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OATH m' PERSONAl. REPRES.:NTATlVE
COMMONWEALTH OF PENNSYLVANIA ss:
COUNTY OF CUMBERLAND
Before me. the Register for the Probate of Wills and granting of Lellers of Adminimalion in and for the County of
Cumberland, personally came
Glenn O. Caufman
who, beingduly~. do PA
depose and say that as
Executor
of the last Will ap" Tesiamonl of
Charles O. Caufman
deceased
he will well and truly administor the goods and challels. rights and credits of said deceased according to law. And
. also will diligently comply with the provisions of tho law relating to Transfer Inheritances. Sworn and subscribed before me.
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Register
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DECREE
Be it remembered that on the 27th day of
Aup;ust
.A,D..19..J!L. there was probated and
recorded the last Will and Testament of
~rles O. Caufman
late of
Snllth Mirlrlle.1on Township
. Cumberland County. Pennsyll'ania,
Gleim O. Caufman
Deceased. Lcllers Testamentary were granted to
Witness my hand and official seal the day and year aforesaid.
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TOT"L CONTIlIBUTIONS
INCOM~~ BI':t'l'~IVI.;n
A,'countant ('hal'gl's Idlllsulf with U\l~ following tnt'Olllt' :llllUlllltS I'I'lTIVt'd:
lHlIl
-
Au~.
Sept.
Od.
Nov.
1)Pl':.
Illll2
.1 ~
-I
4
4
4
4
12
4
ITNH ll"III<, N.A. . illtel'eHt 011 NOW ,\''''"IIl,1
CCNH Balik, N.A. . inlel't'st 011 NIlW AI"''''IIII
CCNB Bank, N.A, , intel'es( on NOW ^\'~'Olllll
CCNB Bank, N.A. , in(("'('s( on NOW ,,\ 'I '( HlIll
CCNB Bank. N.A. . intel'e:;( on NOW ^1.t~Uullt
CCNB Bank. N.A.. interest 011 NOW ^t't:OUllt
CCNB Bank, N. A., interest 011 Cl','llfil'alt' ,,1'
])(.'po~it #35513 ft'OII\ .1uly ~O, 1!1B1, ill .I:lli. l~. lqa~
TOTAL INCOME Hr;CI~IVF.ll
DISBUHSEMENTS
Accoulllallt daim'; cl'edit 1'0" the following amounts paid:
1!181
Aug.
4
Ch"I'k <'leared after death
17
Bille H idge 1I,)me, a,,,'oun(
17
M(,M Pharmacy, account
24
.Iosel'h W. Gihson Funerallloll\e, flllll'I'"l 'H'I'\'Il"";
,:,'..: 101 1M 285
1:1,0(10. (III
1I7, Ii?
$111, 140, !12
$
4. Oil
2il.li5
:W.l!J
1 :l4.1I:l
72. !If>
11. till
115\1. !If.
$1,12:1. :l:l
$
~l. 1;)
:,(1. :!!l
411, III
2,511:l.()l)
REV-1iOQ' EX ~.J9.811
BUREAU OF EXAMINATION
PENNSYLVANIA DEPARTMENT OF REVENUE
P,O. BOX 8327
HARRISBURG. PA 17t05
/ ( - 3{),;) - \3
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FiI. Numbor .l..1 - '8 1-0 5 ~ (.,
~
Doced.nt'. N.m. (Lnlt, First, .nd Middl. Inili.il
DECEASED C1UJ..lrno.nt~
Socl.1 SecUty Number D.te of De.th
C(1t.,~-a.,lo\'~
01-3_D-'g1
Dec.denl'l Addres.
~.'\).I.>, (bl))(.I4-i
&.r\i~\( PA 1'01"')
.:J
2, Suppl.m.nlll RelUrn 0
3, Rem.inder Return 0
CHECK
" Drigin.1 R.turn rn
BLOCKS
4, Lilo Est.te 0 5, Federel Elt.t. Tax 0
R.turn Required.
S, Decadent di.d t.II.I. f1:l 7, Dec.dent m.inteined .lil'il1g 0 8. Number of safe d.po.it 0
(Attach COpy of Will) ~ tru.t (AROCh copy of trust! boxes Inventoried
All correspondence nnd oonfidenlial tax inlormation .hould be dirl1cted to:
APPRO.
PRIATE
CORRE.
SPONDENT Nam.
I'i' . ~{t
Teiephone No.
Recapitul.tion
1. Real Eltate (Schedula A) ( 1)
2. Stock. arid Bond. (Schedule B) ( 21
3, CIOIely Held Stock/Partn8llhlp Intere.t (Schedule cl ( 3)
4. Mortgages and Noles (Schedul. 0) ( 4)
5, Cash & Milcelllneoul Personal Property (Scl1.dule E) ( 51
RECAPIT. S, Jolnllv Owned Property (Schedule Fl ( 6)
ULATiDN 7. Tronsf8ll (Schedole Gl ( 1)
8, Total Gro.. A..all hotal lines 1.71
AND 9, Funerel Expense. Admlnistretive Co.II/Miscellaneous
Exp.nles (Schedule HI ( 9)
TAX 10. Debll/Ml1rtg.ges/Lienl (Schedole il (101
\1, Total D.duction. hotallines 9 & 101
12. Nat Valul1l1f E.late (line B minullin. 'll
CALCU, 13, Charitable Bequesll (Schedule Jl
LATION 14, Net Valu. .ubject to tax (line 12 minus line 131
City
Zip_
33,500.DO
:l1l)lI>D'l. ~ '1
~15,:1I., ",21
(Bl l,OllD~5.qD
(Ill \.:1, OlP I. 'i!5
(121 4%1 511\. O~
(131
(141 l\~ 514, DI5
Computation of Tax
15, Aml1unt 01 line 14 taxable at 6% rete (15) ~lfJ}.6
!include v.luel from Schedule KI
IS, Amount l1f1ine 14 taxabl. It 15% rite (161
(include vllues frnm Schedul. KI
17, Principal tex dueledd tlX frnm line 15 plostex from Iin116)
lB, Total Prior p'Vments:
(eI Amount Plid _
(bl Plul Discount
(t! Minol 'nterelt (1BI
19, Blllncl Due (lin.17 minullin.'BI
Mlkl Check PlYlble to: Regiller of Wills, Agent
... PLEASE RECHECK MATH" .
x.OS< ~,C\J 4.~
x.15'
(171 ~11..\.l(4
(191
--.-- -~-_.__.-
Under pen.lties of periu<\"l decler. th.t I hive examined thil retorn, including Iccomplnying schedoles Ind IIltemenll, Ind to the best of my knowledge
.nd belief, it ;, troe, cor t. Ind complete, Deol'l1lion 01 prep."r other thin the personel representltive Is b.sed on III inform.tion of which prepI"r hes
Inv knov.1edge, ..s / ~/ g ~
ADDRESS I DATE
---.,.-...-----------
ADDRESS
DATE
PENNSYLVANIA INIlERITANCE T~~GENERAI~l~FORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of tho Inheritance and Estale Tax Act 01 1961 provide': that the followi!lg pcr,ons sh!J1I prepall! ilnd file
a return: . '
a. The personal representative 01 Ihe eslale of the decedent as lu properly ul the decCltellt il,dll!il]istered by him
and such additional property which is or may be slIbject 10 Inberila:H:e T;lx IIf whicb he/she shall have or
aCQui re knowledge;
b. The transferee of property upon the Iransler of whrch Inheritance Tax is or may be imposed by the 1961 Statute,
including a trustee at property translerred in trust, provided th;lt 110 ccparatc ICtulllneed be milde by the trilnsleree
of properly included in the return 01 a personal representiltive,
2. PLACE FOR FILING
The relurn is 10 be filed in duplicate wilb tlle Register of Wills of the colllily wherein the decedent resided,
3, TIME FOR FILING
The return is due nine rnontllS after lhe decedenl's dealh, unless :In extensinlltor filillg has been <Ipplied lor ilnd
granted by the Secrelary 01 Revenue wilhin tlle nine-month perloll.
4. FAILURE TO FILE RETURN
Section 791 01 the 1961 Slatute provides Iha! ". , ,any person who willfully fails to file a relum or olher reporl
required 01 him, , .shall be personally liable, . ,to a penalty of 25% 01 the tax ultimately found to be due or $1.000
whichever is the lesser to be recovered by Ihe Department of Revenue as debts 01 like amounl arc recoverable by
law."
5. TAX RATES
Inheritance Tax is payable althe rale of 6% on transfers to lineal descendants, such as father. molher. husband. wile,
son. dauRhter, grandchildren, grandparent, son-in-law and daughter-in,law and at the rale of 15% as to all others.
6. PAYMENT OF TAX
The tax assessed on Ihe transler of property reported in tlle return is riue 9 months after the decedent's dealh, Interest
at the rate ot6% per annum accrues thereafter unti I payment is made. All payments received arc Ii rst applied 10 any
inleresl which may be due with any remainder applied [0 tlle tax, IF TAX IS PAID WITIiIN 3 MONTHS AFTER THE
DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT is ALLOWED,
All checks should be made payable to the Register of Wills of the county wherein the decedent resided and are
received subject to the final deterrninalion of the Department of Rovenuo.
7. FAILURE TO PAY
The laxes imposed. logelher with any inferestthereon, are a lien upon real properly, which lien remains in effect unlit
Ihe taxes and interest have been pard in full. TI1e taxes may he sued lor against any !eal property in the decedent's
eslale or against any property belonRing 10 a transleree liable for the tax,
8. fiLING OF FALSE RETURN
Any person who willfully makes a false return or ,eport required III him ~,l1all, in accordance with Sectio~ 793 ollhe
1961 Statute. be guilly at a misdemeanor and, on conviclionlhereof, sh,llllle ,enlenced to pay a fine not exceedinR
$1.000 or underRO imprisonment not exceeding one year or hath.
IH:\I..4!,I) EIH tln.llO)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "A" -PAGE 1
REAL PROPERTY
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ESTATE OF
CHARLES O.
(Instructions on Reverse Sj,h:J
CAUEA'lAN
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'ITEM
NO.
!
DESCRIPTION
ESTIMA TED
MARKET
VAl.IIE
DEPARTMENT
VALUATION
(OFFICIAL USE ONt Yi
=----~~=.
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Undivided one- sixth interest in:
(:
^1,1. IhOHl' two 1'","I:d" 1l1C:i:iUngeR ('Ii" tenenlPlltli and tra('l~ of land ~jtllltll'
ill thp '('nwllship"r SIlllth Micldl1'1on, ('ollnty or Cllmhl'rlnnl'l. a",1 >llat.. nf I'pn'1".\'1..
vnnia, anol hOllnol,'" an" oIl'Hl"riheol as follows:
TltJ\I'T NO. I: 111,:llINNIN1: at a RinkI' al ('nrner of lall",~ I'nrnwl'1y fir Ih.'
._--
clltatE' of .Iohn W. (','ainhr>:ICI. Sr.. f)N'enRl'rl. latl'r of (;pornl' (lito anol now or
rorml'1'\y "I' na,\' I':. Olt,,; th('IWp from said Rlok" :01 the plal'l' "I' I\pginning alon/!
lands forml'r!,\' of' 1>. 1'. \Ioov..,' nnd now or formerly of Andr..w ('ov.1' Norlh 7
dellreeH Wesl n d\.-It:OIlI'l' of 129. R perrhes to a stone; thpnre ,-IlilI hv soid lan,tH
now or formerly of Andrew Coyle South 65 degreps 15 mlnlltps Wpst n ,IIAlanl'e
01' G. 4 perrhes In II Hlake; thenre by land now cr formerly of ,I "hn N. Malltos
Nort.h 26 dt'greell :iO minutes West a distance of 24 perrhes tll a pflHI: thenre
still hy said land now or lormerly 01 John N. MalllOR North 64 ,h'nreps 1';8s1 a
cl i stance of 6.4 pprrhf's t.o a point In the public road known as ""nn\'hrllok Ron,l;
thpnC'e olon~ !lnlrl puhllr rood known all Honliybrook ROAd and Trart No.2 hrrr-
Inart.er ,lrilrrlhl'cl Sollth 62 clp~rees 45 minutes EftAt a ,llatanr.. of 17 perl'lll'll In a
1I0lnt In Maid 1I0nnyhrook Road: thenre still alonl( sahl Bonnyhr,,"', Ho:ul IInd
'frat't No. 2 hprrlnaftpr dpsC'rlhed Sonth 36 degrees }';asl a rliHt:",,'r nl' 14. R lll'r('heH
10 a stone in soirl 1I0nnvhrnok Road at Its lnt ersp-rUon with a H,','onrl rflad known
1111 /leiser's 1.:111<'; Ihelll'l' alon~ said He'lser's J..nne aoel 'fract Nfl. 2.lll'rl'innftl'r,
....II('rlherl and C'on!tnllln~ alon~ land formerly of .1. C. I<raml'r. HOW or formerlv
of I.ester Mellott. North Rt degrees 45 minutes Foast a dlstanC'p of r,n. 7 prrrhes
to a stone: thfmcl!' hy IlInrlll formerly of David Line. IAlrr of 1>1'. ,I. (l. Flrkel.
nnd now or formerly of Pelper. South 26 degrees RRst 8 dlstan('r IIf 111.0 perchPR
to a point; thpnrp hy lands formerly of ,Iamell R. 1)lckson. lot",' of ('alharlHI'
IIrrtmnn, latpr of <lpol'ge Otto. and now or formerly of Ray I':. 0110. Snllth on
drgrees 45 minnlps WI's! n cllstance of 1 t2. 3 perrhes to the l'1a.", of 1I1':(;INNINC.
CONTAININCi 70 At'rl'll nnd 120 perches.
TOTAL
II additional space Is necessary. un 8~i" . II" .n,.eb.
Rt. \1..4',.1 I ~+ {1(1..l\ol
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE" A" - PAGE 2
REAL PROPERTY
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TH^C'l' NO, 2: 1I1':I;jNNINr. at II Hlnn!'! in A pllhlic l'I"Hlll'"di1l~ In Cr"i~Ill';"I's
Sl"ti;-;i'ikrn~\:;li;'-llIl\'hl'onk Iload at. its intersection wilh a Plll,li<' I'""d knnWll;H
1I..1,;<,r's 1.;11\<'; 111<'111'" along saId Bonnyhronl< ROIHlnn,1 Tr:ll'1 !\if>, 1 1'''''"inah,>VI'
d"s''I"ih,'d North:l1 df'I~I'('''S 4fi minutes West a rHslan!''' of 14. I, 1'"",'h"'; If> a slon..;
thl'l"'!'! 111111 alrlllr', said Ilnnnyhrook Rna,1 and 'fro!'t No, 1 her"I1l:d,,,,,,' dl'sl'l'ihl'd
NOI.th fIR degr""s :\fIlllinlltl'S West n dlst.ance of 17 per!'hes tn a "Innl': ""'111'1'
Norlh 2(; rlegr..l's Wl'sl " rllstnnce of 2. fi percheR to a stnn..: 111<'"'''' by lalld 1I0W
or formerly of Mal'y (;ollsha11, North 68 degre'" 15 minuteR Fasl a dislnlll'" nl'
:17 perf'hes to n ston": lI11.,nce hy lands form'erly of .John C. KI'~I,,"r allcl 1I0W Ill'
I'nrmerly IIf 1.l'ster M<'llott. South 20 degrees 30 mlnntes Easl a di,;lall"l' nf :17. 'I
perrheR III a 'ltlllll' ill Ihe' pnhlic road known as Hl'iser's Lane; 1111""''' alllllA fiad
pllhllc roml lwowlI ~s 11..I"er'9 Lane alld,Tract No.1 hel'eilla""'JI' dpsl'l'iilerl SOlltil
Rfi 11l~llrl'eH 311 minll"'>! WI'>!t 0 distance of 24 perchell to a 'ltOlIl' al till' illtersl'..lioll
nf Hllid IIl'isl'r',; I.'aul' with tlonnyilrook Rood at the pl,,,,e of 1I1':(:tNNIN(;'
CON'I'AININ(; 6 ^"I'es, strict meRRllre.
'1'111<: ahuve desl'l'iiled two tracts of land have thereon 1'1'''1'1..01 a 2~, slor,v fl"""('
. dWE'lIlllg hnllHe, frollle hank harn, frame wagon shed, Rnrl otl...,' imprOVPII\l'nIH,
'1'111'; ahovI' deHl'riilell two tractli of land are all of 11,1' tWIl II'"I'\S of Jancl wllid,
navld ^. \.\Illt and wtfe, hy dl'erl dated ^prlll, 1!l1!l ancl rl'cm'''!'d in thl' ()1'1'i....
Ill' the Itecorrl...r of I)"I'IIR In noel for CumllPrlnnll ('nllllly at (":\I'1j""" I '''nil s\' 1 vallia.
in !lee,1 1I00k "I,", ""1111l11'!l, !'nlle 205, rranterl allll I'nnv"y"d In ('IHlrleR I," l.illd".".
'1'111'; sal,l (,i1~I'l"H F, l.il1,lsE'Y eliI'd Fehrllal',V 7, 1!l:!Il, ,(:" illn I'il'St Illlllll' a
l,aHt Will :111,1 'rl'>llall"'"! rlatecl I,'phrunry 6, 1!l20, sin"" hiH ,",,,II, cllIly PI'twp.l
;",,1 rl'lIll';lIil1J:: Ill' ,'1'1'1,,',1 In the Office of the Rellistl'r III' Wills ill allll fnr ('lIl1lilE'I'.
l:1n,1 COll111y 1'1 (':II'II>l\I', l'enOl'lylvanla 111 WI!I1\lIlIk :11, P"V:" 111:;, Wlll"'"ln hI' e1ld
1~lvl' n!1l1 .levlHI' hl>l!"lItlre estate of'whll'h the ahllvl' l\I'n tl'a"I'; ,1\' \,,"d w.'rl''' 1'''''1
tll hiH wtfc', Mary.':. LII1,I:-H!Y 1'01' I iff' or dnrlng hI'" willnwhn"d. wilh "l'lIlaill<I"I'
ill 1"'1' III hlR chilllrl'l1, 1111c1a C, CRllfman, form~l'lv Ililda ('. ('I"""". ;lIl1l,lolon
l,lnlllley. The Hair! MlIrv F. LlndHey, widow of th" IInid Ch,wl' I ,,', I ,il1ll!iP~', ,h'-
I'paHer!, hal'tnllelect,'rlto take aRnlnltt the will of hl'r sairl hllsh,",d (,,"I' nrphans'
("lInrt DUl'ket N60, P"1l1' 77) an IIndivltlerl one-thtrll int.~r,'st 1I"'I'I'in""sll',1 in 111'1',
tl,,' Haiti Mary 10'. I.ln<ls"y, an,1 the othf'r IIndlvlllE'11 two-tllll'd;, i"I"'l'"st vl'st",1 in
thl' ,1:1101 I1l\da ('a"flllan awl the Hald John UnclRl'v.
HI''V''4',.1 I"),. (Il'l."nl
COMMONWE'ALTIi OF PENNSYLVANIA
OEPARTMENT DF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEOENT
SCHEDULE "A" - PAGE 3
REAL PROPERTY
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DESCRII'110N
E511MA TED
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DEI'A/lIMWT
VAI.UATIOrl
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Till': "aid lIilda C. ('allfnwn waR also known :'H II"lda and I"", nliddl.. 11I11i:1\
wns SOIlIf'1inlf'H written "c" nod HonuHirnp.s 1\1" nnd SnlllC.~l.illleH "hili tallll Snlllp.~
I in,,',; 1II111t1I'd.
TIll': ,H:oid II"lda K. (':onf"1:1n awl (,I':II'l/,s O. (""lflll;lIl. In/,,'II"'I' will, 11,1'
"aid ,Inhn ,.. 1,lndH".\'. Hing!.. niall, hI' <1"1'11 dnted 1)(""'111"1'/' ~!, I !.:n :",,1
1'1'1"OI'dl'd 1l"('I'IIIIII'I' :lI, In~1 in flaid rt"corder'fl tlffi"" III 1l1'1't1 linnl. "I.",
\'olllllle n, Pagt.. 2nfil nrantf'cI :loci C"onvp\,pcl their lInrlividf'd lwO..lhir'dH illlf't'(':-;f
III ",lid IJr"IlI;';PH 10 lil"ir lllotilpr, Ihe Raid Mary E. 1.indHI'Y, II"," 1'''''' ing ill
',,'r Ihe (,lItit'e fl'(' simp!.. title 10 the RamI',
Tim saicl Mnry E. 1.Indsey suhsequently mlll'ried William II, 1,':111"1' wl,n
pre-deceafled hf~r on "'"Ill'lIitry 20, 1053, and the flaicl Mat"y E. I,';dlo/'. rllrllll'l'l\'
Mary F., I.lnds"'v, ,died n widow on DeC'emher 5, 1'157, havi"I' i'i"'lI Iliad,' a I :0:;1
Will and TeHtanll'lIt dalpd ^pril 23, 1054, since her d..alh dilly 1"'ll\,..t1 an'\ I'e-
malninll of reclll'd in laid Office of the ReglRter of Will!! in and fllr ('IIIllI,prland
COllnty at e'II'lIs)", l'l!nusylvania In Will nook 51, page 6n, Whl'I','ill "i1" IIl'vi"I'''
,ill' ahove llesC'rlil!'d 111'1'111 1 fl"""10 her oallr,hter, Hlllela K, Caufllla" 1'01' lif", :iIld
at hel' r\eath dlre!'ted thai the Harne shoulel he solrl and the I1rOl",..<I" Ih"I'I'of
dIHtrlhllt..,l equa11\,' a/llOlIl( the followlnl( Rlx (6) pPI'!!OnR liS remai",lp.'IllI'II: h/'r
H'"l, ,Illhn L; I.tudHI'Y, her Ron-ln-1aw CharieR Cnllfmnn, nnd 111'/' 1'0111' (,I) grulld-
"'tilrlren - Freidn, S1l1'rrnan, Cllenn Caufman, LoiR Shllghal't, nnd ('IO:II'leH l.indHI'Y.
SI''' gRtalp No, RR3rl~ allll Tax Docket #4, page 357, line 34.
'filE Haid Hlllda K. C:Ollfman, also known as IIl1lla Callfmn",li/~d 1\1:OI'('h 21,
t !17fi, thuH '''''I;oInat ill/.( h..r life estate.
THE above-described two tl'acts of land were
sold at public sale on September 26, 1981, fOl' a total
of $201,000.00
1981 Tax Assessment: $10,400.00
Value of undivided one-sixth interest of decedent
33,500.00
TOTAL
33,500.00
II additional spac. is necessary, use 8'," . 11" sheets,
, ,
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedenl, 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, wiUlin lwo years of dealh, transler property from himself! herself to himsell/herself and another parly
or parties (including a spouse) in joinl ownership? (Answer "Yes" or "No",) ~
3, If Ihe answer to one or 100 above is "Yes" and the transfers are claimed te be nontaxable, plOvide Ihe lollowing
information:
a, Age of decedent at time of transfer.
b. Copy at death cerli ficale.
c. Affidavil by the atlending physician indicating Ihe stale of decedent's health altime of transfer.
d. All other infonnation supporting nontaxabilily of transfer.
4. Did decedenl, in his/her lifetime, make any lransfer of properly wilhout receiving a valuable or adeQuale consideration
therefor which was to lake effect in possession or enjoyment at or after his/her dealh? (Answer "Yes" or "No".) No
. a. Was there any possibility Ihal Ule property transferred might relurn 10 transferor or his/her eslate or be subjecl
to his/her power of disposition? (Answer "Yes" or "No".)
b. What was the Iransferee's age altime of decedenl's dealh?
5. Did decedenl in his/her Iifelime make any transfer wilhout receiving a valuable and adequate consideration Iherefor
underwhich transferor expressly or impliedly reserves for his/her life or any period which does in facl end before his/her
death:
a. The possession or enjoyment of or the right to income from the pfJperty Iransferred? (Answer "Yes" or "No".) No
b. The righllo designale Ihe persons who shall possess or enjoy the properly transferred or income therefrom?
(Answer "Yes" or "Ne".) No
6. lithe answer to live b. above is "Yes," was the right reserved in decedent alone ( ) or decedent and others ( ).
7. Did decedent in his/her lifetime make a Iransfer, the consideration for which was transferee's promise 10 pay income
to or for the benelil or care of transferor? (Answer "Yes" or "No".) No
8. Did decedent, at any time, transfer properly, Ihe bll1eficial enjoymenl of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could reverl to decedent under terms of lransfer or by operalion of
law? (Answer "Yes" or "No".) No
9. If the answer 10 eighl above is "Yes," was Ihe power to aller, amend 01 revoke the inleresl of the beneficiary reserved
in the decedenl alone ( ) or decedent and others ( ).
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INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship, Both tangible and intangible property are to be
included. List real estate first.
1.
Describe all real propertY as indicated in the instructions for Schedule "A," Describe all personal property
as indicated in the instructions for Schedule "B," Include the name, address and relationship to the
decedent 01 the co.owner[s] and the date the joint ownership was established,
2.
3.
Indicate the total market value of the jointly owned property.
,\
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Indicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest,
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GENERAL INHERITANCE TAX INFORMATION
Unsolislied liobililies incurred by the decedent prior to his/her death ore deductible ogainst his/her toxable
estate. In addition 10 debts incurred by the decedent or estate, other items ore c1oimoble including the cost of
administrotian, attorney fees, fiduciory fees, funerol ond burial expenses including the cost of 0 burial lot, tombstone
or yrol'e marker ond other relatedburia,1 expenses.
All debts being claimed against on estote ore subject to the oppro'lal of the Register of Wills with whom the
Inheritonce Tax Return is filed. El'idence to support the decedent's or the estate's liobility for the debts being
claimed should be ottached to this schedule.
A /amily exemption moy be c10imed by 0 spouse of 0 decedent who died domiciled in Pennsylvonia. If there is
no spouse, or if the spouse hos forfeited his/her rights, then ony child of the decedent who is 0 member of the Some
household con c10im the exemption. In the el'ent there is no such spouse or child, the e~ernption con be claimed by
o parent or parents who ore members of the some household os the decedent. The fomily'exemption is ollowoble only
a9ainst assets which poss by a will or by the Pennsyll'anio Intestate Lows.
NOTE: Compensotion poid to on estate representotil'e; nomely, on executor or odministrotor, for services
p~r/ormed in odministering on estate is reportable for Pennsyll'anio Income Tax purposes. This toxoble income
item should be reported on form PA.40.lndil'iduollncome Tox Return.
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INSTRUCTIONS FOR rOMPI FTINr. ~rHFnlll F "F"
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GENERAL INHERITANCE TAX INFORMATION
Unsatislied liabilities incurred by Ihe decedenl prior 10 his/her deolh ore deductible against his/her toxablo
estote. In addition to debls incurred by Ihe decedent or eslole, other ilems ore doimoble indudinQ the cost 01
administration, nllorney lees, liduciory lees, lunerol ond burial expenses including the cosl 01 0 burial lot, lombstono
or grove marker and other reloted buriol expenses.
All debts being doimed ogoinst on estate are subject 10 the opprol'ol 01 the Register 01 Wills with whom 11.11
Inheritance Tax Retum is liled. Evidence to support Ihe decedent's or Ihe estote's liobility lor the debts beinQ
doimed should be alloched to this schedule.
A lamily exemption may be doimed by 0 spouse 01 a decedent who died domiciled in Pennsyll'onio. II there is
no spo'use, or if the spouse hos lorleited his/her rights, then any child al the decedenl who is 0 member 01 the some
household con doim the exemption. In the el'ent Ihere is no such spouse or child, Ihe eXlll11ption con be daimed by
a,parent or parents who are members 01 the same household os the decedent. The lamily exemption is ollowable only
a~ainsl assets which pass by 0 will or by the Pennsylvonio Intestate Lows,
NOTE: Compensotion poid to on eslate representative; namely, an executor or ;'dministrator, lor services
perlormed in odministering on estote is reportoble lor Pennsylvania Income Tox purposes. This taxable income
item should be reported on IorIO PA.40.lndil'iduallncame Tox Retu~n.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. II the lomily exemption is being doimed, indicate the daimant's nome, oddress ond his/her relationship to
the decedent. Enter "Iamily exemption" in the remorks column ond the omaunt doimed in the omaunt column.
2. Assign consecutive numbers to each item listed.
3. Enter the dote on which each debt wos incurred ond/or paid.
4. Enter the nomes 01 each payee.
S. Prol'ide a briel explonation in the remarks colomn lor eoch debt doimed.
6. Enter the omount 01 eoch debt heing c1oimed.
7. The lorm must be signed by the person who hos assumed the responsibility lor paying the debts.
IF AI)DITIO~AL SPACE IS NECESSARY USE 8%" x 11" SHEETS.
REV. 1547EX (1-82)
SUREAU OF EXAMINATION I NDTICE DF INHERITANCE TAX \ASSESSMENT
PENNSYLVANIA DEPARTMENT OF REVENUE APPRAIr.EMENT ALLDWANCE DR DISALLDWANCE CDNTRDL ND, 101
P,O, BOX B327 ., J
HARRISBURG. PA 17105 DF DEDUCTIDNS. AND ASSESSMENT DF TAX DATE
_ 04-05-82
ESTATE DF CAUFMAN CHARLES 0 FILE ND. 21 81-0526
DATE DF DEATH 07-30-81 CDUNTY CUMBERLAND
NDTE: TD INSURE PRDPER CREDIT TD YDUR ACCDUNT SUBMIT THE UPPER PDRTIDN DF THIS NDTICE WITH YDUR TAX
PAYMENT TO THE REGISTER OF WILLS OF THE ABOVE COUNTY, ~AKE CHECKS PAYABLE TO REGISTER DF WILLS,
AGENT," IF TAX PAYMENTS ARE MADE WITHIN 3 MONTHS DF THF DECEDENT'S DATE OF DEATH, A DISCOUNT
OF 5% OF THE TAX PAID MAY BE DEDUCTED,
ROBERT M FREY ESQ
5 S HANOVER ST
CARLISLE PA 17013
PLEASE RETURN THIS
PORTION TO REGISTER OF
WILLS IF PAYMENT DUE
~~I~~9~~_I~~~!~-------------------------------------------------------'
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLDWANCE OR DISALLOWANCE DF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CAUFMAN
CHARLES 0 FILE NO.21 81-0526
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
APPRAISED VALUE OF ESTATE:
1, Real Eslate (Sohedole Al
2, Stooks and Bonds (Sohl1dule SI
3. Close Iv Held Stock/Partnership Interest (Schedule C)
4, Mortgages and Notes (Sohedoll1 D)
5. Cash & Miscellaneous Persona' Property (Schedule E)
6, Jointly Owned p, operty (Sohedule FI
7, Translers (Sohedule GI
8. Total Gross Assets
( 11
( 21
( 31
( 41
( 51
( 61
( 71
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funer.l Expenses/AdminIstrative Costs/Miscellaneous
Expens~s (Sohedul~ H)
10, Debts/Mortgages/Liens (Schedule II
1 1. T ot.1 Deductions
12. Net Value of Est.te
13, Cha..toble Sequests (Schedule J)
14. Net Value Subject to Tax
( 9)
(10)
ASSESSMENT OF TAX:
, 5. Amount of line 14 llxable It 6% rite
16. Amount of line 14 tlxlble .t '5% rite
, 7. PrinCipal T IX Due
TAX CREDITS:
RECEIPT
u
DISCOUNT (..I
INTEREST H
PAYMENT 1
DATE
\' I
....HIS ASSESSMENT IS BASED ON, ORIGINAL RETURN
NIl INTEREST IS DUE IF PAID BY 04-30-82
IF PAID AFTER DATE lNDICA TED SEE REVERSE FOR INSTRUCTIONS
ACN 101
DATE 04-05-82
33,500.00
.00
.00
.00
24,609.27
2,526.63
.00
( el
60,635.90
12.061.85
.00
(111
1121
(13)
(141
12,061.85
48,574.05
.00
48,574..QL
1151
1161
48.574.05
.00
2,914.44
.00
2,914.44
X,06=
X,15=
1171
AMOUNT PAID
TOT AL TAX CREDIT
BALANCE OF TAX DUE
2,914.44
(If Bal.nce Due 15 Ie,s thl" $1.00 no p.vment " fttlYlred)
RETAIN THIS POHTiOl\; ~on \'OU~ RECORDS
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, .eolion 2485),
If the lax i. p.id wilhin thre~ (31 month. .fler Ihe deoedl1nt'. de.lh, . di.coonl 01 5% of Ihe I.x p.id is .Uowl1d,
Inheritance Tax becomes delinquent nine (9) months after the decedent's death. Interest is charged at the
flte of six (6) percont per annum on the amount of unpaid tax. ISEEEXAMPLE BELOWl
EXAMPLE: If. b.l.no~ of I.x due of $2,000,00 i. in . dehnqoenl .I.IU. from ~. .nd p.ymenl i. m.de
on 5-2.3-80. the interest is calculated as indicated below;
STEP ,
Determine the rale of
interest from the table below.
STEP 2
Multiply the balance of
tax due bv th~ rate of
interest.
STEP 3
Add the interest
to the bal.nce of
lax due.
Intere.t from 3-03-S0 to 5-23-80
Results in:
2 MenU,s =
20 O.y. =
Rite of interest =
,010
+ ,00335
,01335
Balance of tax due
Rite of interest
INTEREST
$2,000,00
x ,01335
$ 26,70
8.I.nce of I.x doe $2,000,00
Plus Interest to
~!!. of Paym.nl (+1 $ 26,70
TOTAL lax and
interest \0 Olte
of p.ym.nt $2,026,70
------------------------------------------------------------------.---
t month ,005 4 months ,020 7 months ,025 10 months ,050
2 monlh. ,010 5 months ,025 8 months ,040 " months ,055
3 months ,015 6 months ,030 9 months ,045 12 months ,060
I d.y ,00017 11 d.y. ,001S6 21 d.y. ,00352
2 d.y. ,00034 12 d.y. ,00203 22 d.ys ,00369
3 d.y. ,00051 13 d.y. ,00220 23 d.y. ,003S6
4 d.ys ,00068 14 d.vs ,00237 24 d.y. ,00403
5 d.ys ,00085 1 5 d.,. ,00250 25 d.ys ,00420
6 d.y. ,00101 16 d.y. ,00267 26 d.y. ,00437
7 d.y. ,00118 17 d.y. ,00284 27 d.y. ,00454
8 d.y. ,00135 18 d.,. ,00301 28 d.y. ,00471
9 d.y. ,00152 '9 dlvs ,00318 29 d". ,0048e
10 d.y. ,00169 20 d.v. ,00335 30 d.y. ,00500
--------------.--------.--------------------.-------'--------------------
Anv PlrtV In Interest. includIng the Commonwel1th and the personal represent.tlve. not 5Ilt~fled With the
.ppral.~m~n\ and ......m~nl mIV ObJ.ol w,'hln "xtv 1601 d.,. .h., r.c.,pt of thl' NoloO. IS proVld~d bv
S.ol,on 1001 of Ih. lnh."lano. .nd .E.,.le T.. Aol oi 1961 172 P,S, .~o' 2485 - 10011.
MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AGENT"
DETACH THE TOP PORTION OF THIS FORM AND SUBMIT WITH YOUR PAI'MENT TO THE REGISTER OF WiLLS fOR
THE COUNTY SHOWN ON THE REVERSE, SEE THE INHERITANCE TAX INSTRUCTION SOOK FOR ADDRESS,
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