HomeMy WebLinkAbout81-00410
,IV
II.
,..
.
..
Ia_t gallanb ~t~mtnt
I, HU'r11 I~. HOJ"AH, of' H, D, 2, NowvU 113, Cumberland County I r>enn-
oylVania, do make anel puhUsh thio my lust will and testament, hereby
revoking all wills heretoforo mude by mo,
1. I direct my executI'J.x 1',0 pay all my .just debts, funeral and
administt'atiye expenses us Boon as Donvoniently may be done aftor my
death.
2, I give and bequeath the sum ef $3,000,00 to my daughter,
Margaret M. Smith, and ull the rest of my property rea;!. and perBonal,
, '
to my hUBband, Dana S. Holar, absolutoly,
3, If r am not eUrvived by my husband, Dana Si HOlar, then I
order and direct my substitute executrh to sell all of my property,
real and pet'Bona;I., as Boon us may be oonvenient ufter my de DeUBe, at
eith~r publio or private sale or sales; and the proceeds of such a
sale or sales, together with any money or itB equivalent, after pay-
merit dr debtUi expenses, etc., I give und bequeath as follows I
To' my daughter Margaret M. Smith" absolutely,
q, I nominate and appoint DANA S, ROLAR aB executor of thiB
my last will and testament, without the pooting of any bond. Should
he die before my death, res.1.gn, die leaving any of my estate .unadmin1 -
tered, or renounoe for any reason, I nominate and appoint MARGARET M.
SMITH, as substitute executrix with the same powers and also without
bond.
'5. I direct my personal representative to retain the services 0
Irwin, I,!'win & Irwin, as attorneys in the settlement of' my estate.
IN WITNESS WHEREOF, I
~~day of JanUary. 1967,
havo hereunto Bet my h~nd and seal this
./.11 / 7') ~
. ~'(k (0. ,Y.Il:~lC"l./L,
U ) E, Rolar
(SEAL)
Signed, sealed, publ1shedand declared by the above named testa-
trix as and for her last will and testament, in our ~resehoe, who, in
he~ presenoe, at her request, und in the presenoe of epoh other, have
hereunto subscribed our names as
attesting witl'leases. ()
ffi"'1rt"-c ~ ~- ~
9~~'
c~~
OA'fIt m' Pt:RfjONAI, Rt:I'RmU<:N'fA'fIVl<:
COMMONWUAI,TH OF I'IlNNSYl-VANIA SS:
COUN1'Y OF CUMUIlRLANI)
lIefore mo, tho Roglstor for tho l'rohRlo ,of Wills Rnd 8runtlng of I,olhm of Adminlstrntlon In and for Ihe county of
cumberland, porsonRlly ORIllO_. Mo I'f';n 1'<1 \, M,. :l1111 tll
who, bolns duly sworn , do_~~d,oPo8e'"nd suythRI us~~.o Il \; pix
oflhe laHt Will aodTos,tRmunl of~_Jhltl1,I;;, Holo,l'
,-....-
_deceased,
-
will well Rnd Iruly administer lho goods and challols, rights and oredlts of said deceasod accordlns 10 law, And
ahoWII, dlllaenUy comply with tho provisions or the law rolaUna to Transfer Inherltancos. SWann and subsorlbed before mo,
, ~ 8\
, ,', , " J'U1Y~., A.D" 19.-:.:-
'-"~, ~,f 1,,',.,1, ' (!'.f,I,"~,?:J, ~"",,,,{~,,u, <( "/"~,', .
" l. " . - - ,- - -~ _' _ _ - - - _
I - ,
... ,
~ I (! '~f;;;
, ~ . Realster
\1
~\ III
u.. ~
~\ 0 1
,~ ..J .
~ r>:l
"~1 ..J ! ; .
- ~
@ 3: ,a
,... . t .
C9 I"l
~ ~,
.,... =lid
N, r !
1
~
~
1
ex:>
I'1l
!
DECREE
Do It, romoll1berod that on Iho_ 8t~ _dRYof. July
reoorded the laslWIII and Teslament,Of Huth E, Rolan
the BO~Qugh of Newvllle
81 ' ,
1^,D,,19~, thoro was probatod and
lalll of
, CUJllborland Counly, Ponnsylvtlllla,
DcceRsed. Letters ;'l'ostamenta,l'Y were granted to_,
WllltesR tllY hRndand official seal the day and year aforesaid.
MI.\Pl!tll'8 t ' M, Sill:\. \111
~
9&4
/?~ ,"I ~' ' J
':, Zjl~a.,./ ~'
, Resister
"
I
1
I
I
I
I
I'
i
I
I
\
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Old dece,~en(,;,w, Ithln twoyenr~, 01 donth, make any transfer 01 any molorlalllart of his esllllo without recelvlnR
vnlunble0ndlldequate consideration? ,(Answer lIYes" or "No",) , , ,.. . ,
2. Old decedent, within two ye,ars of doat,h, transfer IHoRerty from hlmselfl.hersol f to himself/herself a", d anothor party
or portle& (Including 0 spouse) Inlolnt ownership? (Answer "Yes" or,'%)".) -
3, If lhe answer 10 oneor two olxlve Is "Yes" and the transfers ore claimed to be nontaxablo, provide the following
Infernlalion: " . . .
a, Age otdecodpnt at til.ne 01 honsler.
b, Copy of du,lth certificate.
, c. Allldnvlt by the attendlnR physician Indicating the state of decedent's healthnt time olhonshu.
d, All other Information supporting nontaxabllfly of transler. . '
4. Old qecedent, In hlli/hor lifetime, make any transfer 01 property without receiving a valllnble or udequate consideration
lherelor which was to .take ellect In possession or enjoyment at or afler his/her death? (Answer "Yos" or "No".'
a, Was there anyposslblllly that the property transferred might return to transferor or hls/hor estate orba subjeol
, to hls/lIer,power of disposition? (Answer "Yes" or "No",) .
b, Whal Was the transferee's age at time of decedent's deatll?
5, Old decedenlln Ills/her lifetime maKe any transfer without receiving a valuable and adequate consideration therefor
under which transferor expressly or Impliedly reserves lor Ills/her II Ie orany period which does In fnct OI1d before his/her
death: '
a, Tho possession or enjoyment of or the right to Incoll1o from the IHoperty transferred? (Answer "Ves" or "No".)
b, The right todesl!!l1ate the persons who shall possoss or enjoy the properly transferred or Income therefrom?
(Answer "Yes" or "No".)
6. lithe answer to five b, above Is "Yes," was the right reserve<1 Indecedont alone ( ) 01 docedent and otlwrs ( ).
7. Old deced~nt In his/her lifetime make a transfer, the consldoratlonfor which was transferee's promise to pay Illcome
10 or Iqr the benefltor care of transferor? (Answer liVes" or "No".) , '
8. 'Old decedent, at any time, transfer property, the baleflclalllnjoyment of which was subject to change,. because of
, a roserved power to al ter, amend, or revoke, orwhlch could revert to decedent under tern:~ of trOl1sfer or by opera\lon of
law? (Answer "Ves"'or "No".) " ., ' .
9. \I the an~.wer to elRht above Is "Yes." was lhe, power loaltet, amend or revoke the Interest of the beneficiary reserved
In the decedent alone ( ) or decedent and others ( ), ,
nt':V.463 l':)(" (to.OO)
'COMMONWBAL TH IlF PBNNBVLVANIA
DBPARTMBNT oP RBVBNUB
TRAN8FBR INH8RITANIl& TAli
RB81l'JBNT PBIlBll8NT
SCHEDULE "0"
peN~FIOIARIIlS
IIlImllot/OIlS Oil Rovorlll SIr/Il)
Estate of
't~'\1 lJl. I!Q~AR
PIlNBfl01ARIBS AND ADDRBSSIlS RELATIONSHIP S VIVED DATE Of INTIlRIlST QF IIBNRPlclARV
DlloeOENT PIRTH
Margaret l~. Smith ---'- "'yau6ht~1'. , ~ms )~nt1re 100%
~ ~- -
RoD. n. Box 1~3
-
Shipp.nll1)urg. PA 17257
" -
, ,
,
,
,
-
, ,
, "
, ,
,
, ,
,
,
___.____'---......~..~_______............._'_~7.____'__ u_m~7_c_.~.___.. .., -,~-~~_.._..._- -------.~~._._-~-~_. ~------~_-r._--*" -~_._-~
I,
- .' ,
, ,
-- -
i , "
r ~ , . ,
" "
-
,
. . --------....._~._...~-_....-.,-~ ---- -~_...__..-_._,---,... -_...._-~-_..._..- -._._----_......-_.---'...~--_._~----
'--....-'. "
u ,.-.__~_.~__~.~! .,.' -._ ~___~~~_~m -~-~......,.....~------.._' ~..------ --~., .- ---..-.--.----.--.. ..---
, , , ,
" , ,
, ,
" , ," ~,-
,
,
, ,
, , , , ,
, ,
"
" ,
, , ' ,
, ,
, ' ,
, " ,
,The ebove beneflolatlllswete living lit the time of the deoedent's dflftth ellceptfot thsfollowlng:
NAME
OATE Of DEATH
If fddltlon.1 .p.o.I. Il.o....ry, u.. 8%" M 11" .hoett.
'IWRUGTIONS FOR COMPI..ETING SGHEDlJl..E "EoI
SohedUle 'IE" must Inoludoell proporty, 1'001 and porBonal,'ownetl by tho <:feoadollt Jointly With onol11er '
pertY or parties asjolnl tononts with rloht 01 survivorship; Both tonolblo and Ihtnnlllblo pl'(Jperty ore to bo
Included, I..lst real astete first. '
1. Desorlbo ell 1'001 property IIs,lnclllJUtud In tho InstruotlonB 101' Sohndulo" A", Dosorlllllllll PUl'sot101 property
8' Indloated In the Instruotlon" Il,lr Schudule "a", Includn tho norne, o(ldruBs and relationship to tho
deoedent 01 tho oo,ownol' (~) and the dolO tho 101m ownOl'lilllp WIIS eMobllshod, '
2. Indloote tho IOlalnlllrkot volulI of lho lolnl1y nwned propllrty.
"3. Indloate tho poroqnto\lo qf tho deoudllnt'n Irllnresl.
4. Indloale Iho market valllo of thu dlloudont'~ IntoroBt,
" '
H...._ <c' ~,_._,_,~_~_~_,__~,-,~____'_-"'''_~'_''__"~.____'~''''_''''''''''''''''''''-__-~.~_.....-~
~ ~ 8 8 E; M ~ ~
;;. IJI Z
f,1 R ~ Q. tl ~ ~', ~
:0 P
,.. '/. z ~ M ;;l
. p P IJI ~
, " , z r:il IJI 0
\0.' c. , 9 '1'1 -
L lU t,/~ ' ~
~:,., .
, " !:;~ :::l
\',.," Ln
Co' ,!.--..-( i
(liL .... r>~ _i ~
~: I~.' (~-f;-
~ t._',-,1
-rJ '.~~~n
n: ~-. t'l
~\:! ii5 LUG ~
-'
Ll
0
~
~ '~ '<
-
-*--------.-,-..-~
".V.... oX+ 1"'01
INH!::RITANC!:: TAX SUMMARY SHE!::T
(BUREAU USE ONLY)
(]] Original
o Supplemental
CI R,malnder
fllle Humb.r 21-01...01110
..---.------.-- --. -~_.........,..-_._--
Ibtote Home ~~___ R\\t2~n. u~_~lat'__~~~,_,_-'__'
June 6. 1901
, Pate of Peath _____---,----'-~'-,--
Social Securl ty Number '
101-30-6992
.~._.._."~-----------'-
REPORT OP IHHI!RITANCE TAX APPRAISER
I, the undtrtlvnld duly appointed Inherltanoe TOM Applal." In and 101 the County 01 CumbeX'land
Pennlylvanla, do ",p..tlully IIpOll that I havI apprallld the 1101 and p",onal ;efllP" as I",olled In the 10llgolna
ilium at the valUII ..t follh apposltl eaoh 110m In the loll oolumn the I ht In 50 ulll "A", "B", "C", and "8"
Patedl November> 12, 1981, . ~ ~. .
INH ITANOS T.X .PP In"
VII~UI "' IIPPRAIIIO COOl IIOJU$TMIMTI RIMIIIMoIR IIPPRIIIIIMIMT COOl
INVRNTORY (HIIRRISBURG UII OM~Y)
R,ol P,opertr(hhedUle II) 00+ e
Pe"onal Ploperty ($ohedule II) 1,1171 93 to+
JolnhHeld Ploperty (hhed"le I) 36,392 21 11I+
Tlon,/ere (lIhedule C) , None 30+
TOTII~ GROll ASlITS L__~~I!~?4 14
~e.. Deb" and Deduetlone ~. u.
(SCH8D~~1I P)
C~IIIR VII~UI OP UTAT8
o l.1l1 Ihtate 1IAl! PIICTOR PRIMCI P~ I VA~UI COOl
-
o Annuity
POR U~R OF RIQI;ST1!R OHL Y
T.. on $
To. on S
To. on $ .
To. on $
To. on $
a.,..ptlon.
Total I...t,
Wl.I.
OOMPUTIITION, OPTAX
$
$
$
$
$
611
1511
'TorAL TAX
INTBRI$T PROM
BII~IINce
TO
,
$
$
~... C"dltl
DIITI OP PIIYMINT
AMOUNT P;l.lo DISCOUNT
, + I
INTBRUT
-, .
+
---
.
BA~IIMce
TO _
"_V'4&1 ~.+ 1f..01
COMMONWi:IIL TII 01' Pi:NN5'fI..YIINIII
Di:PiIIlTMI:N1' or 'U,YENUI
TRANSfeR INHIRITANCI TAX
RIIID.INT Dla.'D~NT
INHeRITANce TAX
APPRAISEMENT
o SUPPL.EMENTAL
.
-rnORIClINAL.
e.tat. Df ___, Ruth~_~",~~:~~_u_,_,______,__..___,_,_
"'-.
File No. .,_....,
21-01~Oll10
County
Cumbel'land
Data of Danlh _,_~,~~~..~,',_1.?01_________,__.
r----..-..--:-.--..------....-------.--..~--
In Ih. ...nt that anr futuro Inl....' In Ihl. ..tat. I. iran,f.rred In p......'.n or .nl.rm.nt I. ;.lIal.,al h.lt. .f Ih., d."J.nt aft.. Iho -
OHplrafl.n .f anr ..tal. lot III. .t f.t r.a", tho C.mm.nwealth "...br ..p"..ly t...,... tho ,Iohl ,. appt.l.. and ...... ir.n.f..
Inh'rltanu'tulI at th~ l,wf~1 colla'ltal rClte on any luah fuhHO lntlf.... - '_ _ ' _._
. PROPERTY NOT INCL.UD6D IN ReTURN jlUT APPRAiseD BY THE COMMONWeALTH
-
ASSET SUMMARY
. - ~ -.---
\, Total R.al Property - 5CH. "A". . . , . . $ 30,000.00 Unreport.d $
2, Total P.rlonol Property - 5CH. "II". . . , $ 1,11'11.93 Unreported $
36,392,21
3, Total Jointly Own.d Property - 5CH. "B" $ ---- Unreported $
4, Total Tranlferl - 5CH. "C", . ,.. . , , , $ None Unreported $
..--.
A~pEf~~J~'VinE
$ _ 30,,~~~_ i
$ _~_!~'11. 93
$ ~_6,39~.21_1
$ None I
LIFE ESTATE'
ANNUITY
TOT AI. GROSS ASSETS
REMAINDER
67,884.14
DATB
tl ell'
<0
\'"1.
M .:t
S "I
~ ~ ~
~ ~ 'fib ~
ii1 .
~ ~ I "' "I
! ~ ~
,
i ~l
i
~ lO .-t
.-t 1"\ .-t
S ~ 0
~ ,
0 ~.. Z 0
~ ~ ~. d
~ , z z
i 0 ~ ~
z ~ Q
5! 8 :;.
,I ----,..,. --
,,'
'; ,
-
COMMONWIALTH OJlI'INNIVLYANIA
COUNTY 01' CUM'IRI.AND
'"
O~""'-,_n __._' _ +__,~~,__,_~_..~~,~__,-_._~._,", ,.
M/:1l'(f,nr'o (; Mt SIlIJ. t; h
.._.~- ..-..~.i'_'~'1,,1_-_~_~_....%.C".......-<+-_..___..-.--'-O____...;.. --~""_-,-"",,,+-~_C"'_",,____,
boln; duly ....~~aNor;!L, n_ aooordln') to law, drpOIO\ and laYI Ihd uh. ..,.JJLtllll..Jl.XIil.O.u,C.l~..tx~.,_,
H'._~___,..........,,_.... ... ..'.., ,"_. ... ollho Ellalo 01 ~.Jj)I1;h. g !-B~__,._,_,
lal.ol _.j;!J,~ .,I3ot'oUI.';tl c,~f' N()WVJ. H()n... m_' Cumberl.nd Oounly, P,*" d.b....d and that th.
I'(lIhln II .n Invonlory m.do by 'n.M/.ll'S~W~.L M.L~lll,t.tI1....._ ",_ ~,,-~,th. IIld....e.lill.O U t~'J. x ....._
ollhe .nllro 0,1.10 Olll"ld diood.nl',conllltln9 01 all tho porlonalprof1~rIV" and rOIl ulat., uOIpl rOIl "td. o~hld.
th. Commonwulthol P.nnlylv~nlo, ond thai tho IIQurol oppollt.. ouh lI.m 01 tho Inv.ntory rapr'lont It'l f.lr valu.
ftl oUh. dM., 01 d.oodont'l ,dealh , .
_., 19 ,.._..-:....
InMJr~-~~ ,
fR '. hla.tor ~lnht..tOI
J ,... B..tP.!....,l/l L Bo 1t_1J2.L.___~~_
,___....!;l,h.ll~enB.bul"g, P9nnBl}.vania 11127
...dd....
SWOl"n
_ ond l\iblOrlbod boloro mo,
Date ul D"th ,_..~...,()~I,!__._._..,..,_~_._._..,...__"June_...._,~,__
' PiY Mo,lh
1981_~__
nl'
INSTRUCTIONS
I, An Inv.ntory.mult be flied within thioom~nthl allor oppolntment 01 personal raptolOnt,tlv..
2. A luppl.ment 'nventory mUlt bo flied wlthl~ thirty dOYI 01 dllcovery of eddltlonel e"oh,
3. Addltlonol Ihoats may be ,Haohed .. ,to porlonqlty or re/llty
.li 4. S..ArtloleIV, Flcluqlorl81 Aot 011949. p~
,:;'):'
l\'"
rq)
;I)!r-~
1.' :~;
",l,' f,~;
, ,.: ~r
"-_"i:
05
-
....
\..M
IBm
(.'IM
"..r,-.l
,",rrt ,
;~-~
"
,
~)
,
~
..~..
~
:'~
..~
,<lJ
H
r--I
,~
~
Q) .~
~ 1
I~ ~ '.... ~
i ~.; e 0 J H
rl t
0 ol:l if
p:: l10
t:j i.
, 0
rLl ~
~h 0 !
ol:l CCl ~
.'
::l Q) .
p:: ol:l lit .~
.' )
'1l e
t...{ I
~ ~ .II
J
Inventory 01 the real and porsClnaloatate of
!\
Ruth l~. Holm"
-,--'-- deoeased
----.~....._---
.~. .......,-~~n..~_'n.__..~
... ~ ~. ~..,,_............- < -,- -.
~eal ttlitaDfil
DoUble hOUIlEl with, lot in 1'eal" ai,tun be
NeWVil, Ie" OUlllbel' land Oounty! PennB,y 1 vania,
liia;hStr'Geb, (Assessed at ijlIJ,nO,OO) ,
in bhe BOl"ough or
I<nowl'\ as 111-16 NOl"th'
Pel'Bonal ProPGl"t~
aaah- . . . . . , . i . . ~ t t t . ~ . t . . . , , t , t . , I
F'Ul"tl:!:tUl'e anQ hOUBfJhold items
Valufil ,based On inventql'Y,
it,
. , .f , , .
i . . t' t i .
TheF'amel"S National Bank of NeWVille
'Oal"tifitJates of Deposit jointly ,owned with Mal"gal"et Smithl
#51j9 , , . . . , . , , . , . , , , , , , . , . , , ,
II 59 , . . , . , . , , , . , , , , , , , , . . . , .
,
1/550 , . . . , , . , , . . , , . .' , " . , , . , , .
"
# 60 , , . , , . . , , , . , . . . . , . , , . . . .
SaVings Aooount #4474 . . , . . . ,
Jointly owned with Marsal'et Smith
Oheoldhg Aooount, # ' , , , , .
,JointlY' owned with Margal"et SmHh
I . . I , , , . I t. .
. it . . I " , . . t
lJ'it'st Fadel's.l Savings and Loan AS800iation
\1 \
Certi,fioate of Deposit ;123955 jointly
SmitJ~, . I . , ,I. , . I, . . . , t
owned with Margal'et;
, . , t . I . . . .
OUmbsl'land Va'lley Savings and Loan Assooiation
Oel'tif'ios.tet;>f Deposit 1109~689888 Jointly owned with
Ma~garet Smith . . . , . t . . . . . . . , i . . I
, ,
TOTAL
30,000 0
329 3
1,1/1200
?,OOO 0
1,91511
14593
5,16824
10,012 3
6'7,86114
COMMONWEALTH OF peNNSYLVANIA
OEPARTMENT OF REveNue
BUREAU OF eXAMiNATION
OFFIOIAL NOTiOS OF
INHSRITANOS TAX
ASSS88MSNT
*'
OQlINTY FILS NO:_
,',-
PATS
~ ('1
) .,,--"1 /tY \-/
.~ - ',I' ". .
.-,
TO: ,) .' ",:
,/
/ '--I
SSTATS
'I
".-.
,) , ,
I, 'I "'d
,
I (I "
,
"
.I
/.f,-.
(~j",'
FILE NO,
,'..,
,-I , .' f I -....-~.'_ ,:
COUNTY
./" I".'..-", ..'.{
I: ~ ,. '.~ .:. -.F " ~._". _.
,t j i,' '.. i". ". '.'
1 . _. ....~_...~.. ,," I,
, " ,
PATE OF OEA TH
.' .,'.: '.'
ill'!
,- .
Appr~180d YOluo of S8\ate:
Real Eelole
PersunolProporly
Jolnlly Hold ProperlY/Tronsfors
. , , "
+ ,. ~-,
... , , ,
+ , ., f
u . , ... ,
TOlol O,ro.. Estele
., 'j ,_'J, ',.-' '--',:0-
r,"
TOlel Approved Deducllons
I /f -j I)
-'/,' ,'t' ,'"
Clear Velue of Sslele
.
/ '(..; ;),1
,
Le..: Approved Chorlleble Exempllons
Olear Value of e8tele Subject to Tax
. ", 'I ',.,
'. ; (.'. _.-
')'l
Amounl Taxable @ 6,% Rote
.
I
1.-' J
>,1-
.
lex due
. ..' 1;",) '-I 'I"
Amounl Toxablo @ 16% Rate
tax due
TOTAL pENNSYLVANIA INHERITANCE TAX DUE
. ,;,( /'" --'./ ,/, ,/ I
. .
,
· · · · · · A five peroent dlsoount tolollng .
Will be grenlo~ If the Inheritance Tax Is paid by
La.. Crodll8:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
- .
TAX qRSDIT
.
+ .
. .
+
.
+
.
Interosl aeoruos 01 Iho ,ale of six (81 peroont' per annum
on tho unpaid, bolonoo of Inhorltanco Tax from
to dale of paymen!., InlareBI due If P~ld by Is
BAlANCS OF PENNSYLYANIA INH6RITANOE TAX PUE
~
if II
AS8modby: !/ " I j':d:::. I.,
!I.,lnfotm'lIon on ReYfl'I8.Ald. . Ao.ntf6'th.com~U~~~."
, /\ Ilf, ,j
,.
,')'
i I .-{ .'}~/
~f'L INHe~ITA~pe TAX INfQ6M8~
Unl\Qtllflod lIabllltlos,lnourrau.bY tho dooqdant prior to hls/hor daoth ora uauuotlbla ogolnlt hle/ho,I' taxablo oltote,
In addition to dabtllnourrod bY thodeoeueht Qr oslllto, llther Itoms are olalmable Inoludlno tho oost of odmlnl$tratlon,
attorney feos, f1duolalY feos, fUllaral ond burial ellpellses Inoludlllg tha oost of e burlollot, tombstono or gravo Inarkor,
"
All debts bolng olalmed ugalnst on estate are sublaot to tha approvol of tha Roglstor of Wills with whom the
Inherltanoe Tal!, Return Is fllad. Evldollos to support tlw dsoodont's or tho estoto's liability for tho dobtl being olalrnod
should be attaohod to thll sohedule. .'
A family examptlon of $2,000 may bo olalmed by a spouse of 0 decodentwho died domlcllod In Pennsylvania.
If there Is no spouse, O.r If the spouse has forfeited hls/her rights, then any child of.thsdaoedent who Is 0 momber of
the I\Qmll housahold olin olalm tho eIl8mp.tlon. In \ha ovent thera Is no such spouse or child, tha ellomptlon con be
olalmad by 0 parent or parents who .re mambars of tha sama housahold al tho deoadent.
t: ~ ~ 8 g ~ I ~
~ G'l ~ ~ ~
l'l'l f;l
Z Z t:;j
~.~ p p U'l
~ 0 U'l 0
'Tl 'T' -
5 ~
S ~ ~
!~ z
trl
~ .
tIl ll'> ~
~ s.
~ ~
:.:cJ
.~ ~ .:s
!f.
\~-,
I" CI ,>:
I \,.,,'
" ::_::__,1
lJ,J! ! ,;'':
I:~' Ie;; I '.1 LD
l:~,-,_l . In
l3'" ";,;:'
~liJ ~ f~,-:i
,(0.>
c)
INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. , If the family examptlon Is being clolmod, Indloate the olalmant's name, address and hlslher relationship to the
deoedent. Enter "family axemptlon" In the remarks column and the amount claimed In the amount column.
2. Assign con,seoutlvs numbers to qaoh Itam listed,
3, Enter the date on whloh eaoh debt was Incurred andlor paid,
4. Enter the names of eaoh payee, ,
6. Provide 0 brief explonotlon In the ramarks oolumn for oaoh debt clolmed,
e, Enter tho amollf1t of aoch dabt bolng ololmed, '
7 i The form must be slgnod by thopersol1 who hos assumed tho rOSIJOnslblllty for poVlng tho dobts.
J
REY, 1B47EK (3-S31
BUREAU OF ACCOUNTS SETT~EMENT NOnOI Of INHIRn~1 TAK AeN
peNNSY~VANIA DEPARTMeNT OF REVENUE APPRAISlMINT, AL~O\/"NOE OR OUALLOWANOI ~O~ '
p,o, BOX '~Ollll
H~RRISBURG, pA 17106 or OlouonONS, ANO ASlIISMINT or TAx
07...nB-B3 j,
___________ ...._ if;_ __
UTATE OF ROLIIR RUTlI v: n~1 NO, 2~ 81-0410
lIAlUU'-OIIlTH .llli-06-B 1 ,~_~_,_.__,__,,_.__~___.,~,___,_,__QQJItill'.....--QJlMBlilRJ..At{IL._
NOTI' TO INIURI PROPIR ORI01T TO YOUR AooOUNT SUBMIT THI UPPDR PORTION or TH1I NoT101 WITH YOUR TAx
"",VMINT TO THI RIGISTIR Of WILLa OF THI AaOVI OOUNTV. 'MIIKI OHIOKS PAYAlILI TO "RIG11TIR or WILL.,
AClINT" ,
Cll!lORQl!l B FIILLl!lR
10 W lIIl)H ST '
OIlRLISLl!l I'll ~7013
PLEASE RETURN THIS
PORTION TO REGISTER OF
WHLS IF PAYMENT DUE
OUT AI-ONO THIS I-INB ~ RBTAIN I-OWBR PORTiON FOR YOUR RIlOOADS -
.. .. _ ... .. .. .. ... .. ... .._.. .. ... _ _ ... .. ~ ... _ ~ .. .. .. .. <- _ ~ ~ ...._ ... .. .. n. ._ _ ~ .. .. _ .. ~ ... .. _ .. __ ... .' .. .. .. _ _ <c +- .. ... .. ... - ,. .. ... .. .. .. ..
NOTIOI OF INHIR1TANOE TAX APPRA1SEMINT, ALLOWANOI OROISALLOWANOI OF OEDUOT10NS AND ASSISSMINT OF TAx
RIY, 11471x (B-SBl
IITATI OF ROt..IIR RUTIl Ii: FILl NO, 21 8~-0410 ACN 101 DATI 07-05-B3
TAX RETURN WAS: III 1 ACq!!PTED h,S PI~ED )~~_
R~81RYATlON. CONOIRN1NO FUTlLBJLJ.tfilI!UT - a.. MY1I!n
IIPPRAllllD YALUI OF RETURN IA88D ON, 1 SUPPLEMENTAL Rl'lTURN
1, Rnl' Eela" (Sohedula AI ( 1) ___~QL
2, stooka thd Bonda ISohedule 81 1 21 .00
3. Clouly Held Slook/P.rlnalahlp In"rnl (Sohedule' CI ( 3) .00
4, Morlgagea and Nolea (Sohedule 01 1 4) .00
II, C..h e. Mlaoellaneoua, Pelaonal Property (Sohedule E) 1 5) .09_
6, JOlhlly Owned PIoperty (Sohedule FI ( ,61 u 2,532. 95,
7, TIanafe" ISohedule G) 1 71 .00
8, . To'tal Auela ( 81
2,532.515
APPRDVID DIDUCTIONa AND IxlMPT10NSI
9, Funeral exponaoa/f\dmlhlat'allve Coala/Mlaoellaneoua
Expana.. (Sohodule H) 1 9) 3,043.01
, 0, D.bla/Moltgag../~lenl (Sohodule II (10).00
, 11, Total Doduotlona 'I,,)
1 2, . Not V_lue of Tax Relurn 1121
13, Charltablo/Gllvernmonlal aequoala '(Sohedule J) U 31
14,Nn value of Eatale SubJeot 10 Tax (141
NO':'II ,It ~~ ......IlIII~t W~. pr.vtou.ly tuu.d, 11fl.. 14, 11 end/or 1Bt:nd 17 Will
ref1'o~ flgur.. that Inolude tha tot~1 of JLUL return. ~"",'d to dat..
Aas.SBMINT, O~ TAXI
, S. Amounl of IIno 14 laxablo 116% lale
, e, Amounl of IIno 14 taxable at 16% I ale
17,PrlnolpaITax Duo
TAX ORIOI78I
3,043.0~
510.0b-
.00
58 , 645 . 12
115)
US)
58! 645 .12 ",x:oe.
.00 X,1S.
(\71
3 ,I; IB...L1.L
.00
3,51B.7~
P A VMENT
bATE
12-17-B1
RECEIPT
N
06989S
DISOOUNT (+)
INTSReST ("I
AMOUNT PAID
.00
3,5751.'11
* IF pAID AFTeR THIS DATe SSE ReVERse PORCA~CULATION
OF ADDITIONAL INTeReST
Tor AL TAX CReOIT
BALANce OF TAX DUI Sl.20CR
lNTeR..T ,00
TOTAL Due si:o 20CR
lit allanoe Out ia len thIn $1.00 no pavment'11 lequlled)