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Home My WebLink About81-00397 ..c H ~ >'l tIl ~. . >< r>< ~ p, ~ ~ II: . C.9 II: . ::> C.9 p:: ~ ::> r>< 0 :s: III P:: 0 0 H .. r:Q H . r.i r>< p:: H II: tIl Z t) H 0 ~ .~ H H .c ~ r:Q t) 0r- a) I ..... ~ 0 C\I ~ . ID 0 - Z '" LLI REV",140 (I.SOI COMMONWEAL TH OF PENNSYLVAHIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT ,& r~~ ~.i(iir.:'.". '~fij" I' -, " ,~ , .. ,r: ..t - ..... AFFIDAVIT OF FIDUCIARY (h'structions on Reverse Side) --------.-- .-----------.-- Estate 01 BLANCHE L. BRAUGHT Dote of Death June 21, 1981 ---------------.--..---.---- Lost Address _834 .t!(1mlltOil~t!:e_e,L,_____ Social Security No._JZ~:9.~-1446__ _Cwmlil,LenlKL.-llQiL_. (CITYI {STATU (liP) Burcou File No. Counly File No. 21-81-397 1. Decedent died: ( ) Intestato (without 0 will) ( X) Testate (leaving 0 lost will--copy attached) 2. Is the liling 01 0 Federal Estate Tax Return required for this estate? Yes No V 3. ( X) Executor/IR~il< ) Administrator/ Administratrix Nome Mervin L. Brought. Address 76 Linn Drive Carlisle, Penna. 17013 (CITY) (STATE;:I (ZIP) 4. All correspondence should be moiled to (X) Attorney ) Fiduci cry. 5. If on attorney is representing the estate, indicate: Name Marian R. Lower. Esq-,-- Address _.3.'-5. Hanover St. Carlisle. Penna. 17013 (CITY) ("TATE) (ZIP) List 011 sole deposit boxes registered in the decedent's individual nomehor jointly with, or os an agent or deputy 01 another, or in decedent's individual nome with right 01 access by onot er os agent or deputy. Include the nome and address 01 the bonk or other institutian where the sole deposit box is lacoted, the nome (s) in which the box is registered and the relatianship al the jaint holders to the decedent. I NAME AND ADDRESS OF BANK OR OTHER INSTITUTION IN WHICH DECEDENT MAINTAINED A SAFE aEPOSIT BOX NAME OR NAMES IN WHICH SAFE DEPOSIT BOX IS REGISTEREa RELATIONSHIP OF JOINT HOLaERS TO DECEDENT Commonwealth Nat'l Bank Under penalties 01 perjury, I declare that I hove exomined this return, including accompanying schedules and statements, and to the best 01 my knowledge and belicl it is true, correct and complete. /' J4- --yJ/, , " /1 . i -/.1.~'!:V>1 f --.L...:A11.i'~< ;' SIGNATURE OF FIDUCIARY /. /'-1 DATE [1., 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".j 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 certi ficate. 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 "Nu".) - b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer "Yes" or "No".) 6. If the answer to five b. above is "Yes," was the right reserved in decedent alone ( ) or decedent and olhers ( ). 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".) 8. Did decedent, at any time, transfer property, the bmeficial 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".) 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 decedimt and others ( ). REV-453 EX+ (10.00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES (Instructions on Reverse Side) Estate of BLANCHE I.. BRAUGHT BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY DECEDENT BIRTH Mervin L. Brauqht Son Yes 1/3 76 Linn Drive Carlisle Penna. 17013 Richard M. Brauqht Son Yes 1/3 721 N. West St. Carlisle Penna. 17013 Lois B Sowers Dau~hter Yes 1/3 51.4" St. Shippen,bul:ll_ Penna. 17257 ,- . - --.--- -----... . . 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 necellery. use BY.." x "" sheets, . REV.454 (1.80) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTL Y OWNED PROPERTY .. N .. " . ... \ (Instructions a1l RoVt.'r.m Sic/a) Estate of BLANCHE L. BRAUGHT P TOTAL E VALUE OF DEPARTMENT ITEM R DESCRI I'll ON MARKET C DECEDENT'S VALUATION NO. VALUE E INTEREST 10 flieinl Use Only) N T . I. Commonwealth Nat'l Bank, Carlisle, Po., checking $ 1,120.20 50% $ 560.10 account No. 192-182593-9, acct. joint with Mervin L. Brought, Jr., opened prior to 12-69 2. Commonwealth Nat'l Bank, Carlisle, Po., savings $ 16,210.93 50% $ 8,105.47 acct. No. 19-0010228-4, principal $16,000.00 + into at date of death, 6-21-81 of $210.93, acct. joint with Mervin L. Brought, Jr., opened 8-71 3. Commonwealth Nat'l Bank, Carlisle, Pa'f savings 2,074.58 50% $ 1,037.29 acct. No. 18-0009445-8, princir' $2058.11 plus into at date of death 6-21-81 of 16.47, acct. joinl' with Mervin L. Brought, Jr., opened 8-71 (see attached Itr) .. - TOTAL THIS PAGE $ 9,702.86 " .~. ~ , c, .- "". , .. (1' ~' - l.l. .. C>' ~ '/;::t cr.:V'. ...., (;>>(:5 U"J ~':.:. ::'3 ~a: N IJJU ~ .J ,-' ~ p:: -0:: ~ ~ 5 ;;.. ;;.. z 0 ~ <Jl :> ...1 -0:: - Z U - 0 lot. - lot. ~ 0 lot. 0 ~ p:: 1-1, I E- o <Jl 0 % <Jl ~ <Jl ;;.. I-< 0 ci - Z E- ~ E- ~ Z Z ...1 0 - 0 -0:: p:: Z ~ ~ ~ ...1 Z ~ Z t- o :> u t) % - 0 <Jl ~ 0 0 .-,: ~ ::: <: ~ u CJ 0- J 'lSaJalUI S,luapaoap OllljO anle^ 1a~JeW alll aleoipul 't;> 'lSaJalU! S.luapaoap allljO a6elUaOJad alll aleolPul '8 'A1JadoJd POUMO A\lUlo! alll)O anle^ la~JeW lelol alll aleo!pul '(: 'paqS!lqelsa seM d!lISJaUMO lU!O! aLII alep alll pue (5) JaUMO-OO allljO lUapaoap aliI 01 d!lIsUO!lelaJ pue S5aJppe 'aweu al-!l opnloul '"8,, olnpollos .I0j SUO!10nJ1SU! 0111 U! paleolPul se AlJadoJd leuosJad lie aqposaa '.:if" alnpallos JOj sUOll0nJ1Sul alll ul paleolPU! se ApodoJd leaJ lie aqposaa 'L '15J!! alelsa leaJ 15n 'papnlOu! aq 01 aJe A1JadoJd 0lq!6uelUI pue a\q!6uel 1I108 'd!lISJO^I^Jns jO 111"IJ 1I1!M SlueUallU!O! se sarUed JO A1Jed Jalll0Ue lIl!M AllU!O! luapaoap alll Aq paUMO 'leuosJad pue leaJ 'A1JadoJd lie apnloul lsnw ..3.. alnpallos "3,, 31na3H::lS ElNI131dVIIOO 1:I0d SNOI.L:Jnl:llSNI c " ~ '. I' LAST WILL AND TESTAMENT I, BLANCHE L. BRAUGHT of Carlisle, Pennsylvania, do hereby make this as and for my last will and testament, hereby revoking 311 wills and codicils to wills by me heretofore made. 1. I give, devise, and bequeath all of my estate of every kind and character and wheresoever situate to my children Mervin L. Braught, Jr., Richard M. Braught, and Lois B. Sowers, in equal shares. 2. I appoint my children, Mervin L. Braught, Jr., Richard M. Braught, and Lois B. Sowers, or survivor executors to settle my estate. If they predecease me I appoint Harrisburg National Bank and Trust Company of Carlisle, Pennsylvania, executor to. settle my estate. 3. Attorney executor I request that the services of Marion at Law, of Carlisle, Pennsylvania, be in the settlement of my estate. R. Lower, used by my )><-v."-II , 196$ 11~"j.,.:L" -:i /h.-u4"C'vt B anche L. Braught' Signed, sealed, published, and declared as the last will of Blanche L. Braught in our presence by said testatrix, as and for her last will and testament, who, in her presence and at her direction have hereunto set our signatures as witnesses thereto. r -r/ (1 .-;;.. (.(. ( \.I/,C;;r,;, /11' (- ~....~i:. Ll/' / f\o'-(~,-^- f? L \rlJ.,-V,- 921 ... ::r: a: d III :: :::> 3: <t: Q " r>:: ..,...... 0 ..I -i. III ::;: ... ..J .: . z " .; H ~~ 0: ,:. " III . H H Z ~ " H <t: . ~ ~ E-< < 0 0 U Ul - f- a ... rsl a: f- ,- (f) ... <( " .'-< <t: <t: ::E H H rQ OATH m" PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND Before me, the Register for the Probate of Wills and srallting of Letters of Administration in and for the County of Cumberland. personally came MERVIN l. BRAUGHT, J f( who, being duly SWorn . do es depose and say Ihat as executor of the last Will and Testament of BLANCHE l. BRAUGHT he 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 10 Transfer Inheritances. Sworn a d subscribed before me. '"I)' 1, A.D., 19-6.L. :.,j ME 15] co: :~ Cl'l :~ 1 :" :~ Ll. 1/1: co, 0 1-' ~ {" :c, c-... 1'; ~, ~ , ...J :::>: 8 ", 0'\: <{, ; M: III I, ...J <><: Nj co: - , r-i: - - .: 'M U OJ: ~ , I, ~ -'; Eo< r-i: w: = ~ ~ Ni :c: 'M U: "0 , ex) z: " r-i: ~ ~! "0 N' . : ... 0'\: 0 *i ~ D:I; " C\f .s ~ ~ al ~ "0 - ~ = ~ 'M rIJ ~ l'il ~ Be it remembered that on the DECREE 2nd day of July Blanche L. Draught D 81 ,A. .,19_. there was probated and recorded the last Will and Testament of Carlis Ie late of Deceased. Letters Testamentary were granted 10 Witness my hand and official seallhe day and year aforesaid, , Cumberland County, Pennsylvania, Mervin L. Draught, Jr. ~~.,~~ MARY C. L IS. ... Register - . . . -S';~3 deceased . tr' J1 i I . , ... .J' Q) 01 ~ "I' 0" . ...JQ) ."- i~'I' .... DO :Eu " I I I I I I I , I I I i , i ~. --.-----.--- ...-..... /'. ~ - REV.1162 EX .~L .... .... . COMMONWEALTH OF PENNSYLVANIA , 4 NO.K . 29782 OEPARTMENT OF REVENUE . ..... OFFICIAL RECEIPT' PENNSYLVANIA INHERITANCE AND ESTATE TAX I '" ; If = ~. ~I RECEIVED 'J FROM --. --."" ~ ~---""""'---=- ~~.. . _R TAX AT 6% Mervin L. Brallght, Jr. Marion R. Lower, Eaq. TAX AT 15% TAXAT_% ADDRESS 31 S. Hanover st. ESTATETAX Carlisle PA 17013 TOTAL TAX CREDIT 82;526.32 E's-TA TEINFCiRMATIClN-:--- DA TE OF OEA TH FILE NUMBER 21-81-397 NAME OF DECEDENT au ht m m LESS DISCOUNT PLUS % INTEREST (FROM TO_I 126.32 OATEOFPAYMENT Se tember 17 1981 COUNTY C umber land ------ ------ ---- -- ----- TOTAL AMOUNT PAID $2,400.00 POSTMARK OA TE REMARKS Q "PAID ON ACCOUNT" SEAL RECEIVEO BY // /1./ ,.. '. / I / / " / if / / ( ../ .Ie,/.{. ,-.(.;.<~./ SIGNATURE/ I nEGISTEll OF WILLS -., - _. -- - - ---, - _. - -- - - - - - - -.--.- - - -- -- -' . ..C".~. ..... .. REV.455 (1.ao) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT OECEDENT SCHEDULE "F" STATEMENT OF DEBTS AND DEDUCTIONS I _ , Estate of BLANCHE L. BRAUGHT Date of Dealh June 21, 1981 WHEN CLAIMING THE FAMILY EXEMPTION, COMPl.ETE THE FOLLOWING: '---'---=~---~-:;"_;";::"-_"';";':C_'..;.._. ,C"";';';;";'~'.~_...:.~_;:"",,-,-~_______-,_~_~, File No. ,~ 1- ,f./ - :>'?'l Claimant MervIn L. Braught , Jr. Relationsllip to Decedent Son Claimant's Address 76 LInn Dr Iv.. Carlisi., Penna. 17013 ITEM I DATE NO. NAME OF PAYEE REMARKS AMOUNT Letters testamentar & 2 short cert. Rmm Adv. Itn. Adv. Itn. A $ II Sb..1I 18.00 18.00 65.84 150 00 60~ II II II U II R f II 1111 II II II Belvedere Med. ClinIc b1lL 18 76 Cuttl ravestone 65 .50 1981-82 School taxes on. 278.87 C e 3.000.00 Fill Pa. Inh. tax a 5.00 Fill Debt & Oed. 5.00 F .1 011 & R f F naee 3 2 Fire InslWance & L1ablll InslWanee 30.00 Plumbl~ repair 98.35 TOTAL FORWARDED - TOTAL THIS PAGE $ 8 805~ I hereby cerlify that to the best of my knowledge and belief the foregoing is a just and true slalemenl of debts, funeral expenses and expenses of administration submitted to Ihe eslate as deductions for Inherita9~e T x purposes. I'll ~'JI,~~:::r 1- V, ff. kttl- ~.~. - ~~AIURE OF ATTORNEY/FIOU ARY' IDATE OFFICIAL USE ONLY ~ RIchard N.lder. MechanIcal Servo DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S AT PERCENT. REGISTER OF WILLS DATF GENERAL INHERITANCE TAX INFORMATION Unsatislied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxable estate. In addition to debts incurred by the decedenl or estate, other items are claimable including the cost 01 administration, ollarney lees, liduciory lees, luneral and burial expenses including the cost 01 0 burial lot, tombstone or grave marker and other related burial expenses. All debts being claimed against on estate are subject to the approval 01 the Register 01 Wills with whom the Inheritance Tax Return is liled. Evidence.to support the decedent's or the estate's liability lor the debts being claimed should be attached to this schedule. A lomily exemption may be claimed by a spouse 01 a decedent who died domiciled in Pennsylvania. If there is no spouse, or if fhe spouse has farleited his/her rights, then any child 01 the decedent who is a member 01 the same household can claim the exemption. In the event there is no such spouse or child, the exemption can be claimed by a parent or parents who are members of the same household as the decedent. The family exemption is allowable only against assets which pass by a will or by the Pennsylvania Intestate Laws. NOTE: Compensation paid to an estate representative; namely, an executor or administrator, for services performed in administering an estate is reportable for Pennsylvania Income Tax purposes. This taxable income item should be reported on lorm PA.40.lndividuallncame Tax Return. t'" '" 0 I"l ~ t'1 ~ ~ z ;.. 0 0 '" Cl I"l c:: 0 ~ z ::: z t'" t'1 t'1 ~ Z ;>;l 0 - 9 t'" Z Z t'1 ~ t'1 ~ z 9 9 ~ -< '" t'1 - '" Z 0 '" 0 .., 0 "Tl "Tl ~ .., - 0 Z ~ c " ~ i , -< -< (:; .,.-,: ,.--. t'1 t'1 ...., f:":' ~ ;.. l:..::' W u:: ;>;l 0: N 111;-: SO ..1- '_J INSTRUCTIONS FOR COMPLETING SCHEDULE "F" 1. If the lamily exemption is being claimed, indicate the claimant's name, address and his/her relationship to the decedent. Enter "family exemption" in the remarks column and the amount claimed in the amount column. 2. Assign consecutive numbers to each item listed. 3. Enter the date on which each debt was incurred and/or paid. 4. Enter the names of each payee. 5. Provide a brief explanation in the remarks column lor each debt claimed. 6. Enter the amount of each debt being claimed. 7. The farm must be signed by the person who has assumed the responsibility far paying the debts. IF ADDITIONAL SPACE IS NECESSARY USE BW' x 11" SHEETS. REV. 1S47EX (1-82) j BUREAU OF EXAMINATION NOTICE OF INHERITANCE TAX ASSESSMENT PENNSYLVANIA OEPARTMENT OF REVENUE APPRAISEMENT, ALLOWANCE OR OISALLOWANCE CONTROL NO, 101 P,O, BOX B327 HARRISBURG, PA 17105 OF OEDUCTIONS, ANO ASSESSMENT OF TAX DATE ESTATE OF BRAUGHT BLANCHE L FILE NO, 21 81-0397 DATE OF DEATH 06-21-81 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS OF THE ABOVE COUNTY. MAKE CHECKS PAYABLE TO REGISTER OF WILLS. AGENT," IF TAX PAYMENTS ARE MADE WITHIN 3 MONTHS OF THE DECEDENT'S DATE OF DEATH. A DISCOUNT OF 5% OF THE TAX PAID MAY BE DEDUCTED, PAYMENT OATE 09-17-Bl MERVIN L BRAUGHT 76 LINN DR CARLISLE PA 17013 PLEASE RETURN THIS PORTION TO REGISTER OF WILLS IF PAYMENT DUE CUT ALONG THIS LINE ----------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRAUGHT BLANCHE L FILE NO.21 81-0397 DATE 03-26-B2 ACN 101 TAX RETURN WAS: I X I ACCEPTEO AS FILEO I CHANGEO APPRAISED VALUE OF ESTATE: 1. Re.1 Estate (Schedule A) 2. Stocks .nd Bonds ISchedule B) 3, Closely Held Stock/Partnership Interest (Schedule CI 4, Mortgages .nd Notes ISchedule 01 5. Cash & Miscellaneous Personal Property (Schedule E) 6. JOintly Owned Property ISchedule F) 7, Transfers (Schedule G) 8. Total Gross Assets ( 1) I 21 ( 3) ( 41 ( 51 ( 6) ( 71 39,900.00 .00 .00 .00 3,524.20 9,702.86 .00 I BI 53,127.06 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expensesl Administrative Costs/Miscellaneous Expenses (Schedule H) 10, OebtsfMortg.ges/Liens (Schedule I) 11. Total Deductions 12. Net Value of Est.te 13, Charit.ble Bequests (Schedule J) 14. Net Value Subject to Tax ( 91 ( lOJ 12,312.39 .00 (111 (12) (131 (141 12,312.39 40,814.67 .00 40,814.67 ASSESSMENT OF TAX: 15. Amount of line 14 taxable at 6% rate 16. Amount of line 14 taxable at 15% rate 17. Principal Tax Due TAX CREDITS: (151 (16) 40,814.67 x,06= .00 X,15= (171 2,448.BB .00 2,448.88 RECEiPT # OiSCOUNT (+) INTEREST H 126.32 AMOUNT PAiO 029782 2,400.00 THiS ASSESSMENT IS BASEO ON: ORIGINAL RETURN NO INTEREST IS DUE IF PAID BY 03-21-82 IF PAID AFTER DATE INOiCA TED SEE REVERSE FOR INSTRUCTIONS. RETAIN THIS PORTION FOR YOUR RECOROS TOTAL TAX CREOIT BALANCE OF TAX DUE 2 526.32 77. 44CR ~. . ,- ex> '0" '2," N rT1f1'l ~: ~ ; . ;', ':""lg '.,", r ;'>:~ .-'" --i:o ,~ :':::J '-':J '\ r-. ~'J ". -"" ~,1 ; ., ,- - INFORMATION This document is the Notice required to be given under Section 709 of the Inheritance and Estate Tax Act of 1961 (72 P.S. section 24851, If the tax is 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 Ihe 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 ;s calculated as indicated below: - STEP 1 Oetermine 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 $2,000,00 Plus Interest to Oate of Payment (+) $ 26,70 TOTAL tax and interest to Date of Payment $2,026,70 Interest from 3-30-80 to 5-23-80 Results in: ---------------------------------------------------------------------- 1 month ,005 4 months ,020 7 months ,035 10 months ,050 2 months ,010 5 months ,025 8 months ,040 11 months .055 3 months .015 6 months .030 9 months ,045 12 months .060 1 day ,00017 I I days ,OOlB6 21 days ,00352 2 days ,00034 I 2 days ,00203 22 days .00369 3 days .00051 13 days ,00220 23 days ,003B6 4 days .0006B 14 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 ,002B4 27 days .00454 8 days ,00135 lB days ,00301 2B days ,00471 9 days ,00152 19 days ,00318 29 days ,004B8 10 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 (60) days after receipt of this Notice as provided by Seclion 1001 of the Inheritance and Estate Tax Act of 1961 172 P,S, see, 24B5 - 100ll. MAKE CHECK OR MONEY OROER PAYABLE TO: "REGISTER OF WILLS, AGENT" OETACH THE TOP PORTION OF THIS FORM ANO SUBMIT WITH YOUR PAYMENT TO THE REGISTER OF WILLS FOR THE COUNTY SHOWN ON THE REVERSE, SEE THE INHERIT ANCE TAX INSTRUCTION BOOK FOR AOORESS. Hi;.V.l:iOO ex ~ (U.UJ) BUREAU OF EXAMINATION PENNSV~VANIA DEPARTMENT OF REVENUE P.D, BOX 8327 HARRISBURG, PA 17105 11-,;;, 7,;,J - I INtlERITANCE TAX RETURN RESIDENT DECEDENT /,1 ,j{:"'(/.-(j Filo Numbor ....,1/ ~ 3') - tJ J j' 7 CHECK APPRO. PRIATE BLOCKS Oocodont's Addro)' ,,/, ~ ?(/'t /'11'1i<-/llf(),</ (.,rr. (!~MJ'.f*,,11 /1c'1;! 2. Supplem.nt.1 R.turn 0 3. Remaindor Return 0 4. life Est.t. D 5. F.der.1 Est.t. T.x 0 Relurn Required. 6. Oecedenl died Ilsllte ~ 7. Decedent m.inl.ined a living 0 8. Numbor of safe doposit 0 (Attach copv of Will) LC::,l trust (Attach copv of trusll boxes invenloriod An correspondence and confidenlialtax inform.lion should b. directed 10: CORRE. SPONOENT Name 1', . /v. e. t" Il/ Telephone No. RECAPIT. ULATION AND TAX CALCU. LATION Computation of Tax 15. Amount of lina 14 taxable al6% rata (includa values from Schedule K) 16. Amount of line 14 taxable at 15% rate (include values from Schedule KI 17. Principal tax duo (add lax from tine 15 plus tax from line 161 18. Total Prior pavmlnts: (a) Amounl Paid (b) Plus Oiscounl (c) Minus Intlrlst 19. Balance OUI Wnl 17 minus line 181 Makl Chick Pavabll to: Ragistlr of Wills, Agent ... PLEASE RECHECK MATH'" ./... &.-r <t i-r R...pilulali.n 1. Re.1 Estat. (Schldul. Al 2. Stocksand 80nds (Schedule 01 3. Closelv Held Stock/Partnership Intere.t (Schedule C) 4. Mortgages .nd Notes (Sch.dul. D) 5. Cash & Miscenanoous Persnnal Properly (Schedulo E) G. Jointlv Dwnad Property (Schedule FI 7. Transfers (Schedule GI 8. TOlai Gross Assets {total lines 1-71 9. Funeral Expenses Admini.trativ. Costs/Miscenaneous Expenses (Schadule HI 10. Debts/Mortgages/Liens (ScheduleU 11. Tolal D.ductions (tol.llines 9 & 10) 12. Net Value of Estat.lIin. 8 minus line 111 13. Charitable Blquests (Sch.dule J) 14. Nel Valu. subi.cl to tox (lin.12 minus tin. 13) Addr... Citv Slate -;,t? 2i (1) I 2) ( 3) ( 4) I 5) ( G) (7) J~ j!N, "'t;'> ? :r..<'I..:!. C ~ 7t:>./. J.(.: ( 8) .14',1 "L7.d '" ( 9) 1101 /..2. 3/o? ,0 tJ . (111 (12) (13) (141 /~ J;.t, pj -'h:-. $'/"'1-. tC 7 , ~tJ. 5'14. I!, 1 , (15) 4-(', i"1 1./. c: 7 , x.06- .,(/ -7'f'f. /f,f (16) x.15- (17) ~. .fIt. ff (18) (19) " Under p.nallies of perjury,l d.clare that I hav. oxamin.d this relurn, including accompanving schedules and statements, .nd 10 the beSl of mv knowledge and batief, it is true, correcl, and completl. Decl.relion of praparer other Ihan the porsonal repra..ntaliv. i. ba..d on an inlormalion of which preparer has anv knowledge. 'SiGNATURE OF PERSONA~ REPRESENTATIVE(S) . SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE AODRESS OATE AODRESS DATE