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HomeMy WebLinkAbout81-00387 ..: . H >< ~ Eo< ~ H )' Eo< :>< ~ CIl ~ ~ M P Q p., Eo< CIl . . .., M . , i'" H ~ M CIl Cf" H H ~ C':.\ S ~ z 0 M t9 II: r CO . Woo r 0 C\I ClJ .. ~ . .5 -9 0 Z ~ No.21.81 ")'i).... '.,' '~,I PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY in the Estate of GOLDIE J. DEWALT , deceased. To Mary C. Iewis , Register of Wills for the County of Cumberland, in the Commonwealth of Pennsylvania, is Petit;one.r(~ the executrix named in the Last Will and Testament of Goldie J. JE.ialt dated February 22, 19~7 Decedent was a citizen of the United States and a resident of Township Carlisle Borough, Cumberlond County, Commonwealth of Pennsylvania. Decedent died on ~esday the 15th day of !\pril A. D, J 9 81 , in the County of CUmberland , State of Pennsylvania at the age of 85 years. mx ~ her Decedent has not been married and has not had children born to :mmx since the execution of the above described Will, Decedent was possessed of personal property to the value of $ 15,000 and of real estate to the value of - 0 - estate situated as follows as near as can be ascertained; said real Elppdyt Therefore, your petitionerlsa respectfully applies for the probate of the said Last Will and Testament and for Letters Testamentary thereon. Dated June 25. 1981 Name and oddress of Petitione~ Ruth K. Taylor I "? ,- / /. /;:};:-J,/ ',1-/, ~jL ("'1,.') ""7, r.; '---./ /, "'/ 7r ~""L.......-' )("ut/!c..t:!-d';/>L4 .5// jcq;; /7//0 COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND Ruth K. Taylor nomed in above application, being duly sworn according to law say(s) that the statements set forth in this petition are true to the best of ),"',. knowledge and belief. q?<.u.i Ii: 72-t0L' . Sl-.urn and subscribed before \ ~'~,*,*-,;l,.(";';;/ ,-)'i,':;;;<;~&,c-' me% June 25, 19 81 />:; 'P. M~; (~lf f'";;:;~, v,~"::~' .,jJJ;,/}J;: . ~ ) - f I 3 t 1) ( I ~ ~(,() _ ..... / 1</ I, '~/)j>'>/~I,r.:..{. ,~~<.:,c-c: Filed: J[ne 25, 1981 ( .::r AttorneY:/~'<<C<'/'''G ;;1; / Ii' / '1/.:;/_7.. E-< .~ ~ en' ~ lzl." E-! ~ ~ e::l ,..:I fj . :J ~ .., lzl H ~ f3 :3 E-< en S ;S t!l ..... . '. ..,,~~ . .- . !.: .~ ,\ ~ tl'l ' ot( w,5 2,.~~!: ' Iii ~ ffi( , ' >~ jUIli'" . .(.J >-.~,x'm," , ,0: Ii J Z ( ,It " III 2~ ' I". --.' , -. .. ' OATH OF SUBSCRIBING WITNESS COMMONWEALTH OF PENNSYLVANIA 188: COUN1Y OF CUMBERLAND r This ...........................?..~,~~,...........,..,....,.........,.......... day of ,..........,.'!.!!:~,~................,............................ A, D" 19...?J, before me ........................,J!I<I.1:y..J::.,...J:.ew.i.s.....,....................................................., 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 ..................... ....,... ......................,p.y.J,y,:!,~..,!'!, ,... .W':!' g!s~,F.g, ....,....' ,............ ........ ..,........ .........,.................. .................................................................................................................................................................................................. the subscribing witnesses to the foregoing instrument of writing purporting to be the last Will and Testament of ...................,......,Goldie...J,...,llelllalJ:. .....,......................................... .......'......'.. Dated ...Febl:uaJ:y,..22"....19,7.,7.. late of ....4fl,2...W,<ll.nuJ;,..B.Q,t.t,Qm..:RQ,ad,....Car,lis.le...,..............,....,............ Cumberland County. Pa" deceased who being duly ....,..,sllZox:n........,.........,.......... according to law, depose and say. that .....she...lIlas....,..........,......,.... present, and saw and heard the testa,tx:ix,.......,...............,. .......Goldie...J....,neNalJ:............................................., sign. seal. publish. pronounce and declare the said instrument of writiog as and for hJ).1:........,.., Testament and Last Will. and at the time of so doing .........................,..!l,h~,.............................. was of sound and disposing mind. memory and understanding. to the best of ...............,...............!I!Y....................,..... knowledge, observation and belief, .,.................~~Q,;:!:I....................... and subscribed before ",..,94L;k{::...la",.."9d"~,~((.c.:l:.,,......,,... ..qJ1dA.4...,(l.,:.. , ~\A~Yrc. ~WIS ............................................................................................ Register, ............................................................................................ AFFIDAVIT OF DEATH COMMONWEALTH OF PENNSYLVANIA 185: COUN1Y OF CUMBERLAND (, - .............................,...........,........,s.y:J,y.;i,,~;;,~Z;:N;i,,~E:~,+.9:.......~:~!,+,h....:k:........D.Jdf/O'!;,:..................... being duly ......................R.W9,!;',I}.............., says that as nearly as can be ascertained the said decedent ..............................,............. ,.......,........., '......,.... ..,........ ......., , ....,.. ............., .........,..,..,.. ..,.... ...g,<?~,~!,~,.. J., "..,q~\'!,~J!:........ .........,............,.. ...., died on ....,~~,~,~~,~~,~,~....... the ,....,lS,th,.......,............ day of .......,Apr,iL..........,................................,.. A, D" 19,e,L. at or about ...........,..............................'..... o'clock, .... M, .....!?,~2E~.......,......................,..,...... and subscribed thi,s ......J?!:!:,.. '..................,...,...... day of ..,-!.~,~~............ /-') ..(j.,,~,f:LL......!i,....-:J~-;;y),!.:L.....................,......,.. 1~" before , ~ fl." ~ ' ,...i21&,y;., ......~..:..'e' !.t.",?L."........,.., RegIster. MAR'l"r L~IS 8:"~2 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA~ SS: COUNlY OF CUMBERLAND Before me, the Register for the Probate of Wills and granting of Letters of Administration in and for the , ' l,. 1/; (If -' { ...' \- //>1.t / / ~'~'-" ./ County of Cumberland, personally came .."".,......,,,,(.,,,......,.,,,.,,,[,,,,..,.,,..,,..,,,':::r'\"<...,..,<...."..,..,...."".."..'....'.....'...... , 1/ !7r ' who. being duly ..,_(g;~,',:;;!~,:".,,',; 'do ............ depose and say that as .....,::,<.f.:,f/.{/:..,..~:(;:!{.,:........,..,...............,.......... / / ') '; of the last Will and Testament of ....,..,.z:j<<.(J({,.:;:..L<;;~:::....,A/....I.t;.i.l.,;,?l.:,............,....,........,..... deceased ,......,.......:>,h.~............,....,.. will well and truly administer the goods and chattels, rights and credits of said deceased according to law, And also will diligently comply with the provisions of the law relating to Transfer Inheritances, ,....,dtb.~I.:::~,~:J::S--a'nd subscribed / before me, ......,J.une...25",..,19,8L,.......,..........., A, D,. 19..,...... R;~~/{;;" . (!r.-;:~!;tl.jL,..,:~:r;;:y&L~,................................... I ............................................................................................ .,j .-I: 00: " 0\ ~ G ... ij Q I.L. LO: {... 0 00: r;:, ~ *: ..,~ . . -' \0: .... ~ -'" 00 0 Ni 0 <'l -' '1 ~ .: ~\ I - U: .-1 , ~ E<: 00 - I':l, "I , 3: I>li ,... .-I rii ,5 .: CO N ~ 0: "0 (l\: I " 00: d "0 ,..- ~ *: C\I z ~! 8 ~ ~ " "0 0 .- "0 0() ~ ~ Z ~ c: " ii: " p.. DECREE , 26th June 81 Be It remembered th.t on the ........,.....,:,.....,... day of ..,....,............................,....,................. A, D,. 19..,....,. there was probated and recorded the last Will and Testament of Goldie J. Dewalt ............................................................................................, carlisle late of ....,..,.......,.................,..,........................,.......,................ ,.., Cumberland County. Pennsylvania. Deceased, Letters Testamentary Ruth K. Taylor ........... ...........,..,.., '......' ,..,....",.... ..........,..' were granted to .. ,....', .....' ....,.... ,...., ....,......,......',.., ...,.. ...,...... ........., .............,...... Witness my hand and official seal the day and year aforesaid, a;, 1 ~ u..'nM'!!d~frS,....::..n: .... 833 _. Register. .. 31" I~r tIInllrr of t~r fplutr of...................~I!l~E..J ,..DE.w.A.L.T.,..,...... ,........,...... DECEASED MARY c. IEWIS To ~. Esq,. Register for the Probate of Wills and Granting Lellers of Administration for the County of WUji1IHK Cumberland Arros A. ~alt ................................................................................................................................................................. ........................................................................................................ ....................................n................... the undersigned being the ,....,..,....,..,..,',..t:!l!?~~..,"",.."......,',..,..,..,.."......."....,.."..,..".....,....,......,..., ...........................................................................-............. ........................................................................ of said decedent, who was II resident of the .......,................ of ..............~~i,s.~~,..,.............'m'.....'..'... Cumberland ~County. Penna,. and who died in the m.........'... of ,..,..,....,..<;;@:JJ~J~m..'..........,.........m..... in the County of ,....,.....~;:~,~9:...................... and State of ......,R~~yJY.~?!.........,.............,.. on the ...........,~,5,~,............. day of ,..........,)\p.;:g,............m'........... A. D, 19..~L at,..............,.....,.... . testate, ,,15 000 o clock ....m..... M,,~ and leaving personal estate not exceedIng In value $........L...........m......... d' $ - 0 - and real estate, not excee mg .............................................................................. do hereby renounce ........~....rjght to have letters testamentary or of administration on said estate issued to ....~............ and do hereby request you to grant same to h..'...,h......J)!JJ;!}..!$"..~,~yJ.9.+.'m'.....m..'.....................,.... .................................................................................................................................................................. Witness....~...... hand and seal this ,hhm'''' day of ..,.............,....,..................,... A. D. 19,Jll... Sealed and delivered in the presence of x~(:;gl)d~mmmm (L" ,......",...........",..,..,...",.........,..,..,..,..,..".....'m'.........'..,... (L. S,) ...",..,....,..",..",....".."",...."....,..,.... ,...,....,......,..,............, (L. S,) ,........"..",.....,......,..."......"....."....,..,......,..'..hh....'......,.., (L, S,) ...,.."",..,...,..",..........,',...........,'" "....".. .'",..,..,..,.. ,.......,.. (L. S,) ,...'..'""", ""..'",..,' ,..' ,'..,..",..',.,.. ",..."..',....,.."""".,....".. (L. S,) 1; , . . ~'- "" io ,"", ,..,- . . :IJJ :tf1 ... " i< III a- u :IJJ V " ~ w :u :l u ,'6'0 ci ~ \IJJ ~ w :. -r- ,0 ';. ,0:: ex) ~ ..,i <i c:! :>. I 1\ ." :;s :0. ,...i IJJ ~ :. N! ~ iO ~ .: = J "" 0 ... ..1 ~i -:;; r;: , : ... M: c.l &\ = ~ 0 ::l .;: >. ell I \ , I I I \ I \ OA TH OF NON-SUBSCRIBING WITN ESS COMMONwa;ALTH OF PENNSYLVANIA l COUNTY OF CUMBERLAND J 55: This ..........,....~,?,~.J:....,.........,.,..,..,'" day of ..,.."xl,!Jl.\'!.............,..........,....,.... A, D, 191C..~.:J.., belare me, .............................,I:tq.;r.Y,..C,...Ll':l:I.:t.'l..................,... Register lor the Probate at Wills and Granting Letters 01 Administration in and lor the county 01 Cumberland,in the Commonwealth 01 Pennsylvania, personally came ....................:lOlc)s:"D...,Tay,lar............., '.,'."".. .',..,..,..."",. ,.",.."."".,..,..,."",..""" ,.""",..""",.",.,.."",.,.."..",... who being duly he is .. ...,....!',~9.~!1.......,.........., according to law deposed and soy that tK~~oX. well acquainted with the handwriting 01 .., ,.... ,'?~~~.~.~..(!,:,.,I?!:\~~,~,~,."" ,.,'..',.,..,. ,..,...... "".""",'.",. "."'......,..,,, h 'tt h d testatrix 't t 1 " w ose nome IS a ac e as ........................................................ to an inS rumen 0 writing purported to be ..,............,....,....,..,.................,.......',........... the Lost Will and Testament 01 .."...,..."..,.".".,...,.... .~9.+H;i,~, ..Q~W<;1J.i;....,....""".....",......,."."".",......."",. ,..,.....,..,.", late 01.....,.. ~il.+.+,~Il;t.li!..., ~\W\I;>,~;r;;t.<;1,I;lH. ,~9,1,1.1).!<y',..,....""...."",.."""",.""..,..",.", deceased and that the said signature is true and genuine, afld tRat.the gsid .T..,...fJnJ..'Hn..f..fL1H........,.. ...................................'............... t~ R .1:';..Qd~hc::p-fJt......................................... ,.....~~~.f.~..................and subscribed before me( this .....,....,....,.,~.~~~..,...."...,',.,."..,.. ....day of June 81 ........................................ A. D. 19' ............. ;/.Lil~mm / ..,92~"..(i~:,.uy~.."..,.., MA~'<lCrJLEWIS ~~ Register per ................................................................ Deputy Register 891 ,..,.., 05 r~ r- ",'" ;2'-'1 N ",'" (. .. ;;)g VJ '3: .::',;::' f'l, J,:; ,-' -;.," ',~i t-v .t>- o INFORMATION This document is the Notice required to be given under Section 709 of the Inheritance and Estate Tax Act of 1961 172 P,S, section 2485), If the tax ;s paid within three (3) months after the decedent's death, a discount of 5% of the tax paid is allowed, Inheritance Tax becomes delinquent nine (9) months after the decedent's dealth. Interest is charged at the rate of six (6) percent per annum on the amount of unpaid tax. (SEE EXAMPLE BELOW) EXAMPLE: If a balance of tax due of $2.000,00 is in a delinquent status from 3-3-80, and payment is made on 5-23-80, the interest is calculated as indicated below: STEP 1 Determine. the rate of interest from the table below. STEP 2 Multiply the balance of tax due by the rate of interest STEP 3 Add the interest to the balance of tax due. 2 Months = 20 Days Rate of interest = ,010 = + ,00335 ,01335 Balance of tax due Rate of interest INTEREST $2,000,00 x ,01335 $ 26,70 Balance of tax due Plus Interest to Date of Payment (+) TOTAL tax and interest to Date of Payment $2,000.00 $ 26,70 Interest from 3-30-80 to 5-23-80 Results in: $2,026,70 ------.--------------------------------------------------------------- 1 month ,005 4 months ,020 7 months .035 1 0 months ,050 2 months ,010 5 months ,025 8 months ,040 , 1 months .055 3 months ,015 6 months ,030 9 months ,045 12 months ,060 1 day ,00017 11 days ,00186 2 1 days ,00352 2 days .00034 12 days ,00203 22 days ,00369 3 days ,00051 13 days .00220 23 day. ,00386 4 days ,00068 1 4 days ,00237 24 days ,00403 5 days ,00085 15 days ,00250 25 days ,00420 6 days .00101 16 days ,00267 26 days ,00437 7 days ,00118 17 days ,00284 27 days ,00454 8 days ,00135 18 days ,00301 28 days ,00471 9 days ,00152 19 days ,00318 29 days ,00488 1 0 days ,00169 20 days ,00335 30 days ,00500 ---------------.------------------------------------------------------ Any party in interest, including the Commonwealth and the personal representative, not satisfied with the appraisement and assessment may Object within sixty (601 days after receipt of this Notice as provided by Section 1001 of the Inheritance and Estate Tax Act of 1961 172 P,S, see, 2485 - 1 DO 1). MAKE CHECK DR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT" DETACH THE TOP PORTION OF THIS FORM AND SU8MIT WITH YOUR PAYMENT TO THE REGISTER OF WILLS FOR THE COUNTY SHOWN ON THE REVERSE, SEE THE INHERIT ANCE TAX INSTRUCTION 800K FOR ADDRESS, HEVo1!iOO l;:X I (~.ull BUREAU OF EXAMINATION PENNSYlVANIA OF.PARTMEllT OF REVENUE P,O, UOX 8327 HARRISBURG, PA 17105 '/ - CJ.fd - .3 INHERITANCE TAX RETURN RESIDENT DECEDENT /7 ). <II--{ MY Filo Numb" ,,.!! - )11 - tJ :l,j' 1 cJ' Docodont's Add.... /1 (j "I)-I"z k4/,..MI- ,(j,,-i-lCM .Itf, el1~/;:i/1! ;;; /1tj/:I 3, Remainder Return 0 DECEASED CHECK 2, Suppleme"tel Return 0 BLOCKS 4, Life Estlte 0 5, Federll Estlto Tlx 0 Return Required, 6, Decedenl died tlstlte r.:71 7, Decedent maintained a living 0 8, Number of salo doposil 0 (Attach copy 01 Will) ~ trust (Attach copy of trust! boxes invenloried All correspondence and conlidenlial tax information should bo dirocted 10: APPRO, PRIATE CORRE. SPONOENT Neme Address City RIClpilulation 1, Real Estale (Schedule Al ( 11 2, Stockslnd Bonds (Schedule BI ( 2) 3, Closely Hald Slock/Plrtnarship Intarest (Schedule C) ( 3) 4, MortgagOl end Notes (Schedula 01 ( 4) 5, Cosh & Miscollaneous Personal Property (Schedule E) ( 5) /,{. /r:/ ,ZO RECAPIT, 6, Jointly Dwnad Properly (Schadule F) ( 6) ULATlON 7, Transl", (Schedule GI ( 71 8, Tolel Gross Assets (10111 lines 1,7) AND 9, Funeral Expenses Administrltiva Costs/Miscelle"eous ExpenIBs (Schedule HI ( 9) ~t11'l,/7 TAX 10, Debts/Mortgages/Liens (Schedule II (10) 11, Tolal Daductions (Iollllin" 9 & 10) 12: Nel Value of Estlte Wne B minus line 111 CALCU. 13, Charitable 8equesll (Schedule J) LATlON 14, Nel Value subiecl 10 lax \lina 12 minus line 131 Stale ~, ( S) / .:1,/,:1. ,.l(J / (111 (12) (13) (14) ?i. t' 7,/,/7 ~ o.f',,?, (J,'J tcJ'~, C,?) Computation of Tax 15, Amount 01 line 141axable at 6% rate (15) ~ t' f,,!, d.j (include values from Schedule KI 16, Amount 01 line 14 taxable It 15% rale (16) (include vlluos from Schedule K) 17, Principel tex due (Idd II' from line 15 plus II' from line 16) IS. TOIlI Prior plyments: (al Amounl Plid (b) Plus Discounl (cl Minuslnleresl (181 19, Selence Due Wne 17 minus line lBI Meke Check Plyablelo: Ragister of Wills. Agenl ... PLEASE RECHECK MATH'" ..06" pl</,9>L ,,15= (17) ~..;I,fL (19) Under penalties of periury,l declare lhal I h.ve ex.mined Ihis return, including Iccompanying schedules Ind ,telemonll, end to Ihe best 01 my knowledge and belief, it is true, corfllct, and complete. Declaration 01 preparer other than the penoAa1 representative is based on all inlormation of which preparer has any knowledge, SIGNATURE OF PERSONAL REPRESENTATIVEIS) ADDRESS DATE SIGNATURE OF PREPARER OTHfR THAN REPRESENTATIVE ADDRESS DATE 'S133HS ..ll x ,,~g 3Sn ^~VSS3J3N SI 3JVdS lVNOll100V ::II 'Slqnp 0~1 6'J!^Dd JDj ^1!1!9!SlIDdsOJ 041 pownssD SD4 O~M UOSJOd O~I ^q paufi!s oq Isnw,uJoj 0~1 'L 'pOU'!DI' 6U!09 Iqop ~'DO jO IunOUID O~I JOlu3 '9 'pOW!DI' Iqop ~'DO JOj u,unlo, S~JDWOJ O~I U! UO!lDUDldxo jOp9 DOp!^OJd 'S 'OO^Dd ~'Da jO saWDU O~I Jalu3 '~ 'p!Dd JO/pUD poun,u! SDM Iqop Y'DO Y'!YM uo 0101' 0~1 JOlu3 '( 'pOIS!1 UlOI! Y'DO 01 sJoqwnu O^!ln,aSUO' ufi!ssV 'Z 'uwnlo, lunOWD O~I U! pOW!DI' IunOWD 0~1 PUD uUlnlo, S~JD'UaJ a~1 U! ..uO!ldwoxo ^HWDj.. Jalu3 'Iuopo,ap 0'11 01 d!qsUO!4DlaJ Joq/S!q PUD ssaJppo 'aWOll S,IUDW!Op "11 'ID'!p"! 'P'W!DI' 6ul09 S! uO!ldwaxa ^l!WDj aql JI 'I ..::I.. 3ln03HJS !)NI13ldWOJ ~O:l SNOllJmllSNI ex: ex: <( <( ~ ~ >- >- M i o-l 0 l:t ~ t-j . 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DEI-!ALT, of Carlisle, C~r.1':->c:l:md County, Pe:1r.sylvania, being of soune: rr.ind, mem::>,)' and understanding, do make, publish and declare this as a:1dfur rr,y last will and testarr.ent, hereby revoking ane makin~ v:J:d all formervills by rr.e at any time heretofore made. F,RS1. I direct all my just debts and funeral expenses be fully paid and satisfied out of my estate by my personal representative hereinafter named as soon as conveniently may be after mv decease. J SECOND. I give, devise and bequeath all of my estate, real and personal, to my husband, AmoS A. De~alt, if living, otherwise to my daughter, Ruth K. Taylor, or her issue. LASTLY, I nominate, constitute and appoint my husband, Amos A. Dewalt, Executor, if living, othen~ise my daughter, Ruth K. Taylor, Executrix, of this my last will and tcstam2nt. IN WITNESS WHEREOF, I have hereuntCl set my hand and seal this ,.,.,. ~I.~ ~-'! I "../ 'day of :':/,f:"'''((~',f / 1977 . .'/ , 11; " ",~ J' /(1, ,;-r- /~cY-:iA-<:- - iLt.-cM,~ ./ (SEAL) Signed, sealed, published and declared by the above named Testatrb:, Goldie J. De,~nlt, as and for her last \~i11 and testament, in the presence of us, who, at her reouest and in her presence and in the presence of ench other, have hereuntD subscri hed our names os witnesses thereto. ,),') I . I A/I. , ' - " ' -~ ! .. / . ., / .. , , , - , . /.'ct ';rL, REV-4r.D EX+ (lo-eO) COMMONWEA~ TH OF PENNSY~ VANIA OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "A" REAL PROPERTY (lns'ruct/ons on Rovorso Sido) ESTATE OF (lnlni",.T nAw"Jt ITEM DESeRI PTION ESTIMA TED DEPARTMENT NO. MARKET VALUATION VALUE rOFFICIAL USE ONL Y! None. TOTAL -0- If additianal space is necessary, use 8\'2" x 11" sheets. iHv-..:J1 l.^t (d-80J SCHEDULE "6" PERSONAL PROPERTY COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVeNUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT (Instructions 0/1 RCV{.lrs(J Sidr.) Estate of Goldie J. DeWalt ITEM NO. "- - -- DESCRIPTION UNIT VALUE L. cash (at date of death, Goldie J. ~t IeS 13,161.2 mld.inq check payable to her in the MDunt of $13,161.20 representing her share of distribution fran Estate of JlIa)b Gephart) If additional space is necessary, use 8'1" x 11" sheets, TOTAL ESTIMATED MARKET VALUE 13,161.20 $13,161.20 ~...... ~' tWi~\" "~~ J ",,(~ . '.r:- "r:~ \~ ~~',1;~:t?'~02.:; DEPARTMENT VALUATION {OFFICIAL USE ONL Y/ 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" ,) lJb 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",) -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",) ~~ 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",) b. What was the transferee's age at time of decedent's death? 5. Did 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 right to income from the property transferred? (Answer "Yes" or "No" ,) ~ b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer "Yes" or "No".) No 6. If the answer to rive 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",) no 8. Did decedent, at any time, transfer property, the boo eficial enjoyment of which was subject to change, because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of law? (Answer "Yes" or "No" ,) No 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 ( ). lleV-453 EX+ (10-S0) COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT OECEOENT SCHEDULE "0" BENEFICIARIES (InstfIJctlans on Reverst! Sldo) Estate of Goldie J. DeWalt BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DECEDENT Yes DATE OF BIRTH Of A e INTEREST OF BENEFICIARY Ruth K. Taylor * 3546 North 6th Street Harrisburq, PA 17110 Dau hter 100% of residue * Alternate residuar beneficiar ets 100\ of re idue by virtue of disclaimer of interest by Amos DeWalt. The above beneficiaries were living at the time of the decedent's death except for the following: NAME DATE OF DEATH If additional space is necessary. use 8~" x 11" sheets. REV-454 (1-80) COMMONWEAL TH OF PENNSVLVANIA OEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTL Y OWNED PROPERTY ." ."" '. , if':" . (1IIstrIJct;oIlS on Rf.''.'crS(! Side) , Estate of Goldie .iI. Dewalt ,- TOTAL PE VALUE OF DEPARTMENT ITEM R DESCRI PTlON MARKET c DECEDENT'S VALUAThjN NO, VALUE E INTEREST rOffir.iIJIU,,,Oniy) N r ._~- None. _\ - - TOTAL THIS PAGE -0- ,-- I J I I nI, J I 0 l>:: 0:: I:!:; -< -< +I I .-II >>J ~ .-I El ~I ~ >- :>< ~ 0' ~ W til , 'tl Z Q ~I ~! ~ 0 . 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