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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
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COUNTY FILE NO:
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DATE
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ESTATE
FILE NO,
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COUNTY
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DATE OF DEATH
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Appraised Value 01 Es,a,e:
Real Estate
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Per'onal Propertv
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Joinlly Held PropertylTranslers
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Total Gross Estate
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Total Approved Deductions
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Cle.r Valua 01 Es'ale
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less: Approved Charitable Exemptions
Clear Value of F.state Subject to Tax
$
AmoUnl Taxable @ 6% Ra'e
$
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Amounl Taxable @ , 5% Ra'e
tax due
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TOTAL PENNSYLVANIA INHERITANCE TAX DUEJ.~"'</" 7
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.. * .. .. . . A five percent discount totaling .
will be granted if the Inheritance Tax is paid by
less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
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Interest accruel 8t the rate of six (6) percent per annum
on the onpaid balance of Inheritance Tal. from
to dale of pa~ment. Interest due if paid by is __~
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BALANCE OF PENNSYLVANIA INHERITANCE TAlC DllE! ~,(c( ',./ _,
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REV.495 (1.801
COMMONWEAL 111 OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
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Estate of Jamea V. Roland Date of Death December 18. 1980
WHEN CLAIMING THE FAMILV EXEMPTION, COMPLETE THE FOI.LOWING:
Claimant
Shirley M. Roland
Relationship to Decedent wife
Claimant's Address
1433 Simpson Ferry Road. New Cumberland. Pennsv1vania
-.-.- , - -- =
ITEM DATE NAME OF PAYEE REMARKS AMOUNT
NO.
.
Jesse H. Stone Funeral Home Funeral bill I~, 229.00
Hershev Medical Cente~ u_~'--L.h'" 2 266.54 -
I~hir' "" M. Fami1v exemption I 2.000.00
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TOTAL THIS PAGE I $ 5,495.54
I hereby certify that to the best of my knowledge and belie! the foregoing is a just and true statement of debts, funeral
expenses and expenses of administration submitted to the estate .l> dcdllctions for Inhel ital1ce Tax purposes.
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OFFICIAL USE ONL V
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S _~il C/!/. V--j
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AT \,..-' j.;..tt't'JLi:::. PERCENT.
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GENERAL INHERITANCE TAX INFORMATION
Unsatislied liabilities incurred by the decedent prior to his/her death arc deductible against his/her taxable estate.
In addition to debts incurred by the decedent or estate, other items are claimable including the cost of administration,
attorney lees, fiduciary fees, funeral and burial expenses including the cost 01 a burial lot, tombstone or grave marker.
All debts being claimed against an estate are subject to the approval 01 the Register of Wills with whom the
Inheritance Tax Return is filed. Evidence to support the decedent's or the estate's liability for the debts being claimed
should be attached to this schedule.
A lamily exemption 01 $2,000 may be claimed by a spouse 01 a decedent who died domiciled in Pennsylvania.
If there is no SpolJse, or il the spouse has forleited his/her rights, then any child 01 the decedent who is a member 01
the same household can claim the exemption, In the event there is no such spouse or child, the exemption can be
claimed by a parent or parents who are members 01 the same household as the decedent.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
I, If the lamily exemption is being claimed, indicate the claimant's name, address and his/her relationship to the
decedent. Enter "Iamily exemption" in the remarks column anri the amount claimed in the amount column.
2. Assign consecutive numbers to each item listed.
3. Enter the date on which each debt was incurred and/or paid.
4. Enter the names 01 each payee.
5. Provide a briel explanation in the remarks column lor each debt claimed.
6. Enter the amount 01 each debt being claimed.
7. The lorm must be sigr.ed by the person who has assumed the responsibility ior paying the debts.
REV-~HI EK+ (7-801
COMMQNWEAL TH OF PEHNSYLVANIA
OEPARTMEHTOFREVENUE
TRANSFER IHHERITANCE TAX
RESIOEHT DECEDENT
11-3()7~'l
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES
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COUNTY HO. J 1- ~ 1- :s Lj 1
(Instructions on Reverse Side)
STA TE NO.
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Under penalties of perjury, I declare that I halle examined this return and
to the be~~,Qf my ~nowledge an. bell~f It Is true, correct and complete.
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Data al Death
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ESTlMA TED MARKE T
VALUE
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DEPARTMENT VALUATIOH
(OFFICIAL USE ONLY)
TYPE OF ASSET
DESCRIPTION
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I do hereby certify that the above osseh were appraised in accordance with Pennsylvania low.
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DATE
NAME OF PAYEE
NATURE Of CLAIM
AMOUHT CLAIMED
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NOTICE OF FILING OF APPRAISEMENT
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELO OPERATIONS
Mrs. Shirley M. Ibland
1433 Sfntlson Ferry !bad
New Cl1niJerland, PA 17070
RE: Estate of
County of
File No.
Jarres V. Ibland
CUrrberland
21-81-0548
Dear Mrs. Ibland:
You ore hereby notified that the ;"""'"","1-
appraisement in the estate of Jarres V. Ibland
has been filed in the office of the Register of Wills of CUrrberland
County on October 16 , 19.1!. Said appraisement reflects the following valuations:
Real Estate
Personol Property
Jointly Owned
T ronsfers
Total
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NrNF.
1InIlR
$2,100.00
$2.100.00
As to such tux thot is paid within three months from dote of death, 0 five (5%) percent
discount is allowable. As to any tax that renlains unpaid after nine (9) months (fifteen months
when death occurred from December 22, 1965 to June 16, 1971, inclusive; and twelve months when
death occurred prior to December 22, 1965) from dote of death, interest at the rote of six (6%) percent
per annum is chorged.
Any party in interest who is oggrieved by this notice may object thereto within sixty days
after receipt of said notice os provided by Ser.tion 1001 of the Inheritance ond Estate Tax Act of
1961,72 P.S. 2485-1001, P.L. 373.
Date ~r 16. 1981
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Signed d9-~ .-' ~':r~'~C-
Title rh;t:aF ~"::II;~'"
NOTE: This is not a bill.