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OATH m' PERSONAL REI'RESENTATIVE
COMMONWEALTH OF PENNSYLVANIA SSI
COUNTY OF CUMBERLAND
Pefore me, the Relllstorfor tho ProPRle of Wills 1\ll<llIrRllllnll of Leltors of AdmlnlslrRtlon In and for Ihe Coullty of
Cumberland, porsollllllY911mo
],l.oyd II , lIullor
who, belllll duly aworn ,do IlH deposo and say thRI as ,gxocll~or
of Ihe lasl Will and Toslamenl of Goorga 0, Ncoulloch
hB
dedoasod
will \\'011 and IrUly admlnlstor lIIe 1I0ods and ohal\ols,'rlllhl. and crodlls of said decea.ed aQ~ordlnlllola\\', i\nd
Blso will dlllllonlly comply wllh Ihe provisions of \he law relallnlllo Transfor Inherllanoes, Sworn and subscribed bofore mo,
AU~\lst 1<:) ~ A,D" 1981
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Be II romemberodlhal on Iho 19th day of
DltCREE
August
IAIO,,1981 ,lherewlUprobalod and
,~Iale of
r~corded Iho Ilisl Will ana Te.lamenl of
oaorlte c. '~qCUllooh
Shi9lolenB~l,Irlt I CUmberland CountY"Penn.ylvanIB.
Oecoased, Lel\on Teetll.lT\entarY wore IIranlea 10 L1Qyif ll. Heller
Wlt"'''~, "'" '''','m':':'''llh' '" ond "" 'f"'''1d~57 ,~<<' ;", . {J '_ L;~'R ' I'
, T ~ ,r. , 0& .ter
COMMONWEA~TH Of PENNSnVANIA
CQUNTY Of ,CUM81Rl.ANP
III
...,~1.9YddH. Holler m_'_ d... m_m ..__. .--....-- ..-..-
beln9 duly .....__.~ll.w()r\} c-.. oooordlng to low, deposes and soys that he .,..J-Iil_ tllllJl1.l()t;l.u.~()~., ._~._,
....._._ _._...... ... 01 tho es\ftto 01 _.oOQrgl;LC.._NcQulJ.Qch.............._.~.,__.___~_
late 01 ~ol.'o'\8h('P 1;11111'1'''\101'''''8 ________, Cumborland Oounty. Pa.. deoOlledand that ,the
wllhln II an lnvantory madnby ,I1:1.m.-- ....-.-..,-_, thosold_:.....ElS60l!.\!s:l.L_._._
91 the entlro OItato 01 laid dooo\:lent, 00nlllt1ng 01 all tho pollonal prop'drty and teal OIhte, eXQept to,al OItato oulllde
the Commonwulth olPennlylvanla, and that, the "gurel opposite uoh 110m 01 ,the Inventory repro"ntlt,'1 hlr value
01, 01, the dato 01 deoodont's dOAth, '
SWO!;'1l to
,
_ and lublorlbod boloro me,
/')1)
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-:~~~y~X:-~:~fi.r;:f/:;Ad~i;,,-;t;;tot'---~--C .--..'
9798 Molly Pitoho!;' lIwy,
- shipp~na~urB;'PD.;"-l i25'f'" _..._m~___'_'''__'
;~.JI4,jj~r/ 7')~A.L--,.19 Jf..ft::L.
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Shlrloy A, MprbutQM. Nol.lIY Publlt
$h1PP'M~uro' M C"mb"llnd c~""1y
Idv COf11mllllon bpl,"0.i.mb" 17. 1981
.r_~__"'__'"__""__""_'" ....__~'._T_..~._.._ ._~_..._~_ _.__..,__. .__'. _...._n.....'.
Add....
Dov
_,._._,_~~l}'_...
Month'
1981
Dale 01 Doath ..., _ 28th
~r' .......__.__......_~_~~_____.~__.......__u__,~....... ~____ ~_._
"y.,t
, '''''' ,,' INSTRUCTIONS , ' ' \2G~
I. .An InvontorVm\ut bo IlIod within throo months alto, appolntn,ont olporsonal reprosontat.I~~,':,~
. ; .. . 11,___.
2. A I~pplo"'ont Invontory mUlt bo lIIod within thirty doy' 01 dlscovoryoloddltlonol auoh. ?f8
3. Additional Ihooh may bo 6thehod AI to patlonalty or roolty 1:,:,::
r -- j.....
4, SoeArtlolo IV, Flduclarlos ActQ11949; :::..
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Inv,ntlHY 01 tho ronl and plrlonnl ..tot. <>1
~~ C1eorJll1~C",.L.Mc9.I.ll1:!)glL.-,.."._... n.:~~'- dle,a ..d.
~.. . _____" . -"".~~.;.~~~~~~~~~:;:;o'<;:-'=;:':~_~~~;'::;-;;::;;:'',c::~""'rl'';'::;::;:~-;:!~';';'~~'~~~";,-;;..;',-,:;-=~~-,~-,,"::~~~-=-':;;,;;.:,
ll,1l57 04
320 78
1 29,
12,975, ' 80
116 55
9,164 19
85 OS
US 00
60 98
23 25
5f 00
150 00
180 00
,
70 89
oommonwealtl\ NAtional !lank- Checking AccoUl1t //512-509Z16-5
,
commonwealth National !lan~-aavinga Acpount "41-1008195-9
Commonwealth National !lank- Accrundintareat to date o~ death
Commonwealth National Bank- Certificate of. Deposit "1_105101~36
Commonwel\lth NlItionlll Bank- CertHicate of Dapoai\: fll-105101-36 Accruetl
intereat to dllte,o~ deat"
(]ot\\mon\~ealth Natiol1ll1 Bank~ Certificate of. DapoBit fll,~105101-37
, , '
Commonwealth NlItional Nationnl !lllnk- Certifioate o~ Dapoait "1-l05101-3~,
Accruetl interast to tlaea of dellth
,
Grand Lodgel<nights of py~hella;' Oallth Benefit
OIlSO ~ound in ho'm!i)at daath
~utherlln Church in Amariop - ~nnuitY
"
Veterans Adminiatration~Burial E~penaaa
A\Ilar~,cim Lasion Oscar' M, uyltlla poat 1/223 - DOllth Ben~fit
j.,el\darNUrains Center. Inc,- ' Rafund
.'Capital. Blue cros'B- Re~und of premium
TOTAL
3 185 82
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fie C-.114./JI
APPLICATION FOR CllARITAaLE EXEMPTION ,;JI ..-J,i., ','-, "), (,,'..'Jj.
PROM PENNSYLVANIA TRANSFER INliERITANCe TAX
(A,'ol Moy 2P, 1956, P,L, 1757, "nd A" of JUII. 15, 1961,
P,l..373/ UI umfnd.d)
COMMONWH~"H O~ PPNNSHVAtIlA
DEPARTMINT OF R~VENVP
BURHAU OF COUNTY COL~PCTlONI
Application II h.r.by 111.d far, tho approval
of an ~Kampllall from P,nnlylVQnlaTranllor
Inherltanc' TaK an the tran.lor 01 Ih,praporty
du.rlb.d b.lawl
I. Bureau 1'11.11..__,..__.......
2. Data of D.ath ..-,~1I1~;l2a. ,1981", ,............._-..,..'--
~, Oat. 01 Approval -. '!/)llLUJ/J~;itf...2.-_.-
, ,
am. 01 .cada t ..., OqorlHl C ,McCulloch
&, Th, Cammanw.alth't appralt,d valu, afth, prap.rly far which un oxomptlan II clallllod II $ ~O
(HatOlWh,r. tho prap.rty It other l.han 0 eP.alfl.d amount of calh, tho aK.mptlan connal bo appravad until Ih. voluo 01
th, praP.rIy hat botn ..tabllthod~y apprallal by tho, Commonwoallh, oxcopl In Ihau aa... whore tho amount, of Iho gilt
or b,qu..I r,ptonnh a IIoI.d frocllonol or poro'nlago portion afth. .nllre ..101, or Iho ontlra ruldu" In than ca"t
.nlor tuah Iraatlanal or p.rcontag. amOUnt abav.).
6, Ch.ak Ih.mqnn.rln whlah tho trantfor'wOl olf.al.d and Iublllll a copy 01 Iho docum,nl aUlharlalng Ih. Iran,fer, unl...
luah malerlal hoe botn prevlaully f11.d,
WI~~ $,
PUPO,
TRUST IHPBHTUllll 0,
SURVIVORSHIP 0,
OTHBR 0,
(If .ther, ..plaln)
~
'7, Correct BUlin." Ham. andAdd,.u of Charltablo Organl.allan roa.lvlng properlyl
HAMB Memorial Lutheran Ohurch
APPRlas 34 RaetWange Street, Shipponeburll
o St, lilting on r,ver.. Bid. for addlllonol charitable organizations covored,
8,httllly Ihal Ih. Infarmall,on conlalned her.ln II, to Ihe bul of my kl1awlodga and bellol, Ituo andoar/aal,
......-Slgnotur. of APPllao"I~g?fjA'I, ~/J;,. ,d''';
Add,... 01 Applloont Ll'>1yd B. Belhr, ,Rr.
OHlolol TIIII Executor of tho Rata te of Oeorae Palt .3-1/-"( ,~
0, MtlCulloch
Thl. ,(orm my" b. oompl.t.d In trlpll.o" and all thr.. oopl._ d.ll.orad ,to Ih~ R.gl"., of Willi fO',lhl county In which the doo,d.nt
.uld,d, or In whlOh I.u.n ym. IHu.d lor. n,on.r..ld.nt d.udonl'l "".1.; 1/ tho d.c.d,nt, wal a n.n"nldlnt of P.Mtylvanla and
ItltOll w." not Inu',d bYo,P.nnlyl"onla R.gl".. 01 WillI, d.II...".1I thrn c.pln t.th. Dlroct.., ,Bura.u of County Coll,ctlan_,
Ponn.. Doportm,nt of RoY.nu., 26 ,. 4thSttoot, Horrl,bufo, Po, '
, OonOl writ. bllow Ihlt Iln" For Offlolal till Onl'
Fllr th.Stotltaty 01 Rov,nu, U!.!1l.B.!.Q 10 BuroauH.odquQrl."
Appro".d L7
For Seorelary 01 Rlv.nu.
Plnlld' 0 "
a/'t;20IR't'lt 01 Will,)
t." ,'.-(/",,' ~,..f''-
~WJ')'" ,"
, 4. '-?; /f ;"..f.!
, (Palt 01 Appro vol) ,
(1.,ltlol. of Rlgllt.,of Wlllt)
(A~thatlttd 'lgnQtur')
(Cqunlv)
(Tltl,)
(Dolt allttl.tlal)
(Doll 01 Acllan)
. S.. 10"'" tld. lar t...ont
Mun II PIL.IIlIN TRIPLIC.'tP
Thl, "ollon will b. Qomp.1.!I.d byllullau H.adquart'lI only wb.n Ih. a~pliaollon for .~.mpllanha, bit" d'nl.~,
Patti,
Th. applloatlon far .M.mpllon conlaln.d on th. fac', of Ihl. form hat bltn d.nl.d b.cauu
-
IloI" Any party In Inl.II.!, Including Ih. Comhlanwtplth. C1g~rllVld by Ihlt acllan may within tl~Iy (60) daYt f.!"
Ih. dcl. of Ihll nq,IOI .urel.. Ih.lr rlghl19f Prq,.."MoIIOl, or Apptolln auordanCl wllh Ih. provlllonl of ppllocbl.
P,nnll'lvnnlQ Inhtrltanc. and e.'al. Tax"'.", '
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P.ENN&YLVANIA INij~RITANCE TAX GENERAL INFORMATION
1. f!RSO~~.BESPONSIBLE FOR RETURN
Section 701 of,the InheritAnce and Estate Tax Act of 1961 provides that the following persons shall prepare and file
a return: '
a, The personal representetlve of the estale of the decedent as t,o property of the decedent administered by him
and such additional property which Is or may be 8ubjectto Inheritance Tax of which he/she shall have or
acqul re knowl edge;
b, The transferee of property upon the transfer of which Inheritance rax Is or may be Imposed by the 1961 Statute,
Including a trustee of property transfe,rred Intrue,t" pr,OVlded that no separate return need M made by theJransferee
o( property Included In the relurn of a personal representative,
2, PLAOE FOR FILING
The return Is to be flied In duplicate with the Register of Wills of the county wherein tho decedent reslded,
~, TIME FOR FILING
The return Is due nino months after the decedent's death, ,unless an extension for filing ha,s been applied for and
granted by the Secrewy of Revenue within the nine-month period.
4, L RETO FILE RE 'UR
Section 791 of the 1961 Statute prOVides that!.' I" ,any person WhO Willfully falls to file a return or other report
required of him, , ,shall be personally liable, . ,to a penalty of25%of the tax ultimately found to be due or $1,000
whichever Is the, lesser to be recovered by the Department of ReVel1ue as debts of like amount are recoverable by
law."" '
5, JAX ~ATU
Inherl,tance Tax Is payabl e at the r,ate 6.1 6%, on Iransfers,to Iln, eal descendants, such as,' falher,' mother, husbandiwi fe,
son, daughter, grandchildren, grandparent, liOn-ln.law and dauRlller-ln.law and at the rate of 15% as to all others,
6.,,~
,
The t,ax a, sS,essed on,the transfer of property re,ported,',ln, t,h"e return Is due 9 mO,nthsMter the decedent's death,lnterest
at the rate of 6% per ennum accruesthereaflor until payment I s made, All payments recel,ved are fI rst, appll ed .to any
Interes\whlch maybe due ,wlt,h any remainder applied to the tax, IF TAX IS PAID WITHIN 3 MONTHS AFTER THE
DEOEDENT'S DEATH, A DISOOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED,
-- - . -.. . . ..... . ....... . -.' -.-' . j
, All cheCksshO,U, ,Id be made, payabl/lto t,h,.,e R,eglste,r of Wllluf the county, wherein the deceden\.resldaa and are
received subject to the final determination of the Department of Revenue, ' ,
\;- .'.' -..
7",.f:AILURE TOPe.y
Th,9, taxes l,m,'p OSild"tOR, other With, any Int9"re9t \h,' eroon, , are ,a lIe,n IIp,o,n realproperty,whlCh lien re",malhs in affOC\u,nlil
thetax9s and Interest have been p',ald In full, The taxesmayne suod foragalnst anx r9al, property In the o9ced9nt's
,estate or aaalns\.any property belonging toa transforee liable tor \l1e tax, ' ,
8. FI~INGOF FA~Se RErURN
Ahyperson who willfully makes a.false return or report required of hlln shall, Inacco,rdance with S~ctlon 793 of the
1961 Statute, be guilty ola ml sdemeanQr and, on con vi otlon \l1ereof, shall be sentenoed to pay a line not exceeding
$1,000 or Undergo Imprisonment not exoeedlng one year orbaUl,
Wl.J;.E: CQll1plil1Satlon paid to an estate representative: l1al1lely,all axeo410r or admlnl~tral9r,for servlOes performed
In admlnlsterh\R an estate Is reportable for Pennsylvania Income Tax purposes, This taxable II)come Item $hould be
rallorted 011 form PA.40.lndlvlduallncollle Tax Rehlrn,'
QUESTIONS CONCERNING PROPERTY TRANSFERS
I, O,IP dec"ed,ent'",wlmln two,yen,rs of death, make any transfer of anymnterlal pari of his astote without recelvlnR
valuable andadllquate consideration? (Answer IIYes" or ,fiNo" ,)
2, Old,d,eoedent, Within, twO years of dtlath,' transferproper,ty from hlmsel f/ herself to hlms, elf/herself and anether party
or parties (Including a spouse) In joint ownership? (Answer IIYes" or "No",) , ,
3" If the answer to one or two ,above Is IIYes" and the transfers are claimed to be nontaxable, provide the following ,
Information: '
"a" Age of decedent at time of transfer,
, b, C(lpy of death certlfl cote, ' .
c, Afflpavltby the attending physlclanlndloatlng the state of deoedent's health at time of transfer,
d, All other Infonnatloli supporting nontaxabllltyof transfer,
4,plpdeoedent, In hls/hor Itfetlme, lI1akeany transfer of property without reoelvlnga valuable or allequate consideration
therefo,r whl~hwas t~ take ,effeot In possession or enjoyment at or after his/her death? (Answer IIYes" or "No" ,)
at Was there any possibility th,at the property transferred might return to transferor or,hls/her eSlate or be S\lbjeot
10 his/her ~ower of disposition? (Answer, "Yes" or "No" ,) "
b, Wilaf,was thlltrai1sferee's age af time of decedent's death?
6. Ol~ daoedentln his/her ,lifetime make any transfel without reoelvlng a valuable and adequate oonsllleiatlon therefor
under whloh transferor, expressly or Impliedly roserves for his/her life or any period whloh dQes In fact end before his/her
death: '
a,The POss9ss19n or enloymen,l of or the right to Inoome from the property ,transferred? '(Answer "Yes" ,or "No",)
b,The right to desl goate Ihe persons who ,shall possess,or enleY the property transferred or Inoome Ulerefronl?
(AnsweruYes~' or "No" ,) ., ,
5. If the answer ta live b,above Is "Yes," waathe right resorved I,n deoodentulone ( ) or deoedent and others ( ).
7,Pld'deoedentln,hls/her lifetime makea transfer, the consideration for which wns transferee's promise to pay Inoome
to or for thl! benefit or c<<re of transferor? (Answer "Yes" or liNo',',)
8, i Old deoedl!nt, at any time, transfer property, the blJleflclalenjoymentof Whlohwes subjeot tOOhange, because pf '
arl!served power 10 alter, amend, or revoko,or which oould revert to decedent under terms of trensferor by, eperatlon of
law? (AnSWer "Yes" ,9r "Na",)
9, If th8,.answer to eight above Is "yes," was th,e,' pQwer to alter, amend or revoke the Interest of the beneficiary reserved
In th~deoedent alone ( ) or decedent and others (, ), ' ",!
RE::V.453 ~X1- (3-80)
gOMMON\'IeA~ TH Of peNNBV~VANIA
OHfAATMeNT OP RBveNUH
TRANBfHR INHeRITANoe TAX
RetlOHNT OHOHoeNT
SCHEDULE "0"
BENllPICIAAIElI
(ln8(rlltJtlbllS 01/ Rovorso S/rlo)
Estate of Oag~~e, c." Mqnl~11 twh
1'1\1l0 t
*'
, , SURVIVED DArE OF
" \tIlNBPIOIARIBS AND ADDResSES RllLATIONSHIP DeceDeNT BIRTH INTBREST 01' BllNllFlclAIW
MIl~ill1r~t Rtt4j11.AY Ni~co ---.--- ---...-----
307 East Garfiald Strllat ,
ShippanBburg, 1.'111 17257 ,
,
, - -
~1",1" F.. u_11_M NllllhetJ
-;~,
on an \.I"nl , ",
-
W/\>,'neBPoro', l.'a I 17268 ,
"
.. , " ,
,M",." Ruth T,,,ona' Niece " ,
, 201 N, w. 69tp Terrace
\it Hol~vwood. Florida 33024 ,- ~
"
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.. ._-_.._~--_..._~ --_................-_.~._- .----- ....~~..._c~_~......_____
Robert Hell er .. Nanbaw .
,
3~34 Orlv Court: - -;' ~ ~--_.- ------- ...--
Tucher~ Geot'llta ~Q084 . ,
~ -.--- -
'~. -.,.
RinhA"c1 HA1'A'- "aphaw__..-c.....- _........-.-_.....-............- .. ..;......._____.._______........_.......-<-'+O.________~..._
13700 N, E. Miami CU, ~- ~.....__....---------_:.._._...- ---~-
Miami. lho#d/\ ........---...--..-----.-- ~."..~..m___..._H.n . ,-~,-".."._-----_.__....-
33161 , -- -~......--.~
" ..
, ,
- - ,
1.1ovd H. Heller, Jt, , Jie.Ilh~------, "
-- --
220 W, King Stt'Ollt , --
., --------....---............-.--..,..,..----...
ShiPPensPllr~, PII. 172S7 , " "
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T,it1,1~ R, U,,11D" ' " I". I,
111 Btllt 1"'" Il ,
R.D.t " "
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Shippensl>llrg, , 17m
Pa,
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The abClve beneflol.rle. Bra living lit thl, tlmB eXQllpt for the following:
NAMIl
-
PAn op DI!ATH
IWV.403 L:)(;-t (3.80)
,~OMMONWIA~ TH OP PINNBV~VANIA
OIPAIITMINT OP IIIVINUe '
TRANBPIR INHIRITANalTAX
RI.IPINT peal PINT
SCHfiDULE "0"
IlBNeFICIARIBS
(tnmuotlolll 011 R/IV~,," Slclo)
Pogo It
*'
estBte of
GI.'Ol'ill C I ~loCuUoch
BBNIlPIOIARI1l8ANP APP~"8Il8 RnATION8HIP SURVIVEP DATE OP IN.TBRBST OP IlBNeFICIARY
DBCllDENT BIRTH
" U,,, ^" "n"haw- , .. ,
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,
1 ~':ln N "n..., .C Re Al)~ ~' , ,
--- --....,.... --
Arlinnton. Val 22205 _c,
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,
A ," .
1666 SlItUl'lj Blvd, " ,
SIII1 piano, CIIJ.~forni!l 92154 ,
.. "
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"....^' " -. , ' Sistel'"IIlMLaw "
'??~t.'nae n. , ,
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Marv E. ~hQap ~. ,
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'c H ~ HR'11';'-",. c" ,
c/o t.lnyrJ ,
--.,.,..-
9798 Molly Pitoher HwY ..-
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.JlhippanBh'p'll , PFl, 17Z." .. , ,
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, ~ r_~__ I~-.__._-_. .-- ............._"r~.._.___....._~.._,._.............___. __r_
Llny,.l H. HAllA,", 'R""'t ---~- -Brll.,the.r.':1lnd.aw-_ ,------- ..--............~~"............ ..r _._.,,~.~_ _.~._...~. .., ._..----'.__. ....-.0- .-...-.--"
919R Mnl1'y :p~ ,.."l"~,,, "W ,
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Ship\)eu.9~11 '"i t .. nh , ?o.? , , " "
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MGlJlodlllLU~hGran Chur~J\ , ., , ,
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34 EaBt OI'~~gG Il ,
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,
" , , ,
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Thubove benBflahirle. are 1IVI110at this time exciellt for the fallowlngl
NAMll
DATE OF DEATH
"
I,
Soh.dul.I~" mUlt InoluduU propertY, roal anU personal, owned by the deoodent jointly with anuther
p.rty or p.rU" "llllnt tonanll with right of Iurvlvorlhlp, Both tangible and IntanglblB property arB to be
i Inoh,ldld, I.llt rlll18ltat!) flm, "
.. 1,
'i,
O.lOrlbe all rBal propertY 81 1I1dloBted In the Instructions forSohe~ule "A"; Desorlbeeil'per,onal property
allndloated In thB Instruotlonl for Sohedule "B". Include the name, address and ralBtlonshlp to the
deoedent of tho oo.owner (I) Bnd the date the joint ownership wel established,
Indloate tho }Qtal market value of the,lolntly owned proper.ty.
2,
3" Indlo.te th~ pBrQentage of the deoBdent'1 Interost,
4, IndloetB the mBrket value of tho, deoedent'slntlirelt,
",
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IWV.4!Hi FX' (.1.1101
COMMONWEA~ TH OF PIlNNBV~VANIA
DBPARTMBNT OF RBveNUE
TRANBFER INHURITANCE TAX
REBIDUNT PBDUPBNT
SCHEDUl.E "F"
STATEMl!NT OF DEBTS
ANo Dl!DUOTIONB
Estate of -GQQ,1:~t ~1"Ou11901J ___,_____ Pata of Doa\h l=-.2.lidl.j,,__._ Fila No,
WHEN Ol.AIMING THE FAMILV EXEMPTION, OOMPLETE THE FOLI.OWINClI
- ~~.-.-...--..-.
'~T'V ---. -~H~"4<f;o-.--,""'"",,4L"'-"'~"""'~'-"-""
OIBlmBnt
ClalmBnt', Addraee
-
Rollltlonahlp \0 POClodanl'
, -
- ..
'N~~ PATB NAME of fAven RBMARKB AMOUNT
. ", -
"~n' ,~_~ nP Willa. . .L. '-~ ~ters+oBtamBntnry 1R.00
, '
".... ~(\~ ,.,'. Arlv"r ,.j Rina_Lo."" 1 ~ nn
n
oumberland LuW Journnl Adva rt is inp. 1..\1 t tar s ' , , J.S,OO
llby Granit\1Works " llngrnvinB monum\1nt , 45,00
, ...,....-.
1i,-, .I.e,.' Funeral Homo Funeral SerV icos 1.418,60
..
.. Don' a~a~ of Wills Oumberlan.i Or i Filin>l lnven torv, Annruis\1m\1nt. 15,00
, National BanlL-__ . lla~&h gneRRR.ts (,. D\1d, "
fJ~,th 1. 75
, "n~" ..'t.la'n'" A 1; torneYB IF"" 1 ' 7 ~o , ?O
, , ,
-
S"'~' an A. Mn',.huru\1r 1I10tnrvFe\1 " lonn
--
'i.J"~;" 1,1.' ,.; R\1imbursem\1nt' for short ,
two ~
" c\1rtifica tes. dupHcatinB. PQatU8\1 30,00
. ,
- - ~--
Ren,a.a.. nF w11,l'.. "hllmbarlnnd 0 I Fill.nP.FiI!!_t und Final Account 75.00
'" n,,,l U "611 ",. .. " , ' 1 759.29
", _~~y~~Co~mission
, "^;,,,"_~ "p t.I,1'a r.ttmh. C1n; li","uses 10,00
, , 1,,,.1,61'6" l1"uroh in AmArics ,
Reimbursement for annuity puvment , 23. 2~
, , preparation of 1981,(' 1982 ~~iduciarY
, ,."~nrna FederAl und See te 200,00
, Commonwealth National Bnnk SufetY Dep~sit Box Rent 6,50
, , ,
"
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TOTAL THIS PMnl ,
$5.4~~
hereby certify thano ths bost of. my knowl~dgo and belle,f Ili~ foregoing is a jusl alld 11:1I0 sleternent of dej,U, funerel
xpanses enq QXpBnsAs of edmlnlstration submitted 10 the os\nlo nsdeductions for Inhorllance Tax purposes.
./
'-" ' " . -J';''i~ ,,9..1
bAn
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM O~ $__
AT
PERCENT.
-_.'
"
; 1~E.GIST(::'l of WiLLS
ol\rl<
. '
Unl8tllfl,ed liabilities Iricurred by the decBdBnt prior to his/her deBth arB dBduotlble agelnst hla/her tBKB~le estBte.
In addition to dBbtl Incurred~y thB decedent or estate, other Items erB clelmBble Including the oost of edmlnlltrBtlon,
Bttornay feBs, fldUOlery fBes, ,funerel and burlel expenses Inoludlng the oost of B burlellot, tombstone or greve mBrker.
All debts being Olelmed BgBlnlt ane8tete Bre 8ubleot to the approval of the Regl8ter of Wille wlthwhom the
InherltBnoe T,aK Raturn Is flied, EVldenoe to support thB deoedem'8 or the estete's liability for the debts being olalmad
Ihould be ettacl1edto this SohBdUle. '
A femlly eKBmptlon of $2,000 mBY he oleimed bYe spouse of a decadent who died domlcllBd In Penhsylvenla,
If there II no 8pOUse, or If the 8POU80 h88 forfeltBd hls/hBr rights, then eny child o,f the decedent who Is e member of
the 18mB household can ol,alm the eKemptlon, In the event there Is no suoh 8pollee or ohlld, the, eKemptlonoen b,e
olelmed by B perent or parents who Bre members of the 18mo household es the deoedBnt, ThB femlly 'BKBmptlon Is
allowablB only agein8t as8et8 which pas8 bV B will or, bv the Ponnsylvanla ,Int08tato Lews.
~ ~ ~ ~ 8 ~ ~ ~ ~
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~Sr~UOTI'ONS FOR OOMPLETING SOHI!DUL8 I/f-~~,
1.
2.
3,
4,
6.
a.
7.
, '
If the family eKemptlonl,belng clBlmed, Indl,cete thB clelmBnt's n~me, eddr088 and hls/herreletlol'\shl~ t~ thB
decedent. Enter "family exemption" In the ramar,ks oolumn and thll amount clelmod.1n the'amo~nt,oolum,n,
As,lgn oonseoutlve numbers to oaoh Item IIBtod, , "
Entar,thedBte on whloh each debt Wes lncurrod and/or paid.,
Enter the nBmBsof oaohpayeo, ",' ,. ,',', " '
Pro.vlae a brl,ef,oxplBnatlon In the r8lnarks oolumn for eBch dobt clalmod,
Enw the amount of eechdebtbalng olBlmed. ' " ," ' ," , ,,' '
The form mUst beslgnad py the person who has al8umed the rBlponslblllty for paylngthll debt..
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INPO~MATION
Thl' ~oo~",'nt I"hl Nollol r,qulr,d 10 b. glVln undlr S.ollon 709 of Ih.lnhlrl"nOI, .nd allll. TI~" AOI
,01 1981 (,2 1I,1l, "cillon 2411B). ' ,
II lhl I.K I, Plld within lhr.. (3) monthl .tt.r Ihl d.e.d.nt'l dUlh. I dl,oounl of B~ 01 th. tlK p,ld I, .1I0w.d,
, ,
InhltlllMI T'K bloom" ,d.lln~~Bnl nlnl (9) month, mlr th, d.e.d.nt', ~..Ih, , Im.rl,t I, oh.tg.~ .1 Ih. '
t'll 01 ,IK (81 p.ro.nt' P't "'num on thl .mounl 01 u~p.ld t'K, (llaB BXAMII~e 8e~ow) ,
BXAMP~e, ,If . blllnol 01 IlK du. of .a.000,00 I' In I dlllnqulnt 't,tUI (tom 3"3"80, Ind p,ym.nl Ilm,d,
on' 8"'23"80, th. Int.rut II o.loul.t,d II IndlO'tl~ b.loW, '
ITIP,'
, OlteimlM thl, tIll 01
lnt,rut Irom, thl "bl. bilow,
niP .
MUlllply th. blllno. 01
ilK ~~. bv Ihl till 01
IMtlrllt,
8,IInol of I'K d~,
,Rltlof"lntfN~~tAaeT
IUP, 8
Add thl Ihtltlll
to, thl bll'nO' of
ilK dUI,
Intlt"t from 3"03"80 10 8"23"80
R..~It, In:
I Monlhl" .010
.', ,20'01Y' iii ~
)~.,. o~ Inl'tll' .., ,01;138
, 12.000,00
f ,0 W,BO
8'"n~1 of ilK" du.,
PIU' nlltlll 10
~1Mnt,,(+)
~
Intlrllt 'to Dill
Qf. lI,ym,nt
$2.000,00
. 2B,'10
$2,028.70
~~~~~~--.~-~--~---~~-~------------------------~-~--~~~--~-------~----
1 nlonth .008 4 month, ,020 , monlhl .0313 10 monlh, .050
2 month, .010 13 monthl ,0213 8 ",onth, .040 II monlhl .088
3 mclnth' ,018 6 month, .030 9 mohthl .0413 12 monlh' .080
'I ~IV ,00017 11'd'VI ,00196 2 I dlYI ,08gll2
.. 2 ~.V. .00834 12 d.va .00103 ,22 dlV' :80313
3 dlv, ,00 81 13,~IVI ,00220 23 d.va
4 II'VI :88m 14 dlya ,00237 24 d'Y' .0040~
13 d.y. 1 IS d'vI '802130 213 dlV' .0042 .
8 d'YI .00101 ledlvl i 8287 28 dlY' ,Og43 ,
"davI' .00118 17 daYI .0 294 27 daVI .0 484
8 dlVI .001311 19 ~IVI .00301 28 dlYl .0 471
9 dlVI ,001U 19 dlVI .00318 i 9 ~IY' "Og488
10,~;ya .00189 20 daVI .00338 o dlVI .0 BOO
"'"-- - -..... ~.....~ - - - -,.... - - - - - ~~~- - ~ - - - - - - -..... - - -.... - -.... - - - -.... - - - - - - - - - - - - .....- --... - - - '!"". - - --
,Mv WIV In Ihl.t,.t,lnol~dlnO Ihl (;ommonWllllh 'hd,thl "Ir,onll r,pr...~tlllve, not Utlllll~ With the
I"prlll,mlnt I~~ ......m.~1 mlV 'o~J,ot wllhln ,lIKtV (eOI ~lv'lft'rr.o.IPI IIf Ihll NOllo' II ptoVI~.d by
S,ellon 100'01 Ih. Inherltenol end 61l1tl.:r'K,Alltof 1981(12 p.e, ItO, 248B . 10011.
MAI<. CHIlli< DR IlotM oRlla" ".V"11.1 TOI "RIQU1'MRD~ IIl~I.', Alllm"
OI'tAllH THe TO," PO~TION OUHIS FOAM ANO SUIlMIT WITH VOUR PAYMeNT 'to tHUeQIS'tBR OF WIL~ll FOR
THe COUNTY SHOWN ON THe ReveRse, see THE INHeRIT ANlle TAX IN6'tRUCTION BOOK FOR ADDrle88, "
"'" "'I"'M I j...~f tl-
)MMONWeAI. TH or l'eNI.uVI.VAHI^
llePARTMltrlT OPRBVeHue
TR^N$PUR INHeRITANce ,TAX
RUllleHT peceoeNT
llUl'l'i,I(J.II\N'I'^I,
_>-u_____~,.
0<' h ~/~ !!:.fej,ff
"
BCI-lEPULE "B"
peR80NA~PROP8RTV
(llIIlrllcl/~1I1 Oil R,lVw,o Sldo)
.Iuta of '...:- aU(l~811 C. Mcculloch
EM
10,
DlISCRIPTIOH
V~~JlI
1!"Sl'MA UD
M RK lIT
VA\.UlI
OI!PARTMBHT
Vt.\,UATIOH
iamCIA4I1S,ON4Y/
-;,
CunUllOI\\~ell1th Nutionlll IlI\UK~ Curtl,riclltu of
Deposit 041~10001j7-5
15,00n,Oo
Commonwealth Nationn1 lll\nk~ Cal'tiHell to of
DupoaH 1!41-1000137~5 l\1tuVpsc Co datu of.
deach
095 t 18
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TOTAl. $15,895,18
If addltlonal.paCe \. neceuaty, u U eVa" X 11 II &hut&1
.. .
HIJI'I'LI':f1l\l~'I'^I,
P""..--' ____-0,...... ._~_..
nLV.4&l'J l:)(. p.on)
GOMMllNWSAL TIt O~ ~INN8VLVANIA
Ofi~AIITMBNT O~ IIBVINUB
TRANHPelllNHBIIITANOB TAX
1Ie&IOONT PBlllPINT
SOHEDULE "F"
8TATI!MI!NT or DI!IIT8
AND PI!DUCTIONS
1 . - - - ~
iit"tuoL~ollru:~ G, MllC\lUodl~~_ Dato of D8ftth-2.~78~RI
NHeN OLAIMIN13 THe FAMll.V~XI!MPTION, OOMPLne THE POl,LOWINQI
RoIOIIOI1ihlp \0 Oocodllnt
:IIIII11Ol't
:lnilllunl'5^ddru$H <llllin" (II D",,"<lolIl'O Dun\l,
IIMOUNT
IIIMAIIKB
NAMe OP PAVn
Hnl'l.. ond Wetglo
..-..-- -
. _],1~1 Ilollo\' I Br',
Intornnl Revanue So\'Vico
I'Bl\nll
DATB
~
Addl,ttOI\l\l
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TOTAL $2,056,33
11~~~~~~'~eae~~1 ~ ~~~~~~ ~r::~\~~tr~\Yo~ns~~~1\~~~\~ ~~~I~~{~~ ~~r~~d~C~'~:$lr~~ r~~e:'r~~~~~B~r;:BS~r~~~:s~t"funera 1
'7 tl .f1 <io~ '( /}..)
I V ~ ,"
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o
)H9T8 ANP OEbUQTION8 ME ALLOWEP INTHESUM OF $
AT
% TAX MTE
-
A.QiI,.eIlO~ WI",,,,I
bAT!
Comm,_llh ,A,',
NatlQnalBarik ~
MIlY 14, 11182
~ll'. ';)on'Y A. Woiglo
AttornoY'lIt I,nw,
113 11l1st KingStt'oot
Shl.pponsbl1rll, l'A 17257
(1[101\011 c. Me CUI.l,OCll . DOll ,JU1,Y 28, 1\1 I! I
00111' Mr. Weiglo:
Goorgo C. McCulloch II1l1intnlnod tho "ollowinn \ICCounta nt tho 5hippoll8-
burg'Offico 118 of July 28. )1181:
Typo of
, Account
Ch.QcklllH
Chocking
SavingB
Ctf of p~p08it
Ctf of ,Poposit
GtE of Pop os it
Pll
Account No.,
l(ogi8tl'lItlo11
ODD, Accruo~
1\1I111nco Int to IJOP
----.--.----.--.-.----
$
.oq
....................~~".._--_...~_.............~--+~...
t.l9yd Hollor POA
Goorgo C. MCCl11loch
412-50\1216-5' 1.10yd 1101101' 1'0A
Goorge' c. McCulloch
,412~ 3(j000 1-2
41-10081\15-11 Lloyd, Hojlor POA
Goorgo C. ~tcCulloch
01-1091.01-36 George C. Mcculloch
01-105101-37 George C. MoCulloch
41-1000137-5 Geol'llo'C, McCulloch
c/o 1,10yd H. HeUer
11 ,857 .04
320.78 1. 2\1
)2.8S9.2S 116,55
l1'i0711.14 85.05
,15,000.00 81lS .18
ThO ObmrnMl'iU1lhN.\IOIliI B.nk. 1 W.1l King aUbO'.~, 0:0'" 40. Shlpp,o'burG, ~., 172~? 17\111;32.al6'
IJENE:RAL INHERITANCE TAX INFORMATIOti
.' ,-
Unsatlsllodllabilltios Incurrod by tho {Iocodont IHlor to hls/hor dooth oro doductlblo agalnBt hls/hor taxablo
ostoto, In addltlol1'lo dobts Incurrod by tho docodont or osloto, ,othor IIams ora clolmo:1lo Including tho cost of'
administration, attornoy laos, fiduciary foos, fUnorlil and burial oxponUs Including tho cost of 0 burial lot, tombBtane
or grove marker a"d othor ralotod burial oxj1onsos,
All dabts baing clolmod ogolnst on oBtala arolulllact to tho app,rovol 01 tho Reglltor of Wills wlthwhom tho
Inllerltonco Tax Roturnls fllad. Evldanco.to supporttha docodant's or tho ostato'sliablllty for the debtB being
claimed should be attachad to this soho{lulol
A family axem~tlon may bo olalmod by 0 spouU 010 docedont who diad domlcllad In Pannsylvonla, II thtirB Is
no apouse, or I.lthe BpOUla hoalarloltod hls/hor rights, then any child of tho dacadent who I. a mamber 01 the some
hauaehold con claim tho oxemplion, In tho avant thera Is no such spouse atchlld, tho eKIl11ptlan can be,clalmed by
a parent arparonts who ora mombors of the SOrlla houBOhold as the docodant, Tho family exemption Is allowable only
agolnBt ouats which paBS by a will or by tho Ponnsylvonlll IntaBtota Lows,
NOTEl Camponsotlonpald to anhtote rapresllntotlvol nomoly, an aXecutar or odmlnlBtrotor,far aervlces
performed In admlnlstarlno an ostate Is reportablo for PennBylvu 10 Incamo Tax pUrpos'" This taxable Incamo
Item should be rellarted on farm P A.40.ll1dl vidual In como Tax Ro urn. '
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INSTRUCTIONS FOR COMPI.:ETJNG SC~"
I. Iflhefomlly oKemptlan Is baing clolmad, Indlcatotho clalmant'B name,'oddrou and hlB/her relationship to.
tho decedent, Entor "family oxemptlon" In tho remarkB column and tho amount clcllmod In th,amollnt column.
2, AlBion consecutlvo numbera to ooch Item IISlod,
3. ElMer tho do to on which oaQh dobt was Incurrod on(1/or pald,
4. lint" tho naMes 01 eoch payoe. '
S,Pro,vlde a bliot oxplanlltlon Inihe remark a calumn for oach debt clolmed.
6. interthe amount of ollch debt being clalmod, .
7; Tho form must be slQned by tho porsonwho hOB aBBumed tho responsibility lor paying thede,bh.
I
,
IF ADDITIONAL. SPACE IS NECESSARY USE 8Yz" x 11" SHEETS.
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I,
II
II
II
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MI\IlK I\tlb W.ia~'
AU"IIt~1 .. L-IW
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FtF'rH. I nominata, constituta I\lHI,lIppo:Lnt I,LOYll H. IIIU,LER to ba tha
-
Ill/acutor of th1amY 1,IISt WHl IInd Testll1Tl!1ntl 1r hll bll ullllblet(l fulfUi
thll dutias pf gl\acutut', 1 than nomillllt,u, !lOllllt:j,tUto IlI\d,"ppoint 1,t.QYP H,
HIlLLRR, .JR, to be (~l\acutot. of thl.lol mY l,llat 'wut IInd 'I'f,letllment,
IN WHNlISS WHllREOIl, Ii OIlORGll C; McCULLOCH, hove hSrB4nt(l list mY
\1,end and selll to this mY Lalit Will and TSlltament, thb 27th
day'of
Iluramh"r. 1977,
,~~.,~)
Thill instrument WIIIl by the Telltlltor, OllotWll C. McCULLOCH. 011 the dllte
hereof, oigned, published and daclllrad by him'to ba his Lest Will and TeBta~
, ' ,
"
, ll\ll.nt, in our pt'f;iBunca. who at his t'eques t. IInd in h:\.s Pl'Oaencaotld in thll
I' ',prasenoe of. elloh Othar. we bf.'l:taVillll h1.,m ,to be of Ilound lInd d:l.lll\iolllllsmind
I
I ltnd mMI\lry, hllvt! hllt'l\lIl1t',u Hllhlwrl,hlHI uur III11I1lJH IIIl wltm,aflllll.
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(lOMMONWIML'I'1I 1111 1'1';NNlinVAN I A I
COUN'J'Y 011 ClIMlllml.ANIl
I'll
"".
I, OgORGI~ C" MoCllLLOWl. thll '['(llltlltur Whusllllome is s181\lld to tho
foregoinll inatrlll1)Bnt. having balln duly qualified acaot'dinQtOlaw,dl1 haraby
,
i ltok\,\owladSll that 1 stllnad llnd lI11ecuted the instrument as my Laat wi'lll that
1
,It dim,', ed it wiiiil\llly Illl'd that 1 lligMd 1.t all my free lInd\lot4t\tary l\Qt for
!l ~n
"
tha'purposea therein ~Kpr~asad.
II
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I' $worn or, afUrmed to l,\lId aoknowtedllijd
, be~ora ma by Qa01:811 0, ~lcCulloch. the
"T..tator, thia ,27th day,qf
II J)"cl'mbol'. 1917.
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