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,.. ..COMMONWEAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEOENT
Estate of
( ) Exec. () Adm. OtherSurvivin;.~ Joint
fllennnt
Nome Blair D. PaClen
Social Security No. '301-10-7095
~ll ""11' (' R d
Address' "1 1 (lms "rove on
(STREET)
MochanicshurR. Penna. 17055
(CITY) (STATE) \ZIPI
Under penalties of perjury, I declare that I have examined this return and
to the best of my knowledge and belief it Is true, correCf and complete.
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SIgnature of FIduciary Date
INHERITANCE TAX RETURN
FOR INSOLVENT EST A TES
(Instructions on Reverse Side)
Grace V. Paden
Las! address Forest PorI, Nursinr; Horn
700 Walnut Botto~SW6~~
Carlisle. Penna. 17011
(CI,TYI lSTATE) fZIP)
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Date of Death
Nov. 28, 1980
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Social Security No. 20!~-()2-9 335
TYPE OF ASSET
Persona1t
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OFFICIAL
USE
ONLY
DATE
11/28/80
~ 6/9/81
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OESCRIPTION
Undivided one-thir'd interest in a
Savinr;s Account No. 161531 with
Cumberland Valley Savings and Loan
Association, Carlisle, rer;istered in
the names of Grace V. Paden or
John H. Paden or 81air D. Paden.
Opened as a ,Toint Account on Nov.
14. 1977. Total balance of account.
as of Nov. 28, 1980 was $916.98.
Reported at one-third here inasmuch
as account is over two years old.
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COUNTY NO. :x / -J' / - ,3~8'
STATE NO.
ESTIMATEDMAR~ET
VALUE
DEPARTMENT VALUATION
(OFFICIAL USE ONLY)
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$ 305.66 .. ''\"1
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TOTAL $ 305.(,6 30.5; ,,(. "
I do hereby certify that the above assets were appraised in accordance with Pennsylvania law.
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APPRAISER
, E
NAME OF PAYEE
NATURE OF CLAIM
AMOUNT CLAIMED
Hoffman and Roth Funeral
Home, North l,ano'Ter St
Ca:rlisle, Pf.l,
Reg1ster of .111s
!;VYl1Rral 81;11
r1 inC InleritBnce Tax
Return for Insolvent. Estate
~; 2918.00
3.00
$
p: -J
,~ 2921.00
BANt<. NO,
RCC-U, (+-,,)
.COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
).615:11
OATE FILED
NOTICE OF DECEDENT ACCOUNT STATUS
Ma 27, 1981
ST':f~i"n"t~Ccl'gi~~'l(JoINT, TRUST, OR 'NVESTMENT
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1l/14/Tl
SOCIA.L SECURITY NUMBER(S)
,1.(-,OM!>O-J -\'7 J
RETURN COMPLETED
FORMS TO LOCAL COUNTY
INHERITANCE TAX OFFICE
NAMES ON ACCOUNT
Grace". Pec:len
John H. l'aden
Bla1r ;:;. Paden
DECEDEN'i INFORMA N
DA.TE OF DEATH
SURVIVING DEPOSITOR (Oeneflcla,.,IINFOR/olATION
o n He Paden RELAT'ONSH'P
Bl 1 D P d TO..OECEOENT.
8 r . a en ~onp.
Grace V. Paden
11/23/80
NAME
/.DDRESS
102 Walnut St..Boiling Springs, PA
ADDRESS .
John _ 103 Walnut St.,Bei1ing Spgt,PA
Blaine _ 511 ~illiam~ Grove Rd..Mechanie
sburg PI, 11050 C'TY
Roiling Springs, PA
CO~H.Tr
l,umb.
z, 7
Cumberland Valley Savings & Loan Assn.
16 W. High SteL P. O. Box 127
Carlisle, PA 17013
BALANCE OF A.CCOUNT AT 000
INTEREST ACCRUED AND COl.LECTIBLE AT 000
ToTAL
$
$ 23.0R
$ Q4().06
BANKIlNSTITUTION ADDRESS
BANK AUTHORIZATION
I HEREBY CERTIFY' THAT THE INFORMATION CONTAINED HEREIN IS A
CORRECT REPRESENTATION of INFORMATION IN:>UR FIl.ES IN ACCORD
WITH SECTION 740:. pi&: E TA.Y. AcT OF '96t,
SIGNATURE OF FINANCIA.L INVESTIGATOR DATE
"