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HomeMy WebLinkAbout81-00594 ::i ~ . >< E-< ...:l ~ >< II) ~ c:>:: r4 ~ t>.. ~ r.. liJ ::> z ::> ::> Cl III II) \;" . U II) H Cl ~ >< lI: 3 u "J'. u ~ Q) u, ..... CO . - ..... 0 C\I ~ . JJ -J. III LLI " f,( J(~'.:.' />/~-;:. 1.:'12-'" / COUNTY NO.,'y"f/',SY/ , nCV.,19 [X4 (12.60) COMMONWEAL TH OF PENNSVLVANIA DEPARTMENT OF REVENUE TRANsfER INHERITANCE TAX RESIDENT DECEDENT Estalo of INHERITANCE TAX RETURN FOR INSOLVENT EST A TES (InslIuctions 011 Reverse Side) STA TE NO. ':.;\ 0:",1 ::'. ( ) E,ec. ( ) Adm. IIkl!1. Olh.. ....,:LP:~: u 1) .' . i .... ,;il:'l'I.' Namo Last oddrou J 0(1 :'!OI'i'::tOW'"} .'J"','; (S11'>'-,ITI Social Security No. .JJ!.::-:~-77$3 1,<" '! :' (., , ( 7.11'1 >- n: <C U " o .. ICilY) (:ilAH-1 (ZIPI Ul1df!r Iwnallics of perjury. I declare that I hew examined thl' return and to tho hest of my knowledge llnd belitlf it i5 true, correct and complete. . I .ffr.;'(-k, ;,<. /-_ ll;~-il Slgl1dWre oll-lducll1ry , , Addre" 1 Of., ,(j f::; t,(".-Jl' :'Lo::"d {!>THI-l: TI :':ec:.lanlCDLlll\':, ~ !;tl.L:I. 1ClTVI (51 "H_. (:P'\': i e:' t,' '" i . J :: r:D) .:~. ----.----. 17'::;; Date of Death \,111'(:1',1 l<}. li~d,l ')(lf3 I ~'-" <3'" Social Security No. ,- - i~. (. TYPE OF AsSET Personal t:y OFFICIAL USE ONLY DATE l. , I~ 0"" Q:'-,' 0;:, Ul.J ~u: ij J? rJ Yj lIat~ I DESCRIPTION ESTIMATED MARKET VALUE DEPARTMENT VALUATION {OFfiCIAL USE ONLYI ~n_nctr':! c H1;r~e] ellHO! 1'-~:ol;1 tel ;::))""! ~~-'''n':r, ;>,JP:~:lcnl Coml'nn~r. ,"-;)-:1.( l',}"'.:.c.e. I,J~t1rn1r'll T"1:'11 ~':~if~~_,l cJ.~:,l.::;' (, \' "'''~,1' -.: (";n"l r~: ~!:1~d A~)' (~(11'I{iiti(lllC~, sold to ;\'je]~l'i1 .~)ttrlo. ~::...1.1:'] J'i.Cl~. ~~Tr'.al1 rndlo. S(~ll~ 1:0 >T'D. ,::r:1cn 1:!!.'i.2](. .:inlo IJl'iec. 1Tf,cd stel'f;,) (tnrry; .1.,":"'~':' ,~:',1'~) nr~ :~pn;:::,' r:uP'1hn:E:(~ ['01":'211.(:). "J"(~\:'(:'r'jl m<:lrl~ct VH11J~":!';',l'O)~il"1l1 "1~? (" ] .'2;'(:.(10 ?OO.".(j 1 =~,: . ("r) II' ''1:''_ 1,..,.:.,1 1 ;)~. 00 TOTAL;> 17l;.C.(1() / 7 ;/(!.H) /lA I do hereby certify thot the above ossets; were appraised in accordance with Pennsylvania low. yj' .c ('---~ ! ,J /{$-'.Pr1-1'H,r ~~pf(^ISrl1'Y" .;/ './ NA.ME OF PAYEE NATURE OF CLAIM 'MOUNT CLAIMED :';:tt:~;:.': l.1qrc~':{} '. "Pi ~cr~'~ ~~ ,"'ll (\1' "'; -: ~:. ir:r _ ." 'In,.!", 1 ", 11 J (]6)~.S(J ',' ;, t 1 ~ ~(' r:'.".','~" '. ,', '.); ~~ . ~ '~I t'~~'r: 1.(....~; .~ l-~.c.l.,'rl-t .' " j" ". ~. ,~ ., ('!1: ~ o. . 1 '... >', ) .....> ..:.L."., ,. ,. ~: . ()~.l ......J ,~,,:, -'14.' , ,1.j -.:..,.. 0..;- . , , ~:) -~ -' '-" TOTAL 1 (.; '. (;0 ,-:, . -- G"') /1./(- i .)~7) "'}.j '1 "-..i,' if IzU~1 {l I ,{u, ~-,j R!:"'".,'!' I~ Uf'o "ILL:" ,. Ult11 /1- ,'f.j / inlJUI.lI0"l'l ...i.......:'tn.;D