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I,AB~' WI!.!, AND 'l'Bfl'l'AHIIN'l' 011 IIANNlll A. SllANAUl\OOK
--------_.......---_.............., . ....-... - ;.. ..~--.-
I, llANNIE A. SIIANAIlROOK, ,widow, of 25 SmIth lIanover Street in che
Ilorough of cudisle, Oumhetlllnd COU\lCY. l'onnsylvan1u, ~eiltg of Round and
disposin8 ~ind, mamory and undetstandinl!, do herahy muka, publish und
daolure Chis liS IInd fill' my Last IHll. und 'l'astamenC, hereby ravokinj, nod
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making void any U\ld al.l Hills by me ht anytime heratofore made.
1. I diruet my hureinnftal: named llXllcutr:l1l Co pay all of my dusl: .
dsbts. and funaralexpanfl"s (H3 soon after my deach an may ,be found convenl.ent
Co do no. I diraet thaC my funsral. nurvicue bu eonductud in a rC;lusonab3.e
mannsr by Ewinll Ilrothers ~unerlll lIome, 630 South IIdtlOver Bcraet, Carl.isle.
PennsylVlln:L/I, /lnd that my bo:ly be'interrud beside that of my huebertd, on our
burial lot in 14astminecer Cemetery, che name bein8 l.ot No. 32~l\ of Sectiol1
tlG".
2. All chll rC;lst, residu.e and remainder of my eetatEl, real, 1'ereone3.
and. mixC;ld, .and whereEioevC;lr the eamamay he eituate, I direct ehall be
converted into cllsh nnd 1. 8iVe, devise lI\ld bequent:h tha ellme as follows I
One~haH to my daughtC;lr, Thais Shipp, of, 430 Fllctory Btreet, Carlisle,
PenneylVI\I'Iil\, nnd tha otherohe-hnlf in thr.ee (3) equal eharea to my daughter,
Patricia Deamar and her two (2) child\'en, 'Oryata3. Daamer and Terry L.Ueatner.
3.
Should MY pet;aon lese than .21. year!! of IIge.ehare in my eetate, I
. .' . . . ,
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i\lveet the eame and to pay eo much of the income l1ri~ing ther.efrom together
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nominate, c;onatitute lI\ld appoint' Farmers Truat Company, 1. \4eet High Street.
Carliel.e, Pennay1.vllnia, ita allcceoaors and allB1gne, all. Ouard,ten of the
aatate of suoh minor child and I a\Ithorba IInd direct add Guardian to
with so .muoh' of the prindpd thereof ua in ite opinion is \leceseery o\'
dasirabl.e to be ellpended for the education of suoh'minor child, to ths
pel;'soh having custody of auah rtlinl?r child, and Ilport auch ehild attaining 21
yearn of Aga to pAy the then remairting principal together with any undis"
HMs
OATil 01<' l't:KSONAI. Rt:PRmmNTA'f1vt:
COMMONWEAt..TH OF PENNSYLVANIA SSi
COUNTY OFCUMIIERLANP
Before me, the Register for the Probllle of Wills ond grunting of Lolters of Admhllslrotlonln ond for Iho C~lUnly of
.-Thals ShIpp'
Cumberland, personolly come
who, belna duly sworn
,do as
depose and say thllllls
Fannie A, ShnnllbrQuk
Exeoutrlx
, decoased
of the IlIsl Wlllllnd Teslamenl of
1I1~0 will dlllaently comply wllh tho provisions of lho law rotaling 10 Transfer Inherltancos, Sworn and subscribed bofore me,
June 30 A,P., 19JU_ '7t:;z.a . ~ '.
. /~ ) pp
Mary C.
~
C.
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S\)A will well ond trUly lIdmlnlstor the goods and Chllllots, rights and Qredlts of said dOQeased IIccordlnglo IIIII'. And
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, Reglslor
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Be \I rome\Uborod Ihllt o.nlhe. 7th dayof
Ot;CItEE
JulY
,A,D.,19~, Ihore was,llrobRlo~ and
l~b.nnte A. SIWnnbrook
lato of
recorded Ihelllsl WlIIlInd.Tostlllllonl of
the Borbullh or Carllsle.
Decellsed. Lellers Te slame ntRry were grunled,lO
Wllnessllly hllnlland official seallhe dllY IInd year aforesllld.
,Cumberland Counly, Pennsylvania,
TIHlla Shipp
.046
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'~)lt,tj &. /J{!u.~
Register
I,AH'\' \VI LL ANIl'n:H'\'MII':N'I' Ill" ("ANN II': A, HIli\~AI\1l00K
.T, I'ANNIE A, HIIANAIIIlIlOK. wldo\~, Ill' :!~\ :;'1\1111 1Ii1I1!1V\11' Hlrm'llll 11I1I
1101'0\11111 Ill' CIIl' 11111 \1, C\llllhc I' IlInd Cllllllty, 1'I,,\\lI\Y 1 Villi I n, hl'llIl\ "I' '''l\lIld IIl1d
dlllpOllllH\mJnd, IIIU\I10"Y IInd l,lH\lII'Hllllldl\lI\, dll II"ruhy 11l/ltw, p\lhllHh lIud
dc,cllll'l) thia IIH ul1d fill' illY (,(\Hl: \11.11 IInd 'l'Ufl I 1I111l\1\ I , 1"\I'lIhy l'uvokJ.nll I1l1d
..
IlIl1killll vilLd /IllY IIl1d 1111 Willu by 1110 III IIllylilllll hl\l'111llflll'u IlIl1do,
1 I T dJrollt lilY ho\'ulllllfll'\' nlllllod 1';>(\'\1"1:1'11< III PIlY nil pI' illY .Il1lit
dullt.1'1 Illld fUII'1I'(\1 OXPUIlHlIli 1111 IIIlOIl IIft.c'l' illY dc",l:1I 1If! IlII1Y lw fOl\lld r.(l\lVoIIJeIlC
10 dn aD. I dJt:ecC IIlIlC my fUllul'll1 liorvJeufl ht\ lIlllldul'\'.od :11\ (\ rU(\HOllllbla
\\\(\1\\10'1' hy Ilwll1i\ llrochat:H }lUlieI'll! HOllie, (,30 Houlh 1I111111VOI' Ht:I'llUC, Cllrlll1.1e,
l'OIlIlIlY.1VllIlIIl, nlld 111(\1 my body ho llllerrod hUllldu t.hnl Ill' my lIullbnlld, 011 our
burln1 101 j,n WUHcmJ.lIslllr Oemacery, che, AIIII'" ho1.1l1\ 1,01 No. '\2-1\ of Hacl'!Il\l
"0",
2. All Ihe cost, cesidue ulld romnllldor 0,1' illY oBCLlttl, rUllI, \lOraOIlLl1
and mll1ed I and' wheresollVBC tho samll mllY ba ~JtIlUla, ,J diru~\l shllll bu
convectad'l.nlo oash Slid I give, devlse und 11uqlloalh the llumu as fotlowsl
One-half to my daughter, Tha:le Shipp, of 430 Flloto~y Street. CarlialO,' I'
hnnsylvania, IInl! the othor Ime-half :\.1\ thrlle (3) equlll lIhllrll8 to mydaullhter I
I'lItrldLl llollmor LInd hor IW<l (2) d11 .1dl'lI1\, Gryntn\ \IuUlnUI' Ll1\II'I'urrY \" IIUIII\\(\\'.
'j I Should !IllY par Bon leaa thLln 2l yenrs I1f OliO Hhllro III, my llBtLlta, \
,
lIom!nLllu, conHtlCUtO und tt}lpolnt Fnrmur.a Truat CompnllY, 1 WOHC),lllh Slruut,
CLI\'llHle, l'anllsylvlIlIlu, 1.IfI nUcCllafllll'1l IInd IIHHII\III'1, ,IIH oUlIrdll111 .of cho
"al'o\u of Buch I,,:lnot: child und I ot.lt:hodv.o nil" d'nwl: fluid OIlLll'dlLln Cl!
h1Voal tho sLIme And to pay 80 much of chu 1.\wnme ndatnll ll"'tafruot lo[\alhol'
wIlh 80 mll~\h of the princIpnl cheroof 1111 In Ita llplnlon IH nocOHHLlry or
dc,airohle to ho axpended for tho oduclIlion or llulIh IlIlnor child, I" thl)
parsoll huving custody of sllch \\\inor child, IInd U}lnll lI\ulh I'Idld IIttnlnl.lIl\ ~ I
yent:s of Llga to pny the then t:omni.ninll prine Ipll 1 lll!\ulhar willi IIny \lnd la-
UNIJ BSl'~ THP PIlPARTMBHT
VAL B M R BT VALUATION
VALUB !OFFICIA~ USE DN~ y!
lIID.OO
18. $0
87.311
1"4. 00
1,11411, 3.
193.80
1,33:1. ao
8,072.4D
3D.19
, a6
17,38
IH V-41\II :r;.t (!!'IlO)
COMMONWEAl TH or"I'ENNSYL VANIA
DEPARTMENT OF REVENue'
TIIANSPER INHeRITANce TAX
RESIDENT lleCEDENT
BOHEI)ULE "B"
llPR80NAL I'RorPRTV
(llIslmolillllS WI flovomiSir'lol
teteto of P^NNDIl A. SHANABI.\OOK
Itt~ peSCRIPTION
1. l~fllund or ..curity d,pollt on apartment
lnt.t' ",ton .10 ~rlty d,pollt
a. C".h In deoedlnt',_ po.....ion
3. Cornmonw..Uhol penrt.ylvarila,t'.nt rebate
... Balance Oommonwealth National Bank oheokln,
aooount 1181.108..09....
D. QrOIl prooeed. rrom .ale of hou..hold ,oods In
apartment
II. Prooeed., 'file Prud.ntial In.unno. Co. or
America
, .. ' ,
7, Balance York {<'ed.rat Savin,. and Loan Aln,
. Savin,. Aooount H00114880
lnterut,to June 89, 1981
8, cornmonwealth NaUon.l ~ank l1lv,rllreen saylnllB
Aocount 118.0011981.0
9. R.lund, MUtual ol,Omd'" In'Ul.'lll\oe Co.
If addltlanol 'paCtI 1$ nocessary, use aW' x 11 "sheets.
TOTAL:
11,708. D9
111()~. 1''1
" '?l15-
, ':
UEV.403 no 110.801
COMMoNWeAL TH OP peNNSYLVANIA
oePARTMeNT OP ReVRNue
TRANspeR INHeRITANce TAl<
ReSlaUNT aeceaeNT
BCI~EOULE "0"
IlENEFICIARIBR
IIIIltfllet/QII' nil II(/verlo S/c/ol
Setets of FANNI1ll A. SHANAB~OOK
BBNBFIOIAR1BSANP APPRBSllBS' RBLATIONSHIP SURVlvep PAn OF INTeRBST OF SENBFICIAIlY
PBCllPllNT PIRTH .
-TbJ.~' Sh~p "
---- ,,~~~c_.~_~_ -"
480 Faotory Stre.t , 1----. ..
, -- - .
Carll,le, Pat 17013 dau.httl' YOl l/a r..lduI
~--...- ri..
Patrlol. Be.mer ..
, ~
P. 0. BOle 122 . ..
DU1.bur", Pa, 17019 dau.hter yea . 1/6 ot r"Bldu.
.
.
Cry.tal aeamer .
D n ~"V t 1111 .
.,pUl.bur" . PI.. 17019 , IIranddaughter -.l!! . 1/6 ot r..ldue
......--....-.....-----............~--<~,~.,.,..-._...~.~~__~~~n..T.. ____.,_....... ....~._-~~---~~------- -..~~_.-.- ... .~..m...~".u~.~_,. _~._ ____ __'.~_~.r..__.._._.._._. ,-~,~--~--~..~~~~.._._--
Terry L. B..!!,m.r
-
P. 0, Box 1112 .
.,'
-
DUt,bur" PI., 17 019 IIranddaughter yel; l/a ot r.eldu.
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,
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...._----...._-.......-,...__.........~~~- . _.__.,..__.u..om.'.n_~_____._____.. ~-_._-~._..~ .-,.-. . _.~ ..... -~., - -.....
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The ebove beneflolerle. were liVing et the time of the deoedent'e death ol<cept for tho following:
NAMe
PAtE OF PllATH
"addltlDnel IpeOG II neoellery, UIG aw' x 11",hutI,
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8,qh'~1l18 "e" mutt Inoluqe all propertY, ruel and personol, ownad by tho dpcodont Jointly with another
pertY 91' plrtl81 81lolnt tenants with right of survlvol'ehlp, Bo\h 10nOll>Io And Into'1gll1l0 propmty 01'0 to be
Inel.uded, Lilt reele8tate flret.
1. Desorlbe 011 rOftlllr\lPol'ty eelndlofttad In thlllnsll'UCllol1s for 80110((\110 "A", Descrlbo ftllpo/'sonol proporty .
e.lndloated In the Instr\lollon8 for Schodule "B". Il1cludo Ihe n(lInO, oddl'088 lint! l'ulntlol18hlp to the
. deoudent of \he co:ownor (8) and tho dato tho jolnl ownorBhlp was ostol1l1shorj.
2! Indloate the total market vol\le of thojolntlv ownod proporly,
3. . Indlcete the peroentage of tho deoedent's Intoroet,
4. Indicate the merket val\le of the deoedent'e Inter081.
_.~~..........-~.._-_... _.~--~.~ .__~_~...--,._n
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INHERITANCE: TAX SUMMARY SHEE:T
l.BURE:AU USE ONL.Yl
I'll. Number
?i-B 1 ~ 0" 011
._-------.,--....-~---
(j] Original
o Suppl.m.ntal
o R.malnder
e.tat. Nom. ___..._~....____JillJJljJ'L !\..~.PJJ!lflam~~L-'-u-.--
Dot. of D.ath
_._.___~.,}ll!!.L?g. 1901
500101 S.qurlty~umber _" 1'zh12,,22\l!L","
REPORT oP INHERITANCe TAX APPRAISER
I, the ~nd.;,lon,rl d~ly apPolnt,d Inherlton.. Tox Approl..r In ond for th, County of. CUmbe~land
p.,nn,ylvanla, dornptotlvlly tlPort that I \lay, approlnd th, real and perlonol properly QI ''Ported In thlforegolila
,.l1Im at th,vol~1I Itt forth O~p..ltl lo.h Item Inth_ 1011 .olumn to I rlg~t In S.hld,111 'Wi; "B", "C", and "1"
pot.d. Novemba~ 23 , 1981 C:~--_., -n<4"'. .
INHI ANCI TAX A P . Un
VA~UI A$ APPRAllla eOo'. AOJUeTMIHTI RlMAIHOIR APPRAIIIMIHT coal
IHVIHTORY (HARR"I RO UII OH~Y)
Re.1 Properly (hhldule A) $ 00+ .
. P....n.1 Propetty (Gohedule I) 10+
Joln,.Held Property (Sohedule I) lilt
Tr.n,fer' (hhodule ~l 10+
'TOTAL, GROU ASlITS L_.
~e.. Oeb'l .nd P,du.,'loA' 010. n.
($CHllPU~1 P) --
C~lIAR VA~UI OP UTArll
o l.lfe Ilto'l f!ll! PACTOR PRIHCIP~B VA~UI CODI
- -
o Annuity -
POR USI!OP,RI!OISTI~ ON LV
Ta. an $
Ta. on ,
Ta. an ,
To. on.'
Ta. an $ ~
hemp,lon.
To,.1 "'Iale
Wl.I.
COMPUTATION OF TAX,
,
$
,
6%
1511
,-
,
TOTIJ.'TAX
IHTBIIIST PRoM
BALAHeB
TO
$
,
$-
Le.. Credlll
DATI OPPAYMIH'T
AMOUHT PAIP PISeOUHT
S + S
+
IHTIRBST
.!.AxeRBPIT
,-
- $ .
*
~
BALAHce
TO ~
'8 'Ib
en
~ ~ ~ rl
J 0
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~ rl
0 ~
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0 ~ Z ~
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z
i i i !j ~
~ ~ 8 g:
I'
INCOMJi1IU'lChllVl!1D
-
AeCoHntunt ehul'.IlDl-l ,11lHRulf with tho follllwtngtncolllo flmoH'nt.H l'ocolvedl
11111'1
-
Nov, 10
JJOD, 15
lPunnel'fO Tl'UfOt Compuny ChI' lfOt III II Ii Club
!ntol'llBl on YOI'I< JPodol'II1 SllvlngH &. LOllnAsn,
BuvtngfJ lIo(.dunl H10011403llfl'Oll'I, ,h1l10 :30, lORI,
to ])N'omIJlH' 15, 10Bt
'rO'l'AL INCOME H1DCJi1IVI'lD
lJIS13UI{SgM1DN'l'S
f\ocountant clulml-l c'l'odll 1'01' tho followtng fllllounts puld:
Checks c1el1red lifter dOllth
Mutuul of Oml1hu, pl'emlUIll
p P & L. llocotlnl
[{(,gtater of Wllll-l, Loil(wi:l'l'el-ltumontllry
The gventt1g Senttnel, Ildvol'tlstng LeilerB
Cumberland Law ,loUl'nI11., IldverHs Ing Lollor H
Mbl1tgoll\el' y WaNl, \lC001\l1t
Oommonwoultl,l Nllttonul 13llnl<, Hel'vtoe chuI'go on
checl<lng account
p P & L,.account
Untted '1'eloph0l1l1 Co" uccount
Georges1. FlOWOl'B
'1'llI;llfl J." Shipp. l'olmblll'/:lOmollt 1'01' tolophollP. eX!HmSe
Pllt Boumor, l'olmbul' flel1lnnt for le1ephono expelHHl
lJ1by Orl1111to Work", lolterlng monument
Li:,K 100 ILC: '707
'.
$
:lO,llQ
11>0,65
$
180,55
$ 27.6B
B,80
16,7Q
20.00
18,00
18,00
149,ll1
,20
4,78
3,49
31,80
9,00
12,05
35, 00
Aug.
JU
HI
Sept, 22
Dot. 23
Nov. 3
~
3
fo
'.
I'll tj3onl1HH', cI 0 hi
II. U(l
IUwlllf,( UI'Ot\Hll'l'I I.I'unol'lll lIolTlo, I'ullol'ql flOl'vtIH)H -
$2,712. 00 lOil!; Soollll SIHnll'lty 01' $255. DO
2,4r17.00
Heglatol' 01' Wl1lH, Ilooount 01' )lll. '1'1' llll HI' 01' IlIhol'lt.nno(j
Tnx 300, 00
Ihlglatel' 01' WIllH, flllng Hopol't 01' AH~Jot!; B,OO
Heglil,tOl' of WIlIH, 1'1l1l)gIJobtH IIntl ]Joduotlonfl B.OO
Heglfltel' 01' Will!;, hlllulIl'o I'll. Tl'nnHl'e\' Inhol'ltance TlIx 73. BO
COllllTlol1wenHh NI(tlonulljllnl~, blllll( HBl'vloe '.~11fII'ge .26
'l'halH Shlpp, tlebt duo :lO..oO
[{obed M. lrl'ey, llttOl'noy1t; flW B8B. 3~1
Heg1at,?1' of Wlllfl, fllhig Aocount 66.00
Plddto Thalli Shipp, balalwo of YOI'I\ lrcd(~l'a1 Savlngs
und Loan Alil1, pUlisbool\ flllvlngs L1COOUllt or which she
wuabellefio ial'YI
June aD, I()OI 36.39
,July 31, 1901 :l7.61
Odobol' 26, lOBI B(lO.OO
Novelubel; 3, 1 DB 1. 300,00
r~i11uno e Palcj 7. 024, ~
7,BOB.98 7,898..98
'l'O'PALD!SBUHSlUMlUNTS $11,887,14
IlmCAPITU1..,ATlON
.
1'ot(\1 Pl'lnoipal l{ eoo lved
$11,700.59
Total Inoome l{poo ivetl
lBO,55
11; BB7. 14
Totul Heoelptli
LOlis '1'otu1 J)labul'soments
.11, B87. 14
Bulunc e rOl' Distt'lbut lon
-0.
LU 100 I.\~L ','G8
HI'Y.4&nll.nOI
COMMONWEALTH Of I'ENN8VLVANIA
PEI'AIITMUNT 01' REVUNUB
TRANBfEII INHBRITANOE 'fAll
RBaIOON'f PEOaOaNT
SCHEDULE "F"
'sTATfiMfiNT OP DIHIT8
AND PfiPUCTIONS
-i._. --' ,__,,~___~"~r'T___~~~~_~"-'-~ -~'-"'-"-'~~.i,h'."-'k,"~"';U;*~""~"""- ",,' f, ."c__".~ . "=.,,,,,...;_.,._,~,,"......,,,.,......._,-~.............. ~
Fllo No. 21.81.404
._-~- . --~ ..----.----- TOTAl. THIS PAGE C' 3, 476. 56
I hereby certify that. to the best of my Imowled~o and belief the foregoing Is a Just and true statement of debts. funeral
expenses and expenses of aclmlnlstretlol1 subrnltted to tho Astate as deductions for Inheritance Tax purposes.
't~A;Li " 1t~. $. II/I!
SIONA"UIH~ OF T1'O O^TE
OF ICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ ,~Lj 1C, ,j;-t,
EBtatl! ofUNNIm A. SIiANAl3L'\.OOI<; .Dilto of Dllillh,...}Jll}e 20, ~91l1
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant
_ RulalionBhlp to Docodel1l
91almant'BAddreBB
d~~'~ .o..~ ~'~__".' .n-___ ......~.-, _.~~
__-+'-.-e-+ ___'_T_~
AEMAIIKB
NO.
PATE
NAMU Of I'/lVBQ
heclts cleared after death
.~~.->.~...,._ ..........,....,~....... ............--......... __~_.... ._~_~~~_.-..+___.r__________~'~~__________-.
P & J., Aocount
. ...__-...--.-.--..---...----.---~---~..~._. ................-----<---.- ----..
WgLster ot Wllla ____.._. .Lettera 1~e.~tnmentary
'he EvenLng Sentlnel AUvertLalng.l_,etterll
umberland Law Journal J\.dv~!l-.~.1g_Lettet'!...-.~
ont Omel' Ward ___, Al100unt ,___
6mmonwl!!illJl.NatLona1 Bank _._ l?.Q,\'vLce oharue on..91eold
___ M..Q<lli!!1._.
nLted T::~ephone Co.~____ A~~___.___._
eorges' F10werll _ Acc'?tll1t
ha Ls L. ShLpp HeLmbur sem~,\}t fal' tele hone ex e
at Beamer __.~___.__'_._ l'\.eLmbul'aeme~t for telephone exp,!IDs
b OranLte OI'1.ill.-.____w Letterlna monument
.ro. Beamer _______n Flower aOQQ!.lllt
"wLnBl'o1hel's_Funeral Hpll1.lL_ .EY.n.\'!r a1 aerVLoea
e Lster ot WUls ._...-"-__-- l~.LlLng I'\.epol't of Assets _
,
tteqLster of Wills ,_,.___. FllLng, Debts and I?educt.Lans
Hobel't M. Frey, Attorne 'a fee.
Ite Lster of WLlls FLlLng Account
Commonwealth .NatLonal J3~llll<._. :.J3ank sOl'vlce. charge;
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- ~rn'isTl" "WILL',
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, ol\TE
AMOUNT
27.68
16 70
20.00
16.00
18.00_
149.61
3.49
.31 80
_......_~_.-
9.00._
12 05
35 00
11 66
2,457.00 __.
5.00
5.00
585.3L-
66.00
.26
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PE RC~NT,
Un~utI8f1ed lIobllltlu9 InclInod bv tl\() dUQudonl prior 10 hls/\101' t1uuth 01'0 dudllctlhln ullulnst his/her taxable astuto,
In addition to dobt8lnlJlIl'l'ud bV thu ducedunl or estute, othor Ilums uro clalmuble Innludlngthe c;ost of udmll1lstratlon,
attorney fees, flducllllv jUus, [unural und buritll exp\lnsus IlIclUdll1gtho oost of a blll'lullot, tomhstonu or gravo marker,
All dobts being clalmeduonll\sl 0\1 OSHlte aro subloct to tho opproval of t\1e Roulstor 01 Wills with whom tho
Inlwrltance TlU< Rotul'l1ls iliad, Evldonoe to Ull'lPort tho docodont's or the ostoto's liability (or tho debts bolnoololmod
sllould be attaohed to this ~ohadllle,
A lamllV axomptlon 01 $2,000 moV be ololmedbV u spouse 91 0 decodent who (1lod domiciled In Pennsvlvanla,
If there Ilno spousu,or If the spouse hos forfeited hls/\1or rI\lhts, than .anV ohlld of tho deoodont whO IS a mamber'of
the samehollsehold oal)olalm tho oxemptlon, In thu evantlhOro Is no suoh spouso or ohlld, the exemption con be
claimed bv a parent or purenls who ere membors of tho same household as the deoodont.
~~ lNI1Il.RITANCl; lAX INFORMATION
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1, If th.e iamllv exomptlonIs beln9 clallnod, indicate the ololmant's namo,.address a[1d hls/hor relationship to tho
deoedent. Enter "family exemption" In tho remerks column and tho am(,lunt nlelined In the amount.colllmn,
2, Assign cOl\RO()llllve numbers to eaohltem Ilsled. .
3, Enter the dolO on whioh each debt waR Inourred and/or paid.
4, Enter the names 01 eaoh poyoo,
6, Provide a brlof oxplnnntlon In llio rem$rks column for eaoh debt claimed,
6, Entor the Olnount of ouoh dobt being clalmod.
. 7. The form I1WSt bn slUnod by the pors(ln who has assumod theresponslbllltV lor paV\l1~ tho debts.
INSTRUC,.IONS FOR COMPLErlNG SCHIl.DULE "t:.: