HomeMy WebLinkAbout81-00344
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PERSONAL PROPERTY - List 011 t,ml]iblo !lod intangible porsonlll propClrty ownlll! fndividll!llly by the deco-
dont at tho limo 01 doath.
Estimlllou
Mllrklll Valuo
DeplIrtment Valuotlon
10fficiol Usu Onlyl
1971 V 1/ Bus
1976 l1ercury automobile
Vacation Club
Travelors checks
1,700.00
I,BOO .00
140.00
200.00
Total
JC!)INTLy.QWNED PROPERTY - List 011 real and Oorsonal proporty owned by tho riacaden! with anothor(s)
BS joint tenants with right of survivorship.
3 8 0.00
Estimated
Market Valuo
none
Total
TRANSFERS - List all real and personal property transferred within two years of death,
Estimated
Market Value
Department Valuation
{Official Use Onlyl
None
Total
List all safe deposit boxes registered in the decedent's individual name, or jointly with, or as an agent or deputy of another, or in decedent's individual
name with right of access by another as agent or deputy. Include the name and address of the bank or other institution where the safe depOSit box is located,
the name(sl in which the box is registered and the relationship of the joint holders to the decedent.
Name and Address of Bank or Other Institutloll
In Which Decedent Maintained a Safe Deposit Box
Nama or Names In Which
Safo Deposit Box Is Registered
Rftlotlonshlp of Joint
Ho!ders to Decedent
None
NOTE: YDU may expedite the processing of this return by filing with it and 85 a part of the return, letters from financial institutions or mortgage holders,
certifYing to amouOls'on deposit or owed by the decedent as of the date of death. Such letters must be signed by a responsible officer of the financial
institution or mortgage holder and indicate Clearly amounts of principal ana interest in the dec:edent's account at the date of death and the type of account,
DCCoullt number and the exact name or names in which the account is registered.
BENEFICIARIES
~
BENEFICIARIES AND ADDRESSES
IStoto full namos nnd addtllU010 of nil who hllllO ,111 III lor!!.'
either vUltod, COnlll1lllJf\t or othur Intotusll
RELATIONSHIP
TO DECEDENT
SURVIVED
DECEDENT
STATE YES
OR NO
AGE OF LIFE
TENANTS OR
ANNUITANTS
AT DEATH OF
DECEDENT
INTEREST OF
BENEFICIARY
IN ESTATE
_.--_._--_.---~- ----..--.
Rosa.1~9.w.dlln,_233-I>L.King..s.trCQt,-__.- ._wlfc____ _._Y.CL_ --1OOZ
Shippensburg, I'A 17257
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INFORMATION
. PLACE FOR FILING - The return is to be filed in duplicate with the Register of Wills of the county wherein the decedent resided.
TIME FOR FILING _ The return is due nine months after the decedent's death, unless an extension for filing has been applied for and granted
by the Secretary of Revenue within the nine.month period.
FAILURE TO FILE RETURN - Section 791 of the 1961 Statute provides that ".. . any person who willfully fails to file a return or
other report required of him. . . shall be personally Iiabie . . . to a penalty of 25% of the tax ultimately found to be due or $1,000
whichever is the lesser to be recovered by the Department of Revenue as debts of like amount are recoverable by law."
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