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Home My WebLink About81-00598 .. . ~ ~ . r>: ~ . ~ tj :xl U ~ ~ III . . :.: I( ~ III Iil Z ~ til B ::> III ,... CO '0 . ,.. ... N ~ >D la . ... -1. &.:I C()M\I()J\\'E.\I~I" J>E~l\:S':L\'A~I~ l. SS .......................................................................................... ....('..Vtrl.....et!;.............................c.OlINn , I ...................'8.f(I,I/7.l/l!cIt,fl,...... K,.......kI1t..IJJ./J. ............................................................... IIIl' 1'1'Iilhllll'r(,) ill llwaho\'l' app!i{"llioll. Ill'ill~ dlll~' . .............. at,(,tJnlilJ~ 10 law \;1)'( 'i) Ihllt lilt' !'Ilah'IIlI'III'i wi fmlh ill lhi'i pl'lilillll an' hill' In tIll' ht''il 01 ...i:I.~.S.." . kllllWII'd/-!I' alld lwlid, Sworn ..........,,,.. ;lllcl \lIll'inilll'd 111'1011' 'j~g~~:;~..;;;::;:::.:::..:....::::::::::..:::::::::..:.::: 1l11>)~.. .::;l?P.'I;~Il)l?~5..3Q'..:).. I!J....~J-... ...'::l2/fl1f/:.l!;" ?:Cad:4/....... j' 'l' Ill.~"h-r Fill.d, October 1, 1981 ,.....................................................................,................. Allonw)"s ~aml' illld Address .(] 1/1J1flf.f ....&..,. ..1J..I.I..~c.f.( tf.t,...J.~.I........,...... 11>p.p...l/!.'!.{...~f..f....t!!r.il..~,l:q~'!:!.'I..1.1.l....!..f.b.5'l OATH OF PERSONAL REPRESENTATIVE COMMONWI';ALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND }" : .."..............,..........71.l!.l!f(''!d~. ....I.<.....VMm,.(f"....,... ,.............................,.................."....,.,...,. petitioner(s) being dLW~' ......,...'S.,~,I?,.{?,!1!.........,........,........... uccordin!( to lull' do .b:$..... depose and say that as the administra ~~....... of the estute of ....~.lJ.~!.~4~.....K:......V.fl.t?.M.tt.....,..,..,..,....,....,....,..,.................. ....................................................................,................................................................................................................... deceased ........................ will well nnd trul~' adminisler the goods and chuttels, rights and credits of said deceased, uccording to law, And ulso will diligently compl)' with the provisions of the law relating to Transfer Inheritunces, ..............,..~,Wg,r.T.\...,........,........,.."., und subscribed before me, ~,.. S,~p.~.~!?~,~?:....~9~'......,.. '...,.. A, Il" 19,~.L, e 'J R~grt~~"''''''':'' .~,..........,....,...... BU~9- ~ '1-................................,..........,.........,....."......,.............,........ ..................,......................................................................... DECREE Be it remembered thc!~ll~A~e ..,........)&t...,........ <1a)' of ..............Qc,tob.er.,....,......... A, D., 19...8L Letters of Administration in the estate of ,......,......,......I?~.r.~.O!;\/l..r....K"...V.Ii.X',1;1)II...................,..,..................., .........................,....,.."......,.......,......,.,......................, late of ...,............. .~!1,R.t...p.,\HJ.o,~.l;l,Q.r.Q,..T.Ql:lnllb1.lt....... . Cumberland County, Pennsyll'unia, lleccased, were granted to ..,....~.\1MR.~r.\l!,I1.X'..,K...,'l~:r.rn\l"............... .....................................................................,.,.................................,............................................................................. O/~P Witness my hand and otlil'ial seal the day and year afores~lid:}. , /y;. _' ....,..........~~J~~..~..~ 61.3 . 21.8'1 5~8 IIEr.lSTEII OF \\'ILLS OF (!..u.!.'h~~::.L.!:l'!4...... COU:-<TY :-<0. pE'ITI'IO~ FOil plIOIIATE OF \1'11.1. A:-<Il LETI'EIIS OF AmIlJl:ISTIIATlOl\: Cll\l TES'L\\!E:,\TO ..\Jl:Jl:E:-W LETTEIIS OF AIl\II:'\ISTII.\T10Jl: \lE 1I0\IS \Oili LETTEIIS OF AIl\II\ISTIIATIOJl: \lE !J()\IS \ON CUM TESTA\IEJl:TO ..\~:\EXO ill till' Estat" of .~~/?w.dfl4.....K.'.......v..IJ..f!:.t!'&.tt........ <I",,,,:,,,,d. Pet itiolll"( s ), .....'8.Ift!.l!.l.~fl.I!!.~..... K,....lf.I.I!?m.'!!.................... .........,............. ........................... IIIll'g"(s) Ihal: is <IPP)Y 1. Pt.titimwr( s) an- hwnlY-llIh' yc.ars of a/!,(' or oldt'f and appHl1s for h'tlNS of adminhtration ../J!!.~..,...tf:..:i.~.~r:'.ft.......I11fI.A/~KO'.. ill till' aho"I' l'aplilllll'd ,'slall'. 2. Pm,d"al dkd Oil J.;iX..........1.'l,..I.'lf?l....................... III ..'7.....1.1:...\1. ill Ih,' Coollly of 1?.1f:!(..1!!f:i~......................, Sial<' 01 ..?~,J(.(r.:~r.&....... at thl' a~l' 01 ......1(1.............. Yl'ars, ha\'ill~ made .li.!,!....... Last \\'iIIlllld T"slalllellt dall.d III<' ..l'l..~ <lay 01 .....J....v...<y..................., A.n: 19..f.t. \Vh,'rein ................ appointc.d ,.....,,,............,,,,,..........................,,,.,,,......,..,,,,.......,,.........."................... l~xt'c ................. \Vhich EXl'l: ................ has silll'(~ ... ..........,... ...,.......,.... ......,... ....... ..,.. ,. ..." ,...................."...."....."...""................"............ all On ................ day of ...................................,......". HL".... Letters of Adminhtratinll \\'l'n~ granted to ..............".. .."..............".........."".............."..............".."".,..."....",............".,..........,........."....".......,......".....".....,............,...."".............. d.h.lI. d.h.n.d.,. b t .- ~ ~, 3. L<'lll'rs 01 Adminislralion ,'.I.a. an' nl"'II<-<IIJl'(\(II'" .A&...&XU................/!.......!!K~~.()<.. ..;. '/1 apply' l$..,#..~.kI....r.~.....'#!!......~~......,.............................. and P<'litilllJl"( s) applies in ....11.'.,$......... capacily a" ,........,......~.......;;:;~:~::;~;...;;;:::;..~;;~~;:;;:~..;;>:ai~;;-ylr.:~t.,;............. with his la'~ lamilYefcipal r.sidell<" III ...:?(....a~R.'~(Le'~:~7,~:~(!d&;?..,,J14~~/~........:..~. ,--- was wa.c,; 5. (Wht.rt. dL'("(~d('nl dit.d I('state) l)('{'(.dl'nt was .not marrit.d ilOd a child was not horn to or adopled hy d('C\.denlll!ter ""'I'lIlioll III Ihe will (and where al'pli...nl is alll'~ed spou,e) nor was decedolll di\'orCt'd from app1iCl.Ult afh'r ('X('('Utioll of will ami at (J(.;tth, 6,n,l' silid d(.Ct.d~'nt was poss('ssl'd of Goods. Chattels. Hights and Credits to the estimated valu(' of S".~~~"...... .Hld of H(~al Estat(.. to t11<' ('stimah.d \'alllt, of $.",,,..(.2........."'....... as m'ar as can he a,,<,rtainl'd. TI.al III<' said 1I,'a1 Estal<' ill Sll lar as kllown is hx'aled in .......~4.'-.............................. ...".."...............,...",...."".,.,.",..,.............,....,.............,.,..,....,..,.....".."......"....,..",...,.."....,.....,.......,....."...,.....,.....",.......,......... 7. ('Vh(~f(' deC1.(Jt'nl (!it.lI inlt'st<lh' as tn any portion of Ihis (.still('). PC'titiotwr afh'rei' propr:r 'l'",,'h has a,,,.rtai,,,'d Ihal d.~,,!.>nt was sll,\'iwd hy III<' follllwin~'nallll'd person' .'nlil!.,d I"\:!\i#rihnl~ undt"'r th(' Intt'~lal<' :\(1 of 1~47: 3.:;' . ::l'l", Namp. 1\('latioml1ip "e!ild(>n~c ~ 1..,.................,........................................................................................~~.::..,.......~. 2..,.......................,.........................................,...............,.....................................................,:::.:~..........::. 3, .............,...........,.,...,.".......................,.,................,.....,........",....,...".............,......,...,...........,.......,..."....,.........."t',..,.....~. 4. ................................ ........................................................ .......................................,.......,..<,;,. 5. ,.........,................... .......................... .................. .................................. .................................................:... 6. ............................ ............................ ................................... .............................................. .....,...........,......,..............,..,..,. .,.................... ........,..........."............. , .' ::o~ l"'ln wo (0";0 .;0 "',M " :7l apply llU'f(.fllfl', pdtliulIc',,( ",) n''''I)('(ifllll~' applit.s tor (proh.llt. of thc' will pn''''('lItt-d lU'u'with nnd (or) 1(>ttrr:__o~minj"tmlinl1 ...C.tA.. .......................................... .....rj................................................'.....".............' 1).,..<1, $e;n..$!',I?~/ Si~lll'd, ....?>t/.~~\.~....,.................li.... \,ldn'", ....'1...... (Pl~f)~C...~ {t;g,.f...~I:>~I(l, ~""1l1 '""'1 ,- I,Y IN,T Wl1 L In tLe pvent nf Ill.:/ dC:1th,'.~11 :'(.y rl~~I't': ";,(>LJd b\ 11':-'.11.'1'1 J'l'id in th(~' LC'.I:-!f".. C: [1",,/ Eru~,h(_'l',~-'hurj,r:ci~Jr l':. Varma. l\l.D., and [flY Sistf:r-in-JRw, r\~rs. Set~J(:a V8l'lri:', j:;.lJ.Ti1C' as~~(;t;:; jnciuric my ,88vings ptccount B.t Thp Fit';.;,t F'p'Ci12r:-i] .r~:'jr chcehing r~ccGur.t 8t CCNB and my 1977 Ford Mustang Car. I'. -'-,? ';</ "\ (\(~.-/-'- // (:::U!,j Jldm' K. Varm,q) .-",-- ,er1'i:---' -'S- " l;.' ~--(J /') '79 / 611 "', ,. :: 0 . . ," , "" " .., h,;:. G- , c.: C\,. U:::,L"l C/) r;:., DC' ;,::.. "'1'-' -'~ ~~, ~C::. ~ .~J,.J ~ U '" ~ . c' a.. " -.-' " .~: :, (, 0 ~::i' (. (:l M .. -" l&J~" c" AL~ 01 U-' Cl:'" "" 'm cilb ~::::'f" <'>w '"1:':':i ::!o:: ~ ~.iu ~ .J U ., . REV.lmEIl:+(2111) ~ COMMONW[A~tNSYLV"'NI" lXPARIMfNT Of IIEI/t.NUr allfAU O~ UAMIN""ION P.O. BOXIIJ11 HA.RIHSBURG. PA 1110~ INHERITANCE TAX RETURN RESIDENT DECEDENT \ """~.,,Zl:!i;-ll~ll == Decedent'. Address L( Co.mp' b,.U ()b.u... eo..~p \di It t P A- Ir') CH I CHECK 2, Supplemental Return 0 3, Remainder Return 0 APPRO, PRIA TE 4, Life Est"" 0 6, Decedent died testate r-J. (Attach copy of Willi ~ 5. Fad.rel Estate Tax 0 Return Required, 7. Decedent maintained a living 0 8. Total Number of safe 0 trust (Attach copy of trust! deposit boxes inventoried BLOCKS All correspondence and confidential tax information should be directed to: CORRE. SPONOENT Neme c'hcwJw A. 6u.e.c.hel , 9Y~o3~ RECAPIT. ULATlON Recapitulation 1, Real Estate (Sch.dula A) 2, Stock. and Bonds (Schadule B) 3, Closely Held Stock/Partnenhip Interest (Schedule cl 4, Mortgages and Notes (Schedule 01 5. Cash & Miscellaneou. Personel Property IScheoule El 6, Jnintly Owned Property (Schedu!e FI 7, Tranders (Schedule G) 8, Total Gross Assets (total lines 1,71 9, Funeral Expen.e. Admini.trative COlts/Miscellaneou. Expen.e.ISchedule H) 10, Debt./Mortg.ges/Liens (Schedule II ", Tot.1 Oeductionl (total lines 9 & 10) 12, Net V.lue 01 Eltate (line B ",inu.line 111 13, Charitable Bequests (Schedule Jl 14, Net Value lubject to tax lline 12 minus line 13) AND TAX CALCU. LATlON Add~O ~j~~. City Zi~ (II 0 (21 0 (3) 6 : ~: ---rr-o. ~ c::.~ (6)~- (71 0 (8)~~ ( 91_:2.::t'll1.~.'1o (10) ::~: -'1~\~{!''i (13) l:> (141 - n ~C\7.. ..,-" Computation 01 Tu t5, Amount of Iina14 taxeble.t 6% rete (151 !include v.lues from Schedule KI 16. Amount of line t4 taxable.t 15% rete (161,_ !include v.lues Irom Schedule KI 17, P,incip.1 ta. due (add tax from Iin.15 plu, ta. from line 161 18, Tot.1 Prior paym.nt" (al ' Amount Paid (bl Plu,Oiscount lei MinUllntere" (181___-- t9, B.I.nce Ou. Wn. t7 mlnuslin.16) (19) Mak. Check Pav.ble to: Regi.ter ut Wills, Agtlnt . . . PLEASE RECHECK MATH' . . ..--.---...----..----...--.-------------- ~.._---- Under p.n.lti.. of perjury. I decl.'" that I hav. e"mined thi, return. including accomp.nying schedules .nd st.tements, and toth. b..t 01 my knowladve IRd beliel, it is troe, correct, and complete. Declaration of prep.ref other th,n the penonel represtlnt.tive is b.~d Ofl ell information 01 which prep... h.. .ny knowledge, StGNATURE OF PEHSONAL RE'PRESENT A TIVEtsr-----.- ._--- -';;OOAE-SS' ...-- ....-- ---,-- DATE ------....--------.-..-----....-.. -_.-.._~_.._.._---'-------~..- SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ...----..- ol.n ADDRess REV.4~ EX+ UG-oa. COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT Surindar K. Vat~a SCHEDULE" A" REAL PROPERTY (Instructions on Reverse Side) I j I 1 j 1 1 I i :1 I 1 I i ~ ! ESTIMA TED DEPARTMENT ITEM DESCRIPTION MARKET V ALUA TlON NO. VALUE {OFFICIAL USE ONL YJ NONE TOTAL ESTATE OF I' ....J:.:........t ..__..... :.. ............._.... .....* Ql'.U .. "" ..\.. ........ I'lI:V-.5' ,l, Xt ~!J.eoJ COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSfER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "a" PERSONAL PROPERTY ~ .~:~~f I~,:~x~:i,,~ ~\<.'i':'~~~~~~t.. (Im,'ulJcrions on Rt.'vt.'rstJ Side) Estate of Surindar K. Varma ITEM NO. DESCRIPTION UNIT YALUE ESTIMA TED MARKET VALUE DEPARTMENT VALUA TION /OFFICIAL USE ONL Y/ First Federal Savings & Loan Association Account No. 2-1-611270 $1,454.59 Aetna Life & Casualty Insurance Company Settlement for collision loss of 1977 Ford Mustang - 5-14-81 $3,281.40 TOTAL 4 J}_..9L- II additional space i~ neceSSO't. use 8'/' . 11" sheets. QUESTIONS CONCERNING PROPERTY TRANSFERS 1. Did decedent, within two years of death, make any Iransfer of any materi.ll parI of his est:lte without receivinp valuable and adequate consideration'! (Answer "Yes" or "No",) NO 2. Did decedent, within two years of death, transfer property from himself! herself to ~~self/herself and another party or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) _ 3. If the answer to one or two aoove is "Yes" and the transfers :lIe claimed to he nontaxahle, provide the following infonnation: a. Age of decedent at time of transfer. b. Capy of dea/h certi fica/e. c. Affidavit by /he attending physician indicating the state of decedent's health al time of transfer. d. All o/her information supporting nontaxability of transfer, 4. Did decedent, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consider;jtio~() therefor which was to take effect in possession or enjoyment at or aftel his/her death? (Answer "Yes" or "No".) ----. a. Was there any possibility that the property transferred might return to transferor or his/her estate or be SUbject to his/her power of disposition? (Answer "Yes" or "No",) b. \\'hat was /he transferee's age at time of decedent's de:lth? 5. Did decedent in his/her lifetime make any transfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves far his/her life or any period which does in fact end before his/hi! death: a. The possession or enjoyment of or the right to income from the property transferred? (Answer "Yes" or "No".) ..l:O. b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer "Yes" or "No".) NO 6. If the answer to five b, above is "Yes," was the right reserved in dccedentllone ( ) or decedent 1,,,1 others ( ), 7. Did decedent in his/her lifetime make a transfer, the consideration for which 'lias transferee's promise to pay income to or for /he benefit or care of transferor? (Answer "Yes" or "No".) NO 8. Did decedent, at any time, transfer property, the bllleficial enjoyment of 'Iv11ich was subject to change, because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of law? (Answer "Yes" or "No".) )'Q 9. If the answer to eight above is "Yesl" was the power 10 alter, nmer;d or revoke the interest of the beneficiary reserved in the decedent alone ( ) or decedent ,1nd others ( ), REV-453 I::;X.. (10.80) . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT OECEOENT SCHEDULE "0" BENEFICIARIES Estate of /lnstruct/ons on Reverse Sirle) Surind.1r K. Varma BENEFICIARIES AND ADDRESSES SURVIVED DECEDENT Yes RELATIONSHIP DATE OF BIRTH ..7. 'II Bhupindar K.Varma 4 Campbell Place Brother M, ), :llJ'!tJ 4 Campbell Place Camp Hill, PA 17011 ~ ~ ~"', ~ (t~.'~ . ".\.~.- "f: l*'i\ ,I:&).~ ~ ~ .,'~:.~"~t;;.,,,:':':"~-:' . 50% INTEREST OF BENEFICIARY -....-..-- -_.~------.-- ----'-4 -- -- The above beneficiaries were living at the time of the decedent's death except for the following: NAME .--.------.-----1 , 1 --.--------..---- DATE OF DEATH I i I I I 0:: "" '"" < :;: '"" c '" '" " , .... ~ ;;.. ;.. E , III ,.; ;;- " ...l \ " I " Z > ,.; <: i '" '" 0 . :.: ,.; --<I '0 I .,; I ... " Vl ... i III ,.; " ;;; " , .0 ,.-j '"" , '0 ,,-. - ... - " ~ . III < '.-j rt\' "- ~ V 7. ... U E ::l " ~ C <n '" u U I .. i= ! I - 0 < ex: ~ "" C l- e If, 0 '/ 0 Vl If, ;;.- l- e ~ 2 f- '" I- W ;.r. 7, ...l 0 ,..:, .... ex: :z :.<: ~ ;c ~ ...l %. Z r-: c ;;; U 1.:' %. - C If. C C C ... ~ ::: < '"' < U :::J 0: ::i ---..----.-.. 'lS;iJD1U! s,IUap"~?p "41 jO an\e^ la~JrW a41 aleJiPU\ 'v 'ISaJalU! S,lUapaJap a41j" aD~IUaJJad aliI aleJ!pUI 'C '^lJ?COJO pau,",O ^pu!ol (l41jO aniP^ la~JCW jCl01 a41 alCJ!pUI 'Z; 'p84'Qqelsa Sri." tj'ljSJDUMO liJlOI a41 alep a41 pUP. (S) JaUMO,OJ S41jO IuapaJap . a41 01 O!4SUO!ICI'" pUC ssaJPfl~ 'aweu il.,l apnlJUI '..8.. alnpaqJS JOj [.UO!IJnJ1SU! aql U! paleJ!pU! se AuaooJO IcuosJao IIc o1qpJSao ',:If.. alnpa4JS JOj SUO!I:JnJ1SU' aql U! paleJ!pU! sr ^IJadoJd leaJ lie aq!J:JsaO '1 'I~Jlj alelH' leaJ IS" 'papnl:lU! aq 01 aJC A1JaOOJ(j alq!DUC1UI pUP. ('jq,burl Lll08 'dI4SJO^'^JnS;0 14"!J 41'M SllJruallu,o! se sa!lJed JO AlJed Jal;lour 41!M 1.11Ul01 Wapa~ap "lll Aq P?UMO 'ICUOSJ8d pur IcaJ '^lJaOOJO IIF .,pnpu! lsnw ..3.. alnpa4:JS ..3.. 31n03HOS ONIJ,31dWOO IlO~ SNOI10nlll.SNI .. REV..aS!J EX. 13-BOI COMMONWEALTIi OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INIiEAlTANCE TAX RESIDENT DECEDENT ~ ~~~!- 'l:';;~~ (... SCHEDULE "F" STATEMENT OF DEBTS AND OEDUCTIONS -- - - -- .-- - -- Estate of Surindar K. Varma Date of Death7-l9-8l WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING: File No. Claimant Bhupindar K... Varma Relationship to Derf~dm1t Brother Claimant's Address at tirno of Dt!Ct:,dcnt's Death 4 Campbell Place. Camp ~ill. PA 17011 ITEM NO. DATE NAME OF PA YEE REMARKS Evening Sentinel Administrator's notice Cumberland Lm" .TournaI AdmInistrator's notice R~gister of Wills Letters, short certificate Cumberland Co. National Bank Installment loan #0010068419 Myers-Hall Funeral Home Funeral exp~nse Rolling Gre~n Memorial Gardens Grave space, marker & granite base Harrisburg Hospital Blood bank 24.02 18.00 40.00 602.03 1,362.00 675.00 200.00 5,891.71 160.00 SO.OO 400.00 Harrisburg Hospital Mable Riddle Mae Rader Margaret Hiller Pannebaker & Associates, P.C. Bhupindar K. Varma Has ital bill Private dut nurse Private duty nurse Private duty nurse At to rney fee Famil tion Misc. filin fees 576.00 2 000.00 100.00 TOTAL I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts. funeral expenses and expenses of a.:lministration submitted to the estate as .<!\!ductions for Inh'~l itance Tax purposes. '1. I~I.I fcl"''---H PI ^y,,{- L, SIGNATUR[ OF FIOUCIARV DATE OFFICIAL USE ONLY DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S AT % TAX RATE AMOUNT 'SI33HS lOll ' "'IS 3Sn AHVSS3:J3N 51 3::JVd~ lVNOlI10av :JI 'Slqop o~1 6u!ADd ADI Aj!\!q!SUDdsOA O~I pownssD ID~ o~'" uosAad a~l Aq pou6!s oq jsnw WIOj o~1 'l 'paW!Dp 6u!oq Iqop ~~DO jO lunOWD O~j Aaju3 '9 'PDW!DP Iqap ~~OD 10j uwnlo~ S~IDWDI D~l U! UO!lDuoldxa jO!'q 0 ap!Ao'd 'S 'oDAod ~~oa jO sowou a~1 A81U3 .~ 'Plod .o/puo p.Jln~u! so", Iqap ~~oa ~~!~'" uo ajop a~j AOjU3 '( 'pIIS!! WO!! ~~oa 01 sAaqwnu oA!ln~asuo~ u6!ssV 'Z ,uwnlo~ Iunowo O~I U! 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S,alOlso a~l 10 S,IUDpD~Op .Yllloddns OJ D~UDpIA3 'PDlll SI wnlDH XDI a~UDIJAD~UI '~I WO~" ~!!" 511!/II 10 ADIS!6aH aYI JO 10AOJddo D~I 01 m!qns DJD 010150 UD ISu!oBD pOWIOp Bu!oq 5:q.p IIV '505 uadxD 10!A"q pDIOID. Ja~IO pUD AD~'OW a,oAli AD ',"5qWOI 'IOllo!.nq 0 l~ ISO~ D~I 6u!pnpu! -SD5uad,o IDl,nq puo IO.DUnj '5a3j ~Ao!~np!l '5001 ADUJOIlD 'UO!ID1IS!U!WPD 10 ISO:l '~j 6UIP"PU! alqO""OI~ Dl" swap J8'jl0 'alolso '0 IUOpO,.~ O~l h, pDlln,u, slqap OJ UO!"PPD"I 'alolsa ,.,qoxo. Aa'l/5!~ 15'\!050 alq'l~flp.f' DID '!Iaap Aa'l/S!~ 01 AOI'd jUapD:lDp OYI ~q pDAln,U! 5O!1!l!qD!I PD!jS!ID5Un NOIIVWHO::lNI XV13JNV11~3HNI1Vl:l3N3~ REV-4!1O EXt 00101 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDEllT Surindar K. Varma SCHEDULE "A" REAL PROPERTY ~ ~.~ . ,.:","\I;~ ....:1l~I' ',., ,./~~'lo.b '. ~ "'\;")(t'r?,~-;"i (Insfmctions 011 Reverse Sid" ESTATE OF ITEM DESCRIPTION ESTlt.lA TED DEPARTMENT MARKET VAl.UATION NO. VALUE /OFFICIAL USE ONL Yi NONE . . TOTAL 11.......:.:.....1 .."'.....~. ................. ....... Q','~" .. "" -~ ........ QUESTIONS CONCERNING PROPERTY TRANSFERS 1. Did decedent, within two years of death, make any tlansfer of any material part of his estate without receiving valuable and adeQuate consideration? (Answer "Yes" or "No" ,) NO 2. Old decedent, within two years of death, transfer properly from himself/ herself to himself/herself and another party or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) ~ 3. If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following infonnalion: a, Age of decedent at time of transfer. --- b. Copy of death certificate. c. Affidavit by the attending physician indicating the state of decedent's health at lime of transfer. d. All other information supporting nontaxability of transfer. 4. Did decedent, in his/her lifetime, m?ite any transfer of property without receiving a valuable or adeQuate consideratio~il therefor which was to take effect in possession or enjoyment at or alter his/her death'l (Answer "Yes" or "No".) -----.. a. Was there any possibility that the property transferred might return to transferor or his/her estate or be subject to his/her power of disposition? (Answer "Yes" or "No",) b. What was the transferee's age at time of decedentls death? 5. Did decedent in his/her lifetime make any transfer without receiving a valuable and adeQuate consideration therefor under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end before his!h. death: a. The possession or enjoyment of or the right to income from the property transferred? (Answer "Yes" or "No".) ~- - b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer "Yes" or "No".) NO 6. If the answer to live b. above is "Yes," was !'1e ri"ht reserved in decedent alone ( ) or decedent i\nd others \ ), 7. Did decedent in his/her lifetime make a transfer, the consideration for which was transferee's promise to pay income to or for the benefit or care of transferor? (Answer "Yes" or "No".) NO 8. Did decedent, at any lime, transfer property, the blJ1eficial enjoyment of 'M1ich was subject to change, because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of law? (Answer "Yes" or "No".) )1" 9. If the answer to eight above is "Yes," Wd; the power to alter, amend or revoke the interest ofll1e beneftciary reserved in the decedent alone ( ) or decedent and olners ( ), I I ~ ~ --< >- --< < -.: 0 I ~ "' " , r' I ~ :>- :>- E OJ , --< I >- I u ...l " " I Z I :> I --< .~ ". l ". 0 . I '" I :.<[ --< .1 'tl lJ'J -' --<, " ... '" --<. " I ;:; I r: .c ,'"' ... I , 'tl "'- :I: .. - " I" .. 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'aw~u alll ap"pul '..8.. illnpoqos JOj slJO!IOnJ1SU! a'll U! paICO!pU! $e AlJlldoJd jruOSJ8d IIc aq!Jasao '..'Ii" 3jnpa40S JOj SLlOpOnJI$'" 341 U! palCalpU! $t ^1J3dOJd leaJ lie aq!J:l$eo 'l 'ISJ!l alnsa IPaJ I$!l 'p;lpnlau! eq 01 OJP ^lJ~dOJd a,G!CUl'lUI plll' ~1415lJCl 4108 'd'4SJ01"^Jns;0 l~iilJ ~ll'" SlllPUaIIU!o! sc sa!lJcd JO AIJcd Jlo410ur 4W'\ 1'IluIO! luapa~8p aql ^G 1'"""0 ',CIJOIJalj pue Ical '^IJadeJd lie apl1pu! Isnw ..3.. olnpa4as ..3.. 31n03HJS ONll31dWOJ l:lO~ SNOllJnlllSNI REV."55 EX. (3'80) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIDENT DECEDENT . " f::;',t='.~f~~'t~~.... '.- SCHEDULE "F" STATEMENT OF DEBTS AND DEDUCTIONS ---- Estate of Surindar K. Varma Date of Dealh7-19-BI WHEN CLAIMING THE FAMILY EXEMPTION. COMPLETE THE FOLLOWING: Bhupindar K. Varma File No. Claimant RelJtionship to Decedf:-nt Br<ither Claimant's Address at time of Dl!cedent's DI2Jlh /, Campbell Place, C.1mp lIill, PA l70ll ITEM NO. DATE NAME OF PAYEE REMARKS AMOUNT Evening Sentinel Cumberiand Law Journal Register of Wills Cwnberland Co. National Bank Myers-Hall Funeral Home Rolling Green Memorial Gardens Harrisburg Hospital lIarrisburg Hospital Mable Riddle Hae Rader Margaret Hiller Pannebaker & Alsociates, P.C. , Bhupindar K. Varma J\dministrator'l notice Administrator'l notice Letters, short certificate Installment loan 110010068419 24.02 18.00 40.00 602.03 1,362.00 675.00 200.00 5 891. 71 160.00 80.00 400.00 r'uneral expense Grave space. marker & granite base Blood bank 11"5 ital hill Private dut nurse Private duty nurse Private duty nurse At to rney fee 576 .00 Fami! tian Misc. filin feel 2 000.00 100.00 TOTAL 22,128.76 I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral expenses and expenses of administration submitted to the e5tate 15 deductions for Inhe,itance Tax pur pOles. , ) I f A\l'."- \ I'\"'''I'~ \-' K -....., , '. ~1(~"'ATlJ~[ OF f"lDUCIARV DATE OFFICIAL USE ONLY DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ AT % TAX RATE 'S133HS "II x ,,'is 3sn A~YSS3J3N 51 3JYdS lYNOI1IOOY ::II 'Slq~p a~l 6U!~Dd 'Dj ~l!l!q!suDdsa. a~1 pawnssD SD~ D~'" uoslad a~1 ~q paU6!5 aq Isnw WIOj a~l 'l 'paW!D!, 6u!aq Iqap ~JDa jO IunDWD a~I ,alu3 '9 'paW!D/, Iqap ~JDa 'OJ uwnlOJ s~lowal a~1 U! uO!louDldxa ja!lq D ap!ADld 'S 'aa~Dd ~JDa jO saWDU a~llalu3 .~ 'P!Dd 10/PUD paJlnJu! 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P"I!)!UIOP pa!p O~M IUapaJap D jO "snods D ~q paw!o!' aq ~DW UD!ldwaxa ~I!WDj V 'alnpa~Js S!~I 01 pa~)DllO aq Plno~s paW!D)) 6U!3q slqap a~IIOj AI!l!qD!I 5,'IDIS' a'llID s,lUapaJap n~l poddns 01 aJuap!A3 'pal!! S! wnla~ XD1 a)UDl!la~ul a~1 WO~M ~l!M 51l!M jO laIS!6a~ a~ljO IDAolddD a~l DI pa!qns aID alDI5a UD Isu!D60 paw!DI) 6u!aq slqap IIV "..suadxa JD!."q palDlalla~iO PUD la~IDw llAD.6 .0 ,OJOI<.qwDI 'IOIID!lnq 0 10 ISOJ aql 6ulpnpuI sasuadx~ 10!lnq puo 10launl 'saaj ~Io!)np!l 'sUI ~awOllO 'UO!IOIIS!U!WPD ID ISO) Il~l 6u!pn!,ul alGowlDlJ a'D swap laqlo 'alolsa 10 IU'paJ'? a~1 ~q pallnJU! 51 'lap 01 UD!l!ppD UI 'aIDI" 'I'IOXOI la~iS!~ ISU!06D alq!pnpap aID 'lIDap la~is!~ OIIO!ld IUap,)ap a~l ~q pallnJU! U!l!I!'1D!1 pa!15!IDSUn NOI1VWHO::lNI XV! 3JNY11~3HNllV~3N3~ I . COMMONWEALTH Of PENNSYlVANIA COUNTY Of CUMBERLAND I I ..: Bhupindar K. Vanna . O_P __ __.~ -_... - -_._~,-~... -- ....- .,_.._.-~.. .. '--' - ~.._+, '. . -,-_....~.. -..-- ...----------.--. _..._---~ being duly ..__s\ro'u.rn_,~_. .._ ,-,ccording to I a''''', dCPOH~\ ..nd HIY' that he i.~j. .~_~e____.._^ __--- a~:;i~Hi~.?r--,- __,_ 01 the E,late of __d5!,U:!!ld;Jl'.!<. Vanna. .-----, lat. of ___....._ _ ___ ..._._ . d' __" ,___ ___,____ ..-- -, Cumb.rlan~ Counly, Pa" d.c....d and that tho within i. an inv.ntory made by ,___ _____,_.__..hi.I~, ,_- m.... ,_, ____ .... ,-- ., --, the ..id ...aUm1111.'ll:.ratoJ' - of the entire estate of said decedent, cCln~iJ,ti"q of clIl1 the penonlll propMty .,nd real ('~tt'Jte, except real e\hte ou~..:do the Commonwealth of Pcnnsylv~nia, and that 1hc (jgurl:\ OPPO\ito cdch item of the In'..entcry rcprucnt it's fair v,,:ue a. 01 Ih. dale 01 d.cedon!', death, i\( ut"L.U-_' tlnd subscribed before me, . ~~ rj) -;-,F6 LluuL-.._ " ....-- ---~..,. ..--..-..- t~Il:'..'ot . "'d~;niltuior iliac{ C' (j ,__ (it.,!." /:,.. -.> 19 f" ---.-..--- --...-- ') /l {ill .j.lc lL ---- j _____ _4C!'~nl'.be II Place [\I[/." R. CiJS';[R, H\1i!RY PUBLIC WlSt H~NOYER 11'/1'., OIlllFHIH r.O\INIY MY COMMISSION EXPIRES JUNE 4, 1983 Member, P<n",ylllni. Assocl.tion 01 Hollries Camp Hill, I'A L7011 ~ ._-"-_.. ,..-.--. ._-"_..._~...-.- .A..ddr.1l Dot. 01 Death 19th ,!\!ly. __ Month . J 9.al.. YUt C'Y INSTRUCTIONS I. An inventory must be filed within ihrec months "fte:r ~ppointf":"lcnt of pcrsol'ldl rcpre\cnhtive. 2. A suppl.ment invenlory must b. filed within thirty day' 01 discovery 01 additional a...ts, 3. Additional .he.ts may b. attach.d a. 10 p...onalty or r.alty 4. See Arlicl. IV, Fiduciarie. Act 01 1949. , ~ '" I '.. I' c. a:::'" o~'.: t3~t ",,"" o Z I II >- ~I -0 ~ ... u.I e ~ ~ 0:. ... ... . u.I -< l';! " a.. ... .:> u 0 '" " 0 u.I '" u.I . Q l- I a.. u. ~ ... .... . Z u. .... -< 0 ... a.. W -< u.I .. > 0 Z '" ." f; C c Z 0 Q '... . '" Z ... 0 0:. ::I U u.I -< Vl a.. '" c 4 - ;: 0 " .D ~ E . . -' u I II I " . I' ... ~ . . ... c ~ 0 :: < ... I .... ... I . 0 I ..: 0 r ... N '" , , ~ ~'.:: ,:; ~ t , cO , ::.)~ N f~~ ":') ,'::1 - (.'.:' 1--': C,J - INFORMATION ThiS document is the Notice reCluired to be given under Section 709 of the Inheritance and Estate lax Act of 196' (72 P.S. .ection 24851. If the tax IS paId within three (3) months after the decedent's death, a discount of 5% of the tax paid is allowed. InheritJnce Tax becomes delinquent nine (9l months after the decedent's death. Interest is charged at the rate of six (6) percent per annum on the amount of unpaid lax. (SEE eXAMPLE BELOW) EXAMPLE: If I balance of tlX due at 52.000.00 is m a dehnCluent status from 3-3-80. and payment IS made on 5-23-80. the mterest IS calculated as lndlcat!d below: STEP I DetermIne the rate at interest from the table below. STEP 2 Multiply the balance of tax due by the rate of Interest. STEP 3 Add the interest to the blllnce ot tlX due. Int.r..t from 3-03-80 to 5-23-80 Results In; 2 Months Ie: .010 20 D.ys . . ,00335 R.le of Interest II' .0'335 Balance of. tax due Rate of tnlerell.- INTEREST $2.000.00 x .0'335 $ 26.70 Ballnee of tax due Plus Interest to Cite of Plvment (+) TOTAL tlX and interest to DJte ot Payment $2.000',00 $ ;:6.70 $2.026.70 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .. - - - - - - - .' - - - - - - .. - - - - - - - - - - - - - - - - - - - , month .005 4 months .020 7 months .035 1 0 months .050 2 months .0'0 5 months .025 8 months .040 " months .055 3 months .0'5 6 months .030 9 months .045 , 2 months .060 1 d.y .00017 11 days .001B6 2' d..,s .00352 2 diy, .00034 , 2 d.ys .00203 22 d.y, .00369 3 d.y, .00051 , Z days .00220 23 d.y, .00386 4 d.y. ,00068 , 4 daYS .00237 24 dIY' .00403 5 d.y. .00085 15 nays .00250 25 d.y. .00420 6 dlYS .0010' '6 d.ys .00267 26 dlYs .00437 7 d.y, .00118 , 7 da~'s .002B4 27 dlYS .00454 8 dlY' .00'35 18 dav' .0030' 2B d.y. .00471 9 d.y. .00152 I 9 d.vs .003'8 29 dlYs .00488 10 dly. .00169 20 day, .00335 30 dlyS .00500 - - - - - - - - - - - - - - - - - .. - - - - - - - - - - -. - - - - .. - ------ ------ ---- -..----------- ---- Any party In tnterest, IncludInG the Commonwellln and the persoNl representative. not satIsfied With the appraisement and au.essment mI~' object Within Slxt. 160l days. after receipt tit thIS NotIce IS prOVided bv S.cllon 1001 of tho Inh."I",e. and Est.l. T.. Aelof 196' (72 P.S ..e. 24B5 - 100l). MAKE CHECK OR MONEY ORDER PAYABLE TO: 'REGISTER OF WILLS. AGENT' DETACH THE TOP PORTION OF THIS FORM ....ND SUBMIT WITH YOUR PAYMENT TO THE REGISTER OF WILLS fOR rHl: ::OUl'~TY SHOWN ON THE '<EVEoSE SEE THE INHERIT ANCE TAX INSTRUCTION BOOK fOR ADDRESS.