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RE""~ig C8-78)
COMMONWEAL TH or PENNSYLVANIA
DEPARTME'lT OF REVENUE
BUREAU OF FIELD OPERATIONS
TRANSFER INHERITANCE TAX OIVISION
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES ONL'!
OP RESIDENT DECEDEIITS
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COUNTY OF ..Q..l!M~E%AmL____
This return mUlt b. completod 'n dotall and flied In duplicate, with Iho Rcgii:lcH of Willi in tho County whore tho decedent resided within nino
month. after dore of doath, un/cus on extension is granted hy lilt' Socrotory of RI!VOnud.
Will ~/- '51 -S-!' J
Admn. No. 19_
56 West Main St.,
Florence M. W<l;gner __.._"1' Newville, PA. ])~..11
(N AMID (A1}()I~FSSI
Mise .
hcill~ duly sworn IIccurdil1g In law, deposes DIllI says Ihal he is the _~urvivi!!9~.Q.~]S~___~,.". _____
(EXeC" ADM., [.E.GAlEE, ETC.l
of lhc cslalc of-J/illiam_A.._.Wagner___...____________. laiC "r..J3grg~gl1__gLN..t3Y1YJ_Ue_
(CI'TY, [W IlQU (iH, OR TOWNSHIPI
August 23, 1981
~"._-._- lOA Tl:l-
I.
deceased, and that the whole of lhe CSlalc Ill' said del:cdenl, whll JieJ on
consisted of the assets Iisled helow and lhal allowahle dehts alld deJut.:liolls e.\cceJcd (he fail IIwrkl't \',,\lue of the asst.'ls ,JIll!
no Pennsyl\'ania Transfer Inheritance Tax is J~w,
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--":~_,,'::':'::ll_I'::.' J{L.k_\?ocf4-1........~i_ s.urvi.ving_s pouSE.!___
(SIGNATURE) /J (TITLE)
Type of Auet:
R.oi E,'ole, POri,
Prop"rty, Jointly
HeU Prop. or
Tronsfer.
ASSETS
(Attoch oddltlonol;"h;;t;"H neceS'tHY)
Deu:ription of Anet
Estimated
MOlkot
VOrlJ~
Deportment
!:.c!~lJ..o~_~
CAUTION
(Do not write
in this 'pocc)
1968 Chevrolet Impala automobile,
Serial No. 164478U187193, appraised at
$200.00 by Sheriff's Auto Sales
(appraisal attached).
$ 200.00
NOTE: all other property of decedent,
both real and personal, was held jointly
as tenants by the entirety with Florence
M. Wagner, his surviving spouse.
TOTALS
$
200 . 0 0 -T~-~:;-~~--A,Ii'
REPOIU' OF INIlEIUT,\:'oiCE T,\X AI'I'R,\ISl'lt
I, the undersigned duly appoinled Inheritance Tax Appraiser in and fur the ahuw CUllllly do respecrfully ft.'pOlI that I hJ.\'(;
appraised the real and personal properly as reporll'd in the forecvjnl,: Sclll'dull' a~),hl.' \';Ilues St.'1 fmlh uPl'o,Silt.' t.'adl ilem HI
DlhC IdaSI eolu";:' 1~~Ryghl. <-~~.!L:L~c<..A;! ._-:>'_"'_L_._.__..
ale ;" ~ - _ ,. (INt'HRITA~CE \1)1( Al.>PRAI!>EI,)
Nom. of Payee
DEBTS AND DEDUCTIONS
._~;;;C~._-
Amount
C,loi't,ed
Amount "PPlo\lll'd
br Regi.lf'f
Florence M. Wagner
Egger Funeral Home
Bietsch & Morgenthal
Janice E. Hertzler
Register of Wills
Family Exemption
Funeral Expenses
Attorney Fee
Notary Public
Filing Fee
$2,000.00
2,587.00
150.00
1. 50
5.00
II ..RI(~ - .:t
TOTALS
I
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I. the' undrrt.i"ned dul)' dedel! Rl'!-,i"'(t'f Hr Willj" in -ItH! ft" 1I1l" ilb'l\t~<< ~lillt1\" J., 'I''''r~'ldulh ft.-rIll I Iilal f hall' aIJI,\\,',J
drduC'li..n,,: in Iht" Amounh ",c( fonb In Ihl..' ahm'c ltol.:hnfuft-.lI" ,.:I"tnlt'll, 4-',.t'rl \.\hlh" tIH(' ..('I iul1ll.. j:lt'.th"j HI tp'''~'fJI1\''UtH
in Ihe Ilhl i,'ulumn h, Ihe; 11,,:111. "hit'h {:h'JICf Hf It""I" 4lUluUnl ""f'h."I'nt-. 1111' "Wi! lO"tJ a.... LhJ~'>Il1"n,
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NO U01J28
-
. AUTO SALES ~M~_~_~%."f L!L&f,I\ICl:_Lv f1 Gjy6R. _
SHERIFF'S
135 BEECH ST. , s7
CARLISLE, PA. 17013 _.l~RDJ!~~Lb- f.,_~V-,-)V} Ilffil
Phone 249,1183 CITY N FW VI LL/i",._ rf/Pr
. D?j, I . ~ I J CU>T. OHDCH NO. J WHEN ,"OM'SEO PHONE
. PART No. NAME OF PART .....
AMT AMT. j1'{fjo :cfl.~fT-;~~]:E~ - E~:::~ ::Lt,!frl8U I II ---
-- L.ICI!NSI! NO. MlI..E~.i.7 j 1..31 WRITTEN OV
f--
f--- DESCRIPTION OF WORK AMOUNT
- A?P.. :::JDD )
<J
.-------
-
-
- -
-- f--- _.n_ -~._--_..~_...._---_.
--
.
----
- ----- -
-- ------. -
. GAS OIL III GREASE CHECK BELOW
LUDRlCATE LAPOR ONLY
- --.- ---
GAUl. GAS CHA1~GE PARTS
ENGINE OIL.
--------- -, --- ----. --- --- --,
TOTAL P ,un " .. QTS. OIL TRANSMISSION ACCESIiORIIZS
.:,
-.-.....--.......---....- -.-..- - .......- ---.------.- - ----- .~.-
, ACCESSOR1ES- TIRES AND TUBES UJS. GRt:A51! DIFFl;:HE:NTIAL GAG, OIL
AND c.:.REA"!!
n._''''____''_'__ ..,--.---_.. - ...-.- --.- -.-.--.....--..----- -- ---
'3 MI.C.
- ~----------- .-.-- -- --_.- ~_. ------ - -- - -- -j __ q-u ___ -- _MEII'CHANDISE!:
BUPL.ET
- ..~--------- -- - -.-- --- - - -- --- u_ ,o.>L _' _(__ ___ -.-- !!."~u.~_ --- I--
, ..--' ,". .~'r'j, ~ TAX
101M, /\CC[S~;()Hlr ;; .. AUTH?~P"B":;; k;-'" lC;lAI. ..
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