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OATH OF SUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND
This 2nd day of X~ .Tune _ A.D.. 19.!!L_,
before mc, Register for the Probate of Wills and granting letters of Administration in and for said County of Cumberland, in
the Commonwealth of Pennsylvania, personally came
THOMAS 1. ~lYERS
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the subscribing witnesses to the foregoing instrument of writir,g purporting to bc the last Will and Testament of
RF.M,Tl\MTM l<' ~()MuT.nq
Dated
July 26, 1973
late of East Pennsboro Township,
Cumberland County Pa., deceased who being duly
sworn according to law, depose and say, that
he was
present, and saw and heard the testa to r
BENJAMIN F. CONKLIN
sign, seal, publish, pronounce and declare the said
instrument of writing as and for his Testament and Last Will, and at the time of so doing he
his
was of sound and disposing mind memory and understanding, to the best of
knowledge, observation and belief.
Sworn to
V!:::!r.7::s
and subscribed before
0(tli (? ~<~
RegIster
cPf: ~.0-!1i~
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA t ss:
COUNTY OF CUMBERLAND \
Donald E. Conklin
being duly
sworn
says that as nearly as can be ascertained the said decedent
died on
the
;j.,
)~ "'6 L day of
A.D.,19 '? I,
Jlf }/I J
at or about
o'clock, ~.
sworn
and subscribed this
2nd
tJ tr>'<-ct jlc/ f (:'-VU~
day of
June
81
'9~r".
7//7 (J.
~dA)
Register
738
Gr.l.
. . . ..
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ED
LIFE & CASUALTY
THE A:TNA CASUAL TV AND SURElY COMPANY
Hartford, ConnlJcllcut 06115
POWER OF ATTORNEV AND CERTIFICATE OF AUTHORITY OF ATTORNEV\S\.IN.FACT
KNOW ALL MEN BYTHESE PRESENTS, THATTHE AOTNACASUAL TY ANOSURETYCQMFANY,,, corporallOnduly mgoni,odundorthol.wsof tho
Stat. of Connocticut, and haVIng its pdncipal offico in tha City of Hanford, County of Hartlord, SloW ot Ccnnceli",', ha.h m,lI., constituted and
appointed, and does by these presonts make. constitute and appoint Shirley A. EekeX'd - -
of Camp Hi 11 pennsy 1 v anis ,II, ,rue end lowful Atlorney(s\.ln.Fael, with full pown"nd authority horeby conferred
to sign, execute an'd acknowledgo, at any placo wllhin the Unlled Statos, or, if .ho "'"owing line bo fillud in, wilhin Iho area Ihero desig-
nated . the following instrumont{s}:
by his/her sole signature and act, any and all bonds, recogni"nces, con"aclS of Ind,mnlly, and other wrilings obligatory in the nature of a bond,
recognizance, or conditional undurtaklng, and any and all consonts incidents thereto not exceeding the sum of FIVE
HUNDRED THOUSAND ($500,000.00) DOLLARS -
and to bind THE iCTNA CASUALTY ANO SURETY COMPANY, theraby as fully and to the samo oXlent as if thu same werssignad by the duly
authorl,ed officers of THE iCTNA CASUALTY AND SURETY COMPANY, and all tho acts of said Atlorney(s}.in.Foct, pursuant tothea,'hority herein
given, are horeby ratified and confirmed.
This appointment is made under and by authorlly of the following Standing Resolutions of said Company which Rosolutions are now in full force
.nd effect:
~OTEO: That each of the following officers: Chairman, Vice Chairman, President, Any Executive Vice President, Any Senior Vice President, Any Vice
,residenl, Any Assistant Vice President, Any Secretary, Any Assistant Secretary, may from time to time appoint Resident VicePresldants, Resident
Alsistant Sacretaries, Attorneys.in-Fact, and Agents toectfor and on behall ollhe Compeny end may give any such eppointee such authority es his
",rtificate of authorlly may prescribe to sign with the Compeny's name and seal wllh tho Company's seal bonds, recogni,ences, contrects of
iIldemnity,and other writings obligatory in the nature of e bond, recognizance, or conditional undortaking, and any of said officarsorthe Board of
OIrectorS may at any time remove any such eppointee and revoke the power and authority given him.
~OTED: That any bond, recognizance, contract of Indemnity, or writing obligatory in the nature of a bond, recognizance, orcondltional undertaking
",all be valid and binding upon tho Company when lal signed by the Cheirman, the Vice Chairman, the Prosident, an Executive Vice President, e
lenior Vice President, a Vice President, an Assistant Vice President or by a Resident Viee President, pursuant to the power prescribed In the
~rtificateof authority of such Resident Vice President, and duly attested and sealed with the Company's seal by e Secretary or Asslstent Secrotery
or by a Residen. Assistant Secretary, pursuant to the power prescribed in the cartificate of authority of such Resident Assistant Secretary; or (bl duly
,xecuted lunder seal, if requiredl by one or more Attorneys.in-Fact pursuant to the power prescribed in his or their certificate or certificates of
luthority,
This Power of Attorney and Certificate of Authority is signed end sealed by facsimile under and by authority of the following Standing Resolution
voted by the Board of Directors of THE AOTNA CASUALTY AND SURETY COMPANY which Resolution is now in full force and effect:
VOTED: That the signature of each of the following officers: Chairman, Vice Chairman, President, Any Executive Vice President, Any Senior Vice
President, Any Vice President, Any Assistant Vice President, Any Secretery, Any Assistent Secretary, and the seal of the Compeny may be effixed by
fecaimila to any power of attorney or to any certificete relating thereto eppointing Resident Vice Presidents, Resident Assistant Secretaries or
Attorneys_in_Factforpurposesonly of executing end attesting bonds and undertakings end other writings obligatory in the nature thereof, and eny
auch power of attorney or certificate bearing such facsimile signature or fecaimile seel shall be valid and binding upnn tha Company and any such
power $0 executed end certifiad by such fecslmile signeture and fecsimile saal shall be valid and binding lIpon the Company In the future with
respect to any bond or undertaking to which it is attached.
IN WITNESS WHEREOF, THE ,ETNA CASUALlY AND SURETY COMPANY hes caused this instrument to be signed bV its
Vice President ,and its corporate seal to be hereto affixed this 27th
day of April ,'9 81
Assistant
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THE
IETNA
CASUALlY
AND
SURETY
COMPANY
By
77 i?~
Assistant Vice President
State of Connecticut \
55. Hartford
County 01 Hartford
On this 27th day of April ' '9 81 ,before me personally cama R. T. RIPPE '
to me known, who, being by me duly sworn, did deposa and sey: that he/she is Assistant Vice President of
THE ,ETNA CASUALlY AND SURElY COMPANY, the corporation described in and which executed the above instrumant: that he/she knows the
seal ohaid corporation; thatthe seal affixed 10 the said instrumant is such corporete seal: and that he/she executed the seid instrument on bahalf
of the corporation by authority of his/her office undor the Standing Resolutions thereof.
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commission ellplres March 31. 19 84 " Notary Public
CERTIFICATE
I,tha undersigned, Seere tary of THE oETNA CASUALTY AND SURETY COMPANY, a stock corporation 01 the
Stataol Connecticut, DO HEREBY CERTIFY that the foregoing and att.ched power of Attorney end Certificate of Authority ,emaina in full force and
haa not been revoked; and furthermore, that the StandIng Resolutions of the Board of Directors, as set torth in the Cert,ficataof Aulhonly, are now
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day of
PRINTED IN U.S.A.
. (S-,II22.Ej (M) 3-79
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INVENTORY OF REAL AND PERSONAL ESTATE
---- -
. 3ln t~r Sluttrr of tilt Estate of..""IlEJ:IJ.t-.11J.lLf..."CQNKLlJL"" ............,...."..".
Cumberland .
laIc of ..J;:.f;\~.j;..p.i:)).t).\1.1;>.9.r.~..:\'.Q,o/.(\~h~P...,...."..in the County of 1!IlIIf>1\I!., State of Penna., deceased,
Jl1l1rnlllfU of the real and personal estate which were of the above-named
,,,.I;l.~.ni?,[ry~n...r:.:...9.R!1r,.+.t(\...,.,,.................."".........,....... ..". deceased. Taken and. appraised
the .."..".."...". day of ....JliJY.."."..".....19 81. (Date of death ".1.1..??.I.~L.".....)
.!:.~QD.al Pr2E~!:iz
'fangi ble
1.
r'usc. household i'.oods [, personal items
$1.000 00
Intangible
6. 50% interest in CCNO savings account
(joint wi. tl1 Hobert Conlelin)
$5.358 01
U' 224 12
$1,503 02
$4.022 19
M.020 00
2. U.S. Savings bonds
3. 33.33% interest in CCNE checking account
(joint with Donald & Robert Conlelin)
4. 33.33% interest in Harris SaVings Ass'n
account (joint with Donald & Hobbrt Conleli
5. 50% interest in CCNB savings account
(joint with Donald Conlelin)
7.
Real Property
Residence - 206 Cumberland Hoad.
Enola. PA
:;;25.000 0
RECAPITULATION
Apprals",1 va\ulI of Porsoual Properly..................................................................... $ ,l.(,...\?':7".:,!l
Appraised vILlue of roalll"late .................."""...."...."""..."..".............................. $ ,~.~"nQ,(!".(.lP
Total appraised valull ..""."."..............""...""......",..."""....."..""".".."..,,,,....... $ .4.l..J?.7".3fl
AFFIDAVIT OF PERSONAL REPRESENTA-'fIVE
County 01 Dauphin ss:
.....................,...........,....,....,., .V.9.1! hli.V... I:; .'... .9.9. (! E .1,..1.1.!.........,.,...."........................................
Execut 0 r
muYn'i~Ill'lY"tX of the Estate "r.",,,..,,,,,,.,,.D.cnJil.tIJj.r.I,,.f...,,,!::o.rJ.I:;J.:Ln,,,,,,,,,,,,.,,.,,.,,,,,"".".""".
deceased, being du!y..................9.!:Z9.r.J)..................................... accordinlt to law, depose and say that the
items appearing in the Inventory include all of the personal assets wherever situate and all of the
real estate in the Commonwealth of Pennsylvania of said decedent; that the valuation placed opposite
c:\l'h item of said Inventory represents its fair value as of the date of the decedent's death; and that
decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears
in a memorandum at the ellt) (If the In\'entory.
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hefore me thi,."........':\....."..."........day or
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Address rTlo ::= "'IAJ
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1. An Inventory must be flied within three months after appointment of perBoDn.l representative>-:' ".; !"'!".
-,..,r,'
2. A supplementnllnventory mUHt be mod within thirty daYK of discovery of additional aBBets. ,."- r"
3.. Additional sheetH mny bo attached as to personalty or renlty.
4. See Article IV. Fiduciaries Act of 1949.
INSTRUCTIONS
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QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any material part of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No".)....:2.._
2, Did decedent, within two years of death, transfer property from himself/ herself to himself/herself and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No",) ~
3, If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following
information:
a, Age of decedent at time of transfer.
b. Copy of death certificate.
c. Affidavit by the attending physician indicating the state of decedent's health at time of transfer,
d. All other information supporting nontaxability of transfer.
4, Did decedent, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consideration
therefor which was to take effect in possession or enjoyment at or after hiS/her death? (Answer "Yes" or "No",) 110
a, Was there any possibility that the property transferred might return to transferor or his/her estate or be subject
to hiS/her power of disposition? (Answer "Yes" or "No".) I io
b. What was the transferee's age at time of decedent's death?
5, Dill decedent in his/her lifetime make any transfer without receiving a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end before his/her
death:
a. The possession or enjoyment of or the ri ght to income from the property transferred? (Answer "Yes" or "No" ,) 119.-
b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".) ;;0
6. If the answer to five b. above is "Yes," was the right reserved in decedent alone ( ) or decedent and others ( ).
7. Did decedent in hiS/her lifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No".) lio
8. Did decedent; at any time, transfer property, the bllleficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, orwhich could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".) . ; 10
9. If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone ( ) or decedent and others ( ).
REV-453 E'X+ 11o.eO)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DtCEDENT
Estate of BI:~;,iJ/\:,Ti: j;. CO;::.:Lld
SCHEOULE "0"
BENEFICIARIES
(Instructions on Reverse Side)
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY
DECEDENT BIRTH
Donald F Conl(lin ~~;o 11 YC~j ;)(r.; of pcsidue
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H'r 1, Box '1 ~~
'Perra ^lta '1':'.'1.
nobel~t F. Conldin :";on y r;~i Sty.'!. 0"' residue
,.
11 ESfje:,~ noae!
Cmon IIi 11 , :?I^,
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The above beneficiaries were living at the time of the decedent's death except for the following:
NAME
If additional spaco is necessary. use 8~" x 11" sheets.
DATE OF DEATH
j\
REV;454 EXt {a..e.ol
COMMONWEAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
(InstructiollS on Roverse Side)
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Estate of
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ITEM
NO,
DESCRIPTION
TOTAL PE VALUE OF DEPARTMENT
MARK ET RCE DECEDENT'S VALUATION
VALUE NT INTEREST (OFFICIAL USE ONL Yi
1)72. :1;) :1:3',. ,. 2 ~~t1 .1;?
J<.
1. CC:IIl1 checl:tl1'" D.ccount
C()-O'I'/n0r'S - lJontd d
Conl.:lin, 'fcrra J\l1:l1, ':.~.V. ,".
nobcrt Conklin, Cal;lj) ilill,
FA - cst. irl lU75
;:> CClm saviw~c; account
CO-O\lrler - JJonn.ld E.
Conl~lin, 111errn Alta, 1,.'.V.
cst, in 1~75
:' ,;, C11',4. :~r;
~)U':
::',/1,02(: .10
3. CCI-.;n savinr:s account
co-o\':ner - Hobcr't F
Conl.:lin, Camp lIill, l'A
cst. in lD75
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4
Hnrr'l:::-: ~'3avin~~B AS:3' n 8avin,~-~J5
account
CO-O\'.rllerS - ~)on~l] dE.
Conklin, Terra Altn, ~.V. ~,
pohcl't Conklin, en;,l)) lUll,
PA - cst, in 1~75
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TOTAL
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If additianal space is necessary, use 8'/2" x 11" sheets,
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property. real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. 80th tangible and intangible property are to be
included. List real estate first.
1. Describe all real property as indicated in the instructions for Schedule "A." Describe all personal property
as indicated in the instructions for Schedule "8." Include the name. address and relationship to the
decedent of the co.ownerls] and the date the joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3. Indicate the percentage of the decedent's interest.
4. I ndicate the market value of the decedent's interest.
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INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
Estate Home
Bonjmu;i..n.J'...-_G.Qnl<l in
[] Original
o Supplemental
o Remainder
File Humber
21-81-03115
Dote 01 Death
April 28. 1981
Social Securi ty Humber :<.10-10-3646
I, the undersigned duly appointed Inheritance Tax Approi..r in and lor the County 01 Cumberland
Pennsylvania, do respectfully report that I have apprai.ed the real and personol property a. reported in the loregoing
return at the values sot forth oppo.ite each item in thela.t column to e ri tin Sch Ie. "A", "B", "C", and "E"
REPORT OF 'HHERIT AHCE TAX APPRAISER
Dated:
Novp.mbp.r 12. 1q81
I AaJUSTMENTS REMAINaER APPRAISEMENT CODE
INVENTORY VA~UE AS APPRAISED CODE (HARRISBURG USE aN~Y)
Real Property (Schedule A) $ 25 000 00 00+ 92+
Personal Propert)' (Schedule 8) '0+
Joint-Held Property (Schedule E)
Transfers (Schedule C)
TOT A~ GROSS ASSETS
Leu D,bts and DeductIons 40- 93-
(SCHEDU~E F)
C~EAR VA~UE OF ESTATE
OLlie E,'ate ~ FACTOR PRINCIP~E VA~UE CODE
o Annuity
FOR LISE OF REGISTER ON~ Y
Tax on $
CODE
COMPUTATION OF TAX
$
$
$
6%
15%
T ax on $
Tax on $
$-
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REV.455 EX. (3.801
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
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Estate of ".. ,J.' ,:' F, [)(;,.::1.1 Date of Death ,i/;" :1:1
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
File No. ;'1-:',1-:1,1",
Claimant
Relationship lL D(~c(~dl)nt
Clailllilnt's Address at time of Dccedont's Death
ITEM
NO,
DATE
NAME OF PAYEE
REMARKS
AMOUNT
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Func
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Cl11":'ibcrlnnd nond Enoln
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f)
Donnl(l Ciilltcr 'llranS\lrCr
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tr2vel c;.~~)cn;-;c;--::
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" " "
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t" 18 :Jho no c hn r 'c [,;
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7
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ostaffG
2.~4
fi lin~' fee:;
':1, 5GB. no
2.10.00
45.00
39.50
9
7 nl
e.(ll;;iniGtrative fen
1.0 (i:11
c;~ccU tor I f-, bonel
ndvcrtisin;~ fees
l~ll sc ex;' ensc:.:;
30.00
,lttor'nc\' I S fee
750,on
TOTAL ;,S 77n,1.2
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral
expenses and expenses of administration submitted to the estate as deductions for Inher~tance Tax purposes.
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5 GNATURE OF FIDUCtAr~y j 0 E "
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ Ij- '7 '7 t>, /:J. AT
/
/"
% TAX RATE
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t :GISTER OF W LL5
//-Jrl-S/
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxable
estale. In addition to debts incurred by the decedent or estate, other items ore claimable including the cost 01
administration, attorney fees, fiduciary fees, funeral and burial expenses including the cost of 0 burial lot, tombstone
or grave marker and other related burial expenses,
All debts being claimed against on estate Ole subiectto the approval 01 the Register 01 Wills with whom Ihe
Inheritance Tax Return is liled, Evidence .to support the decedent's or the estate's liability lor the debts being
claimed should be ottoched to this schedule,
A lamily exemption may be claimed by a spouse of 0 decedent who died domiciled in Pennsylvania. If there is
no spouse, or il the spouse has lorleited his/her rights, then any child 01 the decedent who is 0 member 01 the same
household can claim the exemption, In the event there is no such spouse or child, the exemption con be claimed by
a parent ar parents who are members of the same household os the decedent, The lamily exemption is allowable only
against assels which pass by a will or by the Pennsylvania Intestate Lows,
NOTE: Compensation paid to an estate representative; namely, on executor or administrator, lor services
perlormed in administering an estate is reportable lor Pennsylvania Income Tax purposes, This taxable income
item should be reported on form PA.40.lndividuollncome Tax Return,
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INSTRUCTIONS FOR COMPLETING SCHEDULE..::.E"
1, lithe lamily exemptian is being claimed, indicate the claimant's nome, address and his/her relationship la
the decedent, Enter "Iomily exemptian" in the remarks column and the amount claimed in Ihe amaunt column,
2, Assign consecutive numbers to each item listed,
3, Enter Ihe date on which each debt wos incurred and/or paid,
4, Enter the names 01 each payee,
5. Provide 0 brief explanalion in Ihe remarks column for each debt claimed,
6, Enter the amount 01 each debt being claimed,
7, The lorm must be signed by the person who hos assumed the responsibility lor paying the debls.
IF ADDITIONAL SPACE IS NECESSARY USE BY," x 11" SHEETS.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*'
COUNTY FILE NO:
/ .
, .
.... "
DATE
,j'r / ,. /./'(/
';1 - .( ,1/ _
TO:
"'.<<..1' ~
I
it' /
'.d,. '!
./ '.!. ^(/.:..
ESTATE
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FILE NO,
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,
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I..
/ // //,:
COUNTY
DATE OF DEATH
I (
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/
F /.;/.(>(
,
Appraised Value of Estate:
Real Estate
$ ..": 1,-- /,~.I;"!I ".()
,
Personal Property
+
.,
/
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"J/
Jointly Held PropertylTransfers
t ,:/ ~/// 1. ~~; ?
, /
Total Gross Estate
S .-,'1 ,',' '/ -) Ii
, .i
,", )() /'- ;,
/
Total Approved Oeductions
Clear Value of Estate
$ '--;' ..)~ :'J 1,-;').>' ,)
/
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$ /"') .~.;: 'j-')..' .~,.;,
Amount Taxable @ 6% Rata
$ :..;' /;
-;.; /,-,/ ~,)
tax due
$ .;'//;;/.'/"';)
,
Amount Taxable @ 15% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
$ ~. /.~I/. ",/ OJ
'/
* * * * * * A five percent discount totaling $
will be granted jf the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
,r/~/i) "~/
$ ///!//,- .;..j(/
/
+
S /. '/ .., 'I
$
=
$ "') I "'-'1 ..:/'..,
.' J ~/ , . .,
.;
+
=
+
=
Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
i .#" ~
$ , ,<.l ,.,.
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Alaessedby: ~./') //~. I ('1./ I~'~>> ( ~'r ~I j
See Information on Reverse Side A6In,tf6nhl,. . mo~_W"lIh'''' /
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