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PETITION FOR LETTERS OF ADMINISTRATION
IN 1'IIE ESTATI~ OF .ANTHON'.{,,,J....,,.TR01:1a.INO.....,,,,,,....,,.. IH~CJ~AHE[).
To ....................mqf8.G"..,h~i?..,..,."....................,""',..,.......'"..........
, RagiMlel: p(lI'i\IM 1',", the COllllty M <:;lInl>el'lan<l. ill lilt. ('Ollllllllllll'eallh "I' I'elln'yl\'ania.
The Peti tion of ........ Winif:x:lMr' A~~~..D,ona.de,e..... ....... ........ ..............".. ......... ...... ...... ..... ,.... ...... ........ ......
............................................ ....... ....... reMped full;' ,howet h tha 1 .. ,A.rI. ,t.I1,I?,!).Y....~.:...:!:'J::<:>~)?~~!?.......................
'I{ It'
waM a resident of ......C.amp..,Hi.ll.............................fj,~~gr~ . ('lIll1l>el'ialld COllnly, Slate of PellllMyl-
vania, and a Cili?ell of United Slale" and depal'led Ihi, iiI'" illteMtalc ill Ihe Coullly of .......Dauphin..
.................................,....,. and S tate 0 I' .....F enns y.l:v an ia"",...........,....... ,...................................... .....................
on ..........;;g:;!!!..f.);'.~.<:!~y lhe ........J.2.~h.................. dal' of ........~.u.!!,~................................ A. D., 19.~.L...
at the age of .....p.6...... \,eal's.
That lhe Maid ..........~.!l.~~.~~y....!.:....!.r.?~?,i.!l.~................... deceased, left Murviving the following
named widow or hllsband, heirs and next to kin. 10 wil:
Name
Helation,hip
brother
Residence
~!l:g!l:~.~~~...~:..}.~9.~.~.i.~.C?.......... .
304 Chestnut Street(3rd
........'Har.r'is'liur.g.;...PA...................
That those above named include all of the next of kin, so fal' as kllown.
The said decedenl was possessml of personal propel.t.\, 10 the estimated value of $...?.~..o.Q.Q.,.Q.Q........
and of Real Estate, less incumbrance, to the ",limated value of $.......~...O....".............. as near as can be
ascertained.
That the said Heal Estate in so far as is known is located in ...................................n/.a....................
Therefore, your petitioner(s) respectfully apply(ies) for Lettel's of Administration in the above
named estate.
Dated ...........................,July..,l......., A. D., w81...,
Signature and Addr"s,
of Petitioner (:-;)
~~~..e~......................
.. "40'5' ..CIl:n'tii'il".Ro.a:d.........,...............................
Harrisburg, PA 17109
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COMMONWEALTH OF PENNSYLVANIA) RECORUCl: (" 'i'
}~H' PF.G!S"
COUNTY OF CUMBERLAND I" .
.............. ,.......... '..." ,W;1:\U 'f.~.g...A.,',., PP!1,~~~,~, .., ,....." ... ,.81.""1111,.,, 2, ...n9., :2..: ,...' .....,...,.. ....,.. ... ... .... named
in the above application hcin/( dilly ..................Sl'lD,rn................. a('col'dill/( to lall', sa)' thaI the fact~ ~et
forth in the ahove application al'" \.t'lIe to t1w hesl or ,CI,jillJ>,r.\:,:k'J1ji\i;l.e.(r~e.and helieI'.
S t t..0iml'~"" .'
...................r!.9.'f.!1......9.,.... ....."...,....', and Sll h~cl.ihed 1 .',.'",.........,." ..... ........., ..........'"".... ...., ......... ....... ............
before me, ...../~.~':. ~L;J ..... ................' ......... ,.., ............ ...... ......
...Zh..J.~lY...l.i......:;;;..........,,) D., In.S.L.. rJ~r.-=).',...((,5a.~~................
..../)I!Z/.~..t2..,'~~~......,..R~~'i.~;~~.... ......,...........,..,.,...,.".....,.."..,.......,..............,.,...................
Filed: ' ......J..IJ;J,.Y...R.....;J,.98.;J,..................................... Altoi'll".": .....U)(1~~.&nctb.
Judy Snapp Smith, Esq.
d'f~ \ II front ~+.
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OATH OF PERSONAL REPRESENTATIVE a3~-D'SCXo
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} ss:
Winifred A. Donadee
..... ......... ........ .................................................................................................... ...................................., petitionerM
being duly ..............!!~!?~F.\............................... according to law do e.lL..... depose and say that as the
administra .t.~.:j,x..... of the estate of ................Anthony....J......TJ:ambino..................................................
.........................;y~~.................................................................................................................................................
deceased .....?:................ 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.
................S:worn...to..................... and : subscribed
before me.
....../::1:;;T......J)J1..;I,...~.. A._ ~"J 19...8.1...
R~.;{~(tl..e..;..'1-f:&,C(d,(.................
...W1i'::{~f!{~.............
............................................................................................
DECREE
Be it remembered that on the ...... 6th................. day of ..........Jul;y:........................... A. D., 19.IU....
Letters of Administration in the estate of ......./\,nth0IJ,y...J......1''F0l1Ib:i:n0........................................,..........
........... ............ ................... ............. ..................... ...... late of .........c. !1-.I))P... IIi ;1,.],.... ...n. ............................ ................
Cumberland County, Pennsylvania, deceased, were granted to ......................................................................
...........................................Hinifred..A....Donadee...........................................................................................
Witness my hand and official seal the day and year afores~, " ;I;
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RECAPITULATION
Appraised value of Personal Property............................................................,..,..... $ ..,......,..,......
Appraised value of real estate ..,....................................,....................................... $ ..........,........
Total appraised value ................,.......,.........................................,..........,.........,.. $ ,...............,..
AFFlDA VIT OF PERSONAL REPRF.SENTNlWE
County of Dauphin ss:
Winifred A. Donadee
mK.,......,.....,...."...........................................................................,...,',..,..........."....".".",
Administrat or of the Estate of ....AlJ..!;J:U?Dy....J.......1.r.Qmb,;i.X\9......,......,......................................
deceased, being- duly..........,..........1ll1l'9.rn................................. according to law, depose and say that the
items appearing in the Inventory inrlude all of the personal assels wherever situate and all 01 the
real estate in the Commonwealth of Pennsylvania of said decedent: that the valuation placed opposite
carll item of said Inventory represents its [air value as of lhe date of the decedent's death: and that
decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears
in a ~and\lm at the end of the Inventory.
.,..........,,':'::'t;:.~........, and subscribed
b~e me this......q,f..:<I~.:..........day of
~;f.ed,"".......7..._..." ~9,e"- .
~~~~7.;Cf::5' ..~~l~~'-J
., iT ~~O~.IIJ /lJr2-INSTRUCTIONS
.~Y.~~itrJ~~~~~.............
405 Clinton Road, Harrisburg, PA
.....................,............'..Ad.dr.~~~.."..................................
17109
1. An Inventory mURt be ntod within throo monthe arter nllpotnlment o[ personal fepresentat\ye.
-,
2. A Bupplemonlnllnventory mURt be n1cd within tbirty days or discovery or II.ddtllooal aBBetB.S!.;
a. Addlllonal sheatH may be attached aB to personallY or reallY. ;.:,~ =:-
4. Sae Article tV. Flduchutes Act ot 1949. I
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INVENTORY OF REAL AND PERSONAL ESTATE
In t~r .attrr pf t~r tetatr pf,..,A\n.t;)::1.Q.1:I>:..J,....J'J,9.lJlh:i.n.o........,........................
208 Senate Ave., Camn Hill,. I C fD h' S fP d d
late of ....................,..............,.........,..,..,..,......IR t 10 ounty 0 aup m, tate 0 enna., eceas<: .
]nllrnforu of the real and personal estate which were of the above-named
..~nl;h!1}}y....J.,...Ah,Omp.;i,nQ,............,..............................,........ deceased. Taken and' appraised
the ..........,....... day of ............................19 (Date of death J.un~..12....,198~
1. Apartment - Personalty sold 100 00
2. Capitol Blue Cross Refund 9 90
3. Erie Insurance Group Refund 44 00
4. Dauphin Deposit Bank & Trust Co. -
Checking Account #86-427539 1,867 48
5. Dauphin Deposit Bank & Trust Co, -
Savings Account #19-7-03481 3,995 13
6. Dauphin Deposit Bank & Trust Co, -
C. D. 1128383 25,208 47
7. Medicare Payment - $48.00 + $108.00 156.' 00
8. Security Deposit - Susquehanna View 129 00
9. 1978 Malibu Sedan Chevrolet 2,000 00
10. Pennsylvania Blue Shield - $12.00 + $27.00 39 00
11. Industrial National Banks 872 83
3 , 21 81
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REV.15C,Q EX + (9.81)
BUREAU OF EXAMINATION
PE~NSVLV"'NIA DEPARTMENT OF REVENUE
P.O. BOX 8327
HARRISBURG. PA 17105
Decodent's Name ILast, First, and Middlelnitiall
DECEASED . m . .
Socl8l Security Number
ILl
INHERITANCE TAX RETURN
RESIDENT DECEDENT
File Number J \ - ~ I- 04 0 I
aD</.
~o.lYl
Decedent's Address
~ 4.f)o! e.. ~ v.tI'\ u...L
\-\.i \\1 PA 1101'
CHECK
1. Originel Return 00
2. Supplemental Return 0
3. Remainder Return 0
APPRO.
PRIATE
BLOCKS
5. Federal Estate Tax D
Return Required.
6. Docedent died testate D 7. Decedent maintained a living D B. Number of safe deposit D
IAttach copy of Willi trust IAttach copy of trustl boxes inventoried
All correspondence and confidentialt" information should be directed to:
4. LifeEstateD
CORRE.
SPONDENT Name
H.
Telephone No.
Recapitulation
1. Real Estate (Schedule A) ( II
2. Stocks and Bonds (Scheduie B) I 21
3. Closely Held Stock/Partn",hip Interesl (Schedule C) ( 3)
4. Mortgages and Notes (Schedule D) ( 4)
5. Cash & Miscellaneous Personal Property (Schedule E) ( 51 311, "\~\. ~\
RECAPIT. 6. Joinlly Owned Property (Schedule F) I 6)
ULATION 7. Transfers (Schedule G) ( 7)
B. Total Gross Assets (total lines 1.7)
AND 9. Funeral Expenses Adminislrativa Costs/Miscellaneous
Expenses (Schedule HI ( 91
TAX 10. Debls/Mortgages/Liens (Schedule II (10)
1,. Total Deductions (total lines 9 & 101
12. Net Velue of Estate (line B minus line III
CALCU, 13. Charitable Bequests (Schedule J)
LATIDN 14. Nel Value subject to tax (Jine12 minus line 13)
State
Zip
(B) a~">",~\,~1
1111
(12)
(13)
(141
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Computalion of Tax
15. Amount of line 14 taxable at 6% rate (15)
(include values from Scheduie Kl
16. Amount of line 14 taxable at 15% rate (161\~1~ \ ~ .<1 L,
(include values from Schedule K)
17. Principal tax due (add tax from line 15 plus lax from line 16)
lB. Total Prior payments:
(a) Amount Paid
(b) Plus Discount
(cl Minus Interest (lB)
19. Balance Due (line 17 minus IinelB)
Make Check Payeble to: Register of Wills, Agent
... PLEASE RECHECK MATH".
Under penallies 01 perjury, 1 dedere that I have ..amined lhis raturn, including accompanying schedules and stataments, and to the best of mv knowledge
and belief. it is true, corre t and complete. Declaration of preparer other than the personal representativa is based on all informetion of which preparer has
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ADDRESS 4/ ~ ~ D~E
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(17) ~. ~~ \. ~ ~
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(19)
DATE
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BOB STEVENS
Sales Representative
f!&r,ffr%lJJ
Cavalier
(jJ!iMb'rt
l!,,,~{.,..,.t1
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. .fl.~uf!l/n
HELMS CHEVROLET, INC.
5051 Hampton Court Road
Harrisburg. PA. 17112
Bus. Phone 652.2500
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EXPLAt' . """N of MEDICARE BENEFITS
FOR 11 --'IM RECEIVED ON 081 Z II b I
, PENNSYLVANIA BLUE SHIELD
iUI@ BOX 65 CAMP Hill. PA. 17011
BENEfiCIARIES LIVING IN PENNSYlVANIA
CAll TOll fREE 800,3B3.131'.
Keep thil Medicare claim notice for your recordl.
A Reque't tor Payment torm il endOled tor your UI..
COl I eOl 1 COl 3
SERVICES wEllE AMOUNl
'RO....IDED 8'1 Ol'" tillED
L PATTERSON '\201 bOO
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NDN-ASSIGNf:D * u~G_ TOTALS ~
Amount payable at 80% oher the
annual deductible
Amount applied loward the annual
deductible
Bolance payable at 80%
Inpatient radiology and polhology physician
uHvices ond certain loborolorie~ aid in lull
REMARKS:
.....
[I'AIII:.N15 NAME
~.
'JHONY J T~OMb1NO
,M~Mb\l"c, ClAIM NUMB"
'U3101\414A
(bNI~Ol NUMIH.R
012336711300
. AlINA1'J U~E lNfOIlMl\llON IN BO,l. wlIlN
Wll:lllNG ABoul lHI'J (lAllA
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MEDICARE DOES NOT PAY FOR:
booOSrr ITEM 5 UN B~C~
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----t- MEDIC ~RE
p~ID
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8E SURE 10 READ IMPORT AN '
INFORMA liON ON THE 8A"
Of lHIS "'OlICE.
t. ,', ,\ ')' 'i .
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YOU HAVE MET $
YOUR DEDUC1I8lfR,ft 9,p
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TOT I'l MEDICI'RE PI' YMENT
THIS IS YOUR CHECI<. 'f
.--------------- .-------------------------- --'-- ,-
8.9
430
MEDICARE PAYMENT
FOR HEAL'TH INSURANCE. SOCIAL SECUR\1Y AC'T
, PENNSYLVANIA BLUE SHIELD
iUI@ 80X 65 CAMP HIll, PA. '7011
203108414A
IIEIlTII llIlUlAMU (lIIM IIUMIIl
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TO '&'i'fTHUNY J TROMI\ INU
~E 208 SEN.&.TE AVE
ORDER .&.PT 91 I
OF C~MP HILL
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PIlT5BURGH NRTIONRL BRNK
PITTSBURGH. P.... , !l'2'2'2
OElA(H ON DASHED llNE ...
CHECKNO I; 8 42 Ci:
68424644
VOID IF NOT CASHED WITHIN 6 MONtHS
o...n
",-0 0'" 11
[1011,.1<:1
tl,.!~
08/26/81
5.....48.00
fEOER...l HEMTH INSURANCE &ENEF\l!' A.CU I
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A.UTI401l11D SIONA-TURl
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Employes Benefits Department
November 5, 1981
Estate of Anthony J. Trombino
c/o Smith and Smith, P.C.
Riverside Law Center
2931 North Front Street
Harrisburg, PA 17110
Re: Monexr Inc. Profit Sharing Plan #88300 009
Gentlemen:
Enclosed is a check in the amount of $872.83 payable
to the Estate of Anthony J. Trombino representing Mr.
Trombino's vested interest in the above captioned plan.
A tax reporting form will be forwarded later.
Sincerely,
II /) fil
rileui(>;1;~?u h:a~<(CL~
Heidi~ean Dedrick
Administrative Account Assistant
Enclosure
100 Westminster Street, Providence, Rhode 15Ir~n~ ~,~_!:-~D3 (4~ 1 ] 278.6600
One of the financial services oflN~I>!i-< Industrial Notional Corporation
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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".) No
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 nontaxabi I i ty 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".) Nn
a. Was there any possibi lity 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".) B2-
b. The right to designate the persons who shall possess or enjoy the properly 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 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 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".) 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 ( ).
'REV-454 EX+ (8"80)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
(InstnJctions 0/1 ReVl.'rse Side)
Estate of Anthony J. Trombino
TOT AL PE VALUE OF DEPARTMENT
ITEM DESCRIPTION MARK ET R DECEDENT'S V ALU A nON
NO. cE ,
VALUE N INTEREST {OFFICIAL USE ONL YI i
'f I
I
i
None
,
I
I
,
I
i
t
I
I
,
,
i
I
I
I
i
,
i
\
I
i
I
,
,
I
I
I
I
I
j
-
TOTAL
If additionol space is necessary, use B!~" x 11" sheets.
"
. REV.45~ 0,'80)
"
COMMONWEALTII OF PENNSVLVANIA
OEPART~ENT OF REVENUE
T~ANSFER INHERITANCE TAX
RESIOENT OECEDENT
SCHEDULE "F" .'
STATEMENT OF DEBTS . . t' \
AND DEDUCTIONS '1\"JA~l\i:. ),
__+_____._.~._.____ _. _____~===_,.:......;......;_""....~....................=.....".~.~ .c
Estale of Anthony J. Trombino Date of Death June 12 , 1981
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
File No._
Claimant Winifred A. Donadee
Relationship 10 Decedent
Claimant's Address
ITEM -
NO. DATE NAME OF PAVEE REMARKS AMOUNT
l. Harrisburg Hospital Medical Recor,J" 7Cl.00
2. 1.Jm Ben,J"r M<11^~ M.D. iM",J;^,,1 ",vn"n""" 100 nn
1. !l1"",.,in<> ^ ;n,,1 'o<n(7 ?1 <;0
4. tumberland Law Journal Advertising 18.00
5. Neill Funeral Home Funeral Expenses 2.163.00
6. rachendorf Memorials Memorial Expense 444.00
7. mith & Smith, P.C. Attornev Fees 1.677.00
8. Ninifred Donadee Executrix Fees 1 677.00
9. egister Of Wills Probate 31 nn
10. Degister Of Wills Inventor" - Debts & Deductions 8.00
11. Cardiovascular & Thoracic A s. Medical Expenses l7n n n
12. ~eland Patterson, M.D. Medical Expenses 80.00
13. Pulmonary & Critical Care A s. Medical Expenses 38 5..Jlll
14. Harrisburg Hospital Medical Expenses 8.717.35
.
TOTAL THIS PAGE I $ 1 S I fiOR..B..5.
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 rt:te ~s ded~ctions for Inheritance Tax purposes.
/U...t-f-f .f (). . h( 01'- c;;-/- 8",?,
SIGN-TURE OF ATTORNEY/FIDUCIARY DATE
OFFICIAl.: USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $
AT
PERCENT.
RCC;lsn:R OF WILLS
DATE
,., 05
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..
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 24B5).
If the tax is paid within three (3) months after the decedent's death. a discount of 5% of the tax paid is allowed.
Inherit2nce Tax becomes delinquent nine (9) months after the decedent's death, 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 rale of
interest from the table below.
STEP 2
Mulliply the balance of
tax due by the rate of
interest.
STEP 3
Add the interest
to the balance of
tax due.
Interest from 3-03-BO to 5-23-80
Results in:
2 Monlhs =
20 Days =
Rate of interest
=
.010
+ .00335
.01335
Balance of tax due
Rate of intere!Ot
INTEREST
$2,000.00
x .01335
$ 26.70
Balance of lax due $2.000.00
Plus Interest to
Dale of Pavmenl (+l $ 26.70
TOTAL tax and
interest to Date
of Payment $2.026.70
------------------------------------.---------------------------------
1 month .005 4 months .020 7 months .035 , 0 months .050
2 months .010 5 months .025 8 months .040 " months .055
3 months .015 6 months .030 9 months .045 , 2 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 days .00386
4 days .00068 14 days .00237 24 days .00403
5 days .000B5 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 1 B days .00301 2B days .00471
9 days .00152 19 days .0031B 29 days .0048B
1 0 days .00169 20 days .00335 30 days .00500
---------------------------------------------------------------------
Any party in interest. inc:luding the Commonwealth and the personal representative, not satisfied with the
appraisement and assessment may object WithIn sixW (60) days after receipt of this Notice as provided by
Section 1001 of the Inheritance and Estate Tax Act of 1961 (72 P.S. sec. 24B5 - 1001).
MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WIllS. AGENT"
DETACH 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 800K FOR ADDRESS.