HomeMy WebLinkAbout81-00343
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( ) Exec,
J COUNTY NO.
ST A TF. NO.
Other
naughter
7I'J'!- J</:3
REV.5'.lJ EX' (.12.80)
COMMONWEAL TlI OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERIT ANCE TAX
RESIDENT DECEDENT
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES
(Instructions on Reverse Side)
--
Estate of Brainerd E. Wise
Losl address 431 North Pitt Street
ISTREf.T1
>-
17013 '"
Carlisle PA <
u
ICilY) (STATE) (ZIPI =>
e
,.
Dale ef Death Oecember 14. 1980
Social Security No, 186-28-3381
T"lPE OF ASSET
DESCRIPTION
( I Adm,
Thelma M.
Bosler
Nome
Secial Security No, _ 201-18-6413
431 North Pitt Street
Address
(!>T 1~E1, T)
Carlisle
PA
17013
(CITYl (STI.T1::1 (llPI
Under penalties of perjury. I declare that I have examined this return and
to tho hest of my knowledgo and belief it is truo, corroct and complete.
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SIgnature Of FIducIary
Date
ESTIMA TED MARKET
VALUE
DEPARTMENT VALUA TION
(OFFICIAL USE ONLY)
2.411.91
62.32
2,474.23
27.30
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1,237 .12 ?" . N :.
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Farmers Trust Co. Checking Acct. #
CVSL Savings Acct. #139378 joint with
daughter, Thelma M. Bosler
Total value of account - Pr.
Int.
TOT AL 1. 264. 42 / ~ ~ '1-. ~.:J.., 1U1j'
I do hereby certify that the above assets were appraised in accordance with Pennsylvania law. V
OFFICIAL
USE
ONLY
$./Pf/~I / Iffp,hrJllj)
APPRAISER
June 18 1 81
D/.TE
DATE
NAME OF PAYEE
Hoffman-Roth Funeral Hm.
Thelma M. Bosler
Dr. H. Robert Davis
Register of Wills
OFFICIAL
USE
ONLY
$ -/2S1:!3.!t;O
,dEDUCTIONS Al.l.owED
NATURE OF CLAIM
AMOUNT CLAIMED
Funeral Services
2,258. 60
2,000.00
22.00
3.00
Medical account
Filing Inheritance Tax Return
TOTAL
4,283.60
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II' ,)S?" iQDAT.