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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 551
COUNTY OF CUMBERLAND
Before me, the RUilster for the Probate of Wills And sruntlns of l..ellers of Admlnlstrutlon In and f~r the COllnly of
Cumberland, persqnully cume
who, belns duly'
E~\'lIN F, VAN NOY
. do as
depose and say that as EX~Q\ltn,.
Etb~l M. V~~ Nav
deceased
of the lasl Will and Testament of
. .....he
alsCl will dUlsently comply with the provisions of the law telatlnato Transfer Inherllances,
~ ',D., III 81
will well and truly administer the 1I00ds and chilltels, rlshts and credits of said deceased acoordlnato IIw. And
and subsorlbed before me,
:;ZP." . ~.~"""')
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l;Ie It temelllber~d that on the 16th day of,
DECREE
.rub
,A,D"IIl-L. there was probated "nd
tOeorded tho last Will and Testament of
Ethel M. VanNoy
,
IMeor
I1pD&r Al1&n ~awnBhib
DeQellsed. l..ellors 'r.stalllent,at'y _wore granted to
Witness my ha~dlll)d ofnclal seal tho dllY and year lIforesllfd,
. Cumberland County, Pennsylvania,
Et'win F. Van Nay
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a. Robett stautt.~
Atto~n'y at t..aw
~rk.t Square au11d1nq
Meol)an1a.l:Iuf9' 'a. 17055.
STATE
CAPITAL
SAVINGS'
MSOCIATlON
CD
n DN!,I!ll Auq",.t6, 1981
DECEDENTl Itne1 M. Van NOY
D.O.D.M 7"14M81
*..Q.Q)-..Q9- 094~7 B.l\LMOE AS or DATE OF DEATH $ ;::U:U--
ACCRUED IN'!'IIlRES'l'
I>AT1!l QF DEATH VALUE $
DATE mSTABLISHED
MATURITY DATIIl
AOCOUNT TITLE .Jt'h.~ .~, Van Noy
*~>>~ BALANCIll AS OF DATE Oll' DEATH $ 3~'4U:B9
ACCRU!lD INTEREST
pATIll OF "DElATH VALUE $ 3 J .it-
DATI!: ESTABLISHI!lD
MATURITY ,DATE
AOCOUNTTITLE un
* 003- aGo 07553 BALANCIll AS Ol" DATE OF DEATH $ 40,000.00
_.- AOCRUED ,INTEREST ' J.06.47
OATE OF DIllATHVALUE $ 4(1, J.06 .47 .
DATE ESTABLISHED
MATURITY DATE
ACOOUNT TXTLE. 1111
- -
* MM BALANCE AS OF DATE OF OEATH $
-- ACCRUED INTEREST
OATIll OF DEATH, VALUE $
DATE ESTABLISHED
MATURITY DA'J.'E
ACOOUNT 'l'ITLE . -
'l'H11lPIlNALTY ON pREMATURIll WITHDRAWALS OF TERM XNVESTMIIlNTS
XS WAIV10 ~RIORTO THE INVESTMENTS RENEWAL DATIll. . TO AOTUpON
,",OQOtnl',l'S HIIlt.oO IN AN ESTATJllWE REQUIRIll A SHORT OERTIl"IOATlll'DJ!'
OURRlllNfl' !)ATE' A DlilATH CJllRTXFIOMlE ON JOINTLY HELD AOCOUNTS.
OONTACT Us FOR ANY FURTHER INFORMATION.
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10(\.11,1 Nornl i ~J[COND mlllEl, p{) nnx IN,'. II^nnl~mlmG, PE~JNSYI,V^NI" 1110t\ (/1/l 2JA-tJ;!b;!
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~aV'404 11,801
COMMONWIAL TH OP PBNNln VANIA
OIPAIITMBNT OP IIPVBNUI
TRAN,Pln INHIIIITANOI TAK
nl81PINT PICRPUNT
l:.t8to of
mlih~.lJ.1.l VarU'loy
ITaM
N(l.
DESC~IPTION
None
SCHEDULE "E"
,IOINTL V OWNeD PROPB RTV
1I"~tfl/Dtlollr (J/I ROVOrBO SIc/III
~---:~-.:;:
TOTAL
MARKfiT
VAI.UE
-~ .-&"~
TOTAL TH
'*
.
p\ VAl.UE of OEPARTMIlNT
DGOEDENT'S VAL.UbTION
INTEREST 1011lclnl '9 Oil/vi
.
,
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IN~T,6uCTIONa, ,~,qe C;OMPLBTINCl aC~EPU,L, Ii "gi.
. '. ,..
Sohedule "E" must Inolude 011 properlY, ruol end porsonel, owl1tld by tho dooodentjolntly wlthonother
Party or par,tles ,os joint teponts with right of survivorship, Both tunlllllle olld Into/lglblo propurty 01'0 tQ ho
Inoluded, List reel estote flrsl.. .
. 1, Desorlbe ulll'BolproporlY os lpdlented In tho Instil/ctlanD for Schedule "A". Desorlbe ull porscll1olproperty
os Indloated In tho Instil/ctlons for Schedulo "ll", Includo !ho nomo, nddross oncll'olotl')nshlp to the
dooedent of tho co-ownor M, fmd tho do to tho lolnt ownorshlp wos oslubllshod.
2, Indicate the total,mul'kot VUlllo of tho lolntly llWl10d pl'apfll'ty,
3, Indloate tho pOl'col'itage of tho docedont's Intol'ost,
4. Indicate tho markot voluo olllw deoodent's Interoal.
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INHERITANCE TAX SUMMARY SHF.:ET
(aUREAU USE ONLYl
....._.....___~."....,...,.T'-'_-.____.-....-
Pile Number ___ ~~__ . 21-01..0IUI11
__. "-'"-'*. . .~~ r+-"_~_",",",''-UTn~'~__,._.'_''T<___'~'._n_'''.." ~_'~ _' "~'L_"L~'_"'_"~~_>T+_
Ihtate Name __'_,__._,_,u,...t:~llli.~ .~..Y~~~~~~_'nn__n._"'_~.~_
G:J Original
D Supplemental
DR.malnder
Pate of Peath ___.,__, J,ll.ly 111,'u1\)01
. . _ '-~~''--'---'-'-~' -n''''--~'~~_-'7_~''-'''T'-'c,_''_--''_n_<n.~~_-.T_'_____
Social Security Number __O~}~_~~:.:01~__~___.__n_~~__'----._
.. REPORT OF INHERITANCE TAX APPRAISER
l. _.... . .... '
I, the und,,,lgn,d duly app~lnlld InhtlllQnn TaM ApprQlu' In Qnd fo, tho CQUnly Qf ..iliImb~~anll
P'nn,ylvQnlo, do, ,.'p,otfully "po, II thot I "~v'QPprolud th ,,01 Qnd PI"on,QI ProPlfly U 'fiiiriill~ Ih fo,.goln~
,,11Im ollh, volu.....tlOrth oppOlII' taoh II,," In Ih,IQ,1 oolumn 10 I ,Igh I~ &Ch,d, ,"A', "I', "C", and I I"
Dalld, ...!:eptetnper 25, 1901 c:-'-
INVINTORY
11.01 Prop'''y (hh.dul. A)
P."onol Prop"Iy (hh.dul. I)
Jolnl.H.ld Prop"Iy (hh.dul. I)
T,an.I." (hh.dul. en
TOTAl. OIlOSS AIIITS
l.... O.b" and O.du"Io.,
(SCHIOUl.I P)
Cl.EAR VAl.UI OP UTAn
o LIl. hlol'
o Annuity
,
VAl.UI Al APPRAIlID CODI "O,UI\"'INTI RlhlAINOIR APPRAIUhllNT COOl
(HA RI IU 0 un ONl.V)
NONE 00+ e
$ 136,272 QQI 10+
NONE 11+
NONE JIH
$ 136,272 21
___~~~~,----+ +--+-----.--0 ___ +-__'_T_ --
40. .,.
BA1!
PACTOR
PIIINCIPl.I
VAl.UI
COOl
I
POR USI!'OP RROISTIR ONLY
Tp. on $
To. on,l
To. on $
To. on I
To. on 1
".mptlon.
Total Botol.
WUl
o
COMPUTATION OP TAX
$
$
$
$-
$
611
1511
TOTAL TAX
IHTlRIST PROM
aAl.ANCI
TO
, $
$
$
lo... ClOdl'.
~AT8 Of PAYM~Hj
AMOUNT PAID DISCOUNT
$ + $
+
IN'URI$T
- $ .
,
IIAl.ANCI
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Q..!i.&RAL '.l:Ws,BITANCe TAX INFORMATI.Qli
Unlalllfl,d Ilabil'".. Incurred by tho docodont prior to hll/her doath ora doducllblo,agalnll~ll/h,rtaxable
utate, In addition to debtl Incurred by tho docodont or oltato, othor lton1l ore claimable Includln; th, call of
odmlnlltrallon, cllorn.y f..I, fiduciary fOOl, funoral and burial 'lIpenlOI Including thll coel of 0 bUrial lot, tomblton.
or IIrav. m.arkol' and other rela"d burial oxponu" .. .'
All dobll b',ng clqlm.d agalnlt an OItate ora lub/oct to tho approval of tho R.gl'tor of Willi with whom tho
Inheritance Tall R,turn II fll.d. Evldonceto lupport tho docedont'l or th. ..Iate'l Ilobllltylor th. d',bll b,'ng ,
alalmod Ihouldbe allached to thll schodul..
A family .x.mpllon may b. Clalm.d by 0 RpoUIO of a decodtlll ,who tll.d domloll.d In P.nnIYlvanla, If there Is
nOlpoOlO, or Iflh"PllUI,hal foH,'t.d hl'/her rlghts,lhen any child of tho d,cldenl who II 0 m.mber of th. lame
houl.hold can clalmlh, ,x.mption, In tho ,vont thero I. no luch IPOUI. or child, the 'llllmpllon can b. clalm.d by
,a patent or Parents who or. membors,of jh,.amo household a, th. d.c.d.nl. Tho family eX'mpllon I. allowable only
,agqlnlto..ol. whlchpau by a will or by th. P.nn,ylvanla Intfl'talo l..awI,
NOTE'Comp'n1otlon,pald to on '"at.repr~lOntativ'l namely, an olleCUlor,or admlnlllrator, fair I~rvic..
perfotm.d In odmlnl'fetlng an OItolo II r'portabl. for P.nnlylvanla In como Tall purpos.., Thll laxobl. Income
II,.m Ihou,ld bo,reporl.d On form PA.40.lndlvldual'ncomo Tax Relurn.
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INSTRUCTIONS FOR CO~PLETINGSC~q
1. If Ih. family ,xompllon II,bolngclalnlod, Indl,ceifo the claimant', namo, addrUll and hh/h'r.relallon'hlp 10
Ih. d.c.dent, /!nlor "family 'XOmpll\ln" ,In the remark, calulnn and the amount c/alm.d In fh. amOunt column,
2, Aulqn conUCullVtnumbtra 10 each Item Ilstod. '
~. Enter the date tin which each ,debt was Incurred and/or paid. '
4. Enl., fhe namu of .ach)ayeo.
S. Pt(lvlde a brief 'lIp/anellon In the remarks column far oach debt qlelmed,
6. E,nt.r tho amoUnt of eath debt bOlng claimed.
7. The farm must bo ,Igned by ,the persen w~o has auumed tho respanllblllty far paying the debt"
IF AOOITlONAL SPACE IS NECESSARY USE aw' x 11" SHeErs,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BlIkl!'AU OF EXAMINAllON
OFFICIAL NOTICE OF
INHERITANCE TAX
ARSEIl8MHNT
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COUNTY FILB NO:
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Ap~rel.4Id \I.IUI 01 hllll:
/1"'11111.
P.reon.1 PlOPltlV
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.
t I ,~rc. J~ '7 a ~ J
Jolntlv Held PtoporIVfTren,'.r.
+
TOIlI Oro.. hllle
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/ If 11'/, cl'l, '.
· ilr/.fJ?~f' .9 t . I'~ due
~)lt!J', ()-()
I t,~:~~
TOI.I Approv.ll Dlduolion.
Clear IIlluI 01 E.I.\.
.
Le.., Approvld Chlrll.bl. Bumpllonl
, I
Clear 1I,'uI 01 e"'\1 SUbllot to T.~
Amount TI~lble @ 8% RI\I
Amounl TI~.bll @ 'B% Rile
, ,
.
DAT&
B8TAT&
PILB ~O.
.;;3;{~~At, ?;kb,
,&~~W~'A,;t;
Il~~, .;J.
;/ --
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I'~ due
. '11.t6,'IiJ
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TOTAL PENNSYLIIANIA INHERITANCH TAX DUB
· · · · · · A IIvI plroonl dlloounl loll ling .
will bl grlntld " Ihl Inherlllnol Tu la plld bV
LI" arldl,,:
DATI OF PAYMINT
'7.,~ W..f I
lI-AfJ.ki
AMOUNT PAID _DI8COUNT INTBREST
. 4 (1(\(\ . (10 + . ,Ij I B, 7/f . . .
IJ Ol.~, ?'L t . .
+ .
Inl'rllt IeOruta, II Ihl rell of II~ (Slperoont pe, Innum
. on Ihl unpeld blllnol of Inhorlllnul TI~ f,om
\0 dl" 01 ptvmlnl. Inllrllt duo " pold bV la
BALANOE OP peNNSYLIIANIA INHHRITANoe tAX DUI
.
AlltlHC!bV:
a..'nlblmlllon on A....... 81~
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TAX CIIIDIT
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