.W~QIl~.lJulnunx.----. ..l'.ulUl.tII.L___..._ , , AR~,OO .IQugohing ShuwioL A j ~ P..l ~ .-----.... '176,00 . - - HoW~.\l..l.lilil! Air tllJr... . I/28.nn .-......-..-- -. ,llo~n"t N Hvn>:" -- :A.~.~.\l\lY.J.IlflJl_-. .-.- ,~o.oo , 8 &"6 l1umodnla - ..lli'mo_1C.in1___..__._ IZ9.Q.Q..._ -......." ------- Zocn I S Ilul)ernl JI.IIlL._. I'une rn I , 261.47 --.-~......---_.. - : , . ObgcJ.cy 1"lodats I'lowors 107.00 ~....-.._.. , Rav. Oocnol i!.!L.____..~__,__ lIonorndll\\1 ." ---""-'" 10O.()O '. Un.. r\1 j vn~ . IinnocudUI\\ , 50,00 -- -~--- , 1I"'",:~ "n"(1 Assgmbl V oC Clod llol1fltJ.on 100,00 -,- -- -- -'- .-- - - , ....... - ,~ , ---............---- .-- , ..----- - , , - . , ---..-- .. - ,. , , , . ., , , - -' . . - , , .. . , . " --.--' TOTA~ THIS rAGEI ~ J/.1...2/J/.1 - , I hereby certify that to tho best of my kllDwledgu and ballef tho foregoing Is a just and truustntomont of dobh, funeral ol<ponsas end oxpensos of'odmlnlslratloll submitted t~ u:~:~~~~o a;~~d~.~~I:;,f:~..ln;l:tnce Tax Pllrfl~SOS' SloNATurw of AT'!:onNttv FIOUCIAIlY rJAT! OFFICI l. USE ONLY , DEBTS AND DfiOUOTIONS ARE AI.,~OWED IN THE 8UM OF $ 4.'2,2/. -I' "l. AT " P~ROENT, , ~ ~.;;(b";11 PArr, ; \. '. lJ~~EHA~ INI-lERIrAf)lCE TAX If'lFORMATlm:i! Unsatlsflod Ilabllltlns Inoul'rud by tllu duoudunt prior 10 hla/hur dl1l1111 uru duchll;tlblu 0lluln81 his/her (<<xablo eBlulo, In addition to dobts Inourrod hy Ihu dooudol11 or uslulo, olllUI' \\OIl1S UI'U IllnlmublulllOllldll1U lllu oos\ 01 udrnlnlstrutltll1, otlorney 1008, flduolul'Y 10UB, fUl1ol'ol ulIll burial oxponSOB Inoludll1u tho ollsl of u bUl'lullot, tomilstol1oor wul/O mur~or, " All dobts bolnU ololmed o\lnlnslun estuta aro subloot 10 thu upprovul'ol tho ROllIs\al' 01 wills with whom tho Inherltanoe Tex Roturn Is fIIod, EI/ldonoe to supporl tho dooodont's or tho eBtlllu's l1ublllty 101' thadeills balnll olalmed should ba utlaohod to thlB sohedule. . A family oxemptloll of $2,000 may be ,ollllmad by a BpOUBe of a daOlldent who tlled domlelled In Pennsylvonle, If thoro Is no spouse, or If the Bpouse h~B forfeltod hls/hal'rlghls, thol1 any ohllll of lhu deoudent who Is a mompor 01 tho same housoholcLoan olahn tho oxempllon, In Iho ol/ol1tthul'o Is no suoh spousuor ohlld, th~ axumptlon oan bo olalmod by a peronI or peronts who aro mumbors of thll samo household us the deoedent, ~ :"l ~ 8 6 m 6 ~ ... Z Z ~ ~ " I ~:5' f;; '~ !=' z z ~ j;j !=' 0 !Jl , Z 0 !Jl 0 -c !=' ." "1 1 ,;, -' ~ ~.i (', t..' ll...' 0, ':'i,:J ",.,\ t.;: Z Cd (Xl ~;( ~ J 6' r .... t:.'i ~jl;' 'I -. ,.. fl:i'j1 51 ~~ II!! Ij'wJ .:a:'f l'I'I nt_.. ~ P5 ~j8 c..\ 9 ~ ~ , :>:I' 'I " INSTRUCTIONS POR COMPl.ETING SCHEDULE "P" 1, ,'If the fUf\1lly oxemptlon ,Is being olalmed, Inclloote the olohnant's nome, address en,dhls/herreletlonshlp to the deoedent, Enter "famlly exemption" In Ihe romarks ooluml1 and tlla amount olalmedln the amount oolumn, 2,Asslgn oons80'utlve numbors,to eaoh Item listed, 3, Enlar tho dato on whl9h eaoh debt was Inourred and/or. paid, 4. Entor the names of eooh payee, 6. Provide 11 brief explanation In tho remarks oolumn for oooh dabt olalmed, 6, Enter tho amoullt,ol each debt belngolalJ11ecl, 7, The form must 'bo slgneq by the pOl'son who has asslllned thore~ponslblllty for paYing theelebls. "