HomeMy WebLinkAbout81-00613
Ilrv.,PitlIXI P.IiOI
COM!.mNWUAl,l'fi OP l'ftNNYVLVANIA
DfMllTMPNT OP lleveNue
Tll^NHPftll INHenIT^N06 TAM
llUIDUNT DeceDUNT
SCHEDUI-E "F"
8TAnMENT OF DERTS
AND DEDUQTIONS
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Eslolo oL_~..tm~Jl1lJLl4. ~nIMmlW\H Doto of Doalh 10/4/81
WHEN CLAIMING 1HE PAMH.V EXEMPTION,OOMPI-ETE THe FaLl-OWING I
Fila No,' 21-al=.~1.-:L__
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Ilulntlollshlp to Duclldllnt
Clnlllllll\I" A[IdI08, nt llin'! Df,D[J[:"dnJlI!91~lIntl\
I~g~ DATe NAMe OF PAVU ,', REMARKS AMOl,JNT
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I horClbycor,llfy Ihet to thCl best of myknowledgoand bellof Iho forogolng Is Q Just and true s~atoment of dClbh, lunetal
expenses afld expenses of admlnlslratlon submitted to tho oslqte 9S deductions for Inheritance rax purposes,
OFFICIALG,~~I~~~v~t~w ;l~jcf~;~~t" L 22 ;tT~2.- 4
DEBTS AND OEDUOTIONSARE AI-I-OWED IN THE SUM OF $
AT
_ %TAX RAH
'H!aISTf~R OF WILLS
Unlotllfled IlabllltlOllncurred by the dec.dent prior to hll/h,r doath aro deductible ayolnlt hll/her'ta~obl.
..tat.. In oddltlonto debt. Incurred by the doc.dent or ..tote, othor lIel11l ore ololmable Inoludlng the COlt 01
admlnlllratlon, atlorney Ie.., Ilduclary Ie.., luneral ond burial 'xp'nuI Including ,thecoltaf, a'burlalla'ti tomb.tone
or graYe market and othtri.lat.d burlalupenl", . .
All debtl being claimed agalnlt on ..tote arolublect to tho approyalolthe Register 01 Willi with whom the
Inherllance Tax Relurn I. filed. EYlden~e,to .upport tho d.pedent'l or tho ntate1liloblllty lor the debt, being
claimed Ihould b. ollach.dto thlllch.dule,
A lamlly 'xemptlon may. be claimed by a ,paulO III a !f,c,den! who died doralclled In Pennlylvonlo, If there la
no IPOUIO, or If the .poUIO ho. lorfelled hll/her tight., then any child 01 the decedent who 110 memb,r 01 the lomo
household c,on claim the nemptlon, In the event th,re II no luch ,poUIOQr child, ,the ClMlI11ptlon con be claimed by
a parent or parenti who ore m.mbers of the I,ame housoholdos the docedent.The lamlly lK'mpllon la allowablCl only
agalnlt a..etl which po.. by 0 will ojr by thePennlylvonlo Intutat.l.owl. .. '
NOTEI, COl11p.n,allon paid to onntote roprOlentotlYel namely, on eMecutor or administrator, forserYlcel
perform.dln odmlnltl.rlhg,on ..tate II reportable lor PonnsylYonlo Income Tax purpo.... This taxable Incom\l
Iter,l Ihould be reported on formPA.40.lndlvlduollncoine Tax Roturn.
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. INSTRUCTIONS POR COMPI.Etl~G SCIiS.~UI.E "E"
1. If the filln,lIy,uemPtlon II bllngclolmod, Indicate the claimant'. nomo, odd rei. and his/her rel~tlon.hlp to
the deced.nt. Enter "Iarnlly ,xemptlon"'ln the remark. column ond thCl amount claimed In the amOunt ool.umn.
2. ABllgn consecutive nQmb.r. to each Item Illled. , .
3. Enter tho dot. on which each debt Wo, Incurred oncl/or paid.
4. Enter the names 01 each payee.
5. Provide 0 brlel'xplanation In tho remorks,column lor ,Mch debt, clolmed,
6. Enter th4lOmount of each ~obt being' claimed.
7. The Io,rm mu.t be signed by the porsan who,hos osaumed the responsibility lor paying thodebh.
11= ADDITIONAL SPACE IS NECESSARY USE BW' x 11" SHEETS.
It I' V-r111 {a-lIIl
COMMONnA~ TH OF paNNlY~VANIA
OHPARTMeNT OF RaVENUa
BURHAU ap Pla~o opeRA TlONI
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIOENT DECEDENT
'*
~ (MUST BE FILED IN TRIPL.ICATE)
TO THE PENNSYLVANIA DePARTMENT OFREVENUEI
Application II ~eroby mnda lor c (J\lOnl to tho trnnRlofof tho lollowlno $l)turltlos 01 n ~onnsylYanlo
Cotporotlon or 0 National Bonking As~oalatlan localedln PonnRylyanlol
(a) 100 i,)luo.!t(hL.l!onn BY1YAU!JLPO~!lr~cJLld;(jlL!~~r,omnl'\n.Y_ _...., (c) "JJonunonJH;Qtlk..._.__
(NOTEI In dOlcrlblng IOcurltlU enior In (a), ob 0.'0, olthor tho numbor 0/ sh~roB of stock or tho 10QO amount 01
rogl.tered bond., 111 (b), tho nome 01 tho IBlulng company (mdln (t) thoclU56 01 slocllor tho stulod Intorost rate
and mtiturltydate (II roglsterod bond.,) .
DATE J"fllll'.IlIU'Y"itl,_U 02
ISSUED ON .J\~.\Ul.t......4_.ll!i.!l, and having 0 TOTAL MARKET V AWE OF Ll, 0l2.50
(P~I.)
OR ul the data, oldanth 01 the decedent,
1)\U~11..llL.lL_..z.1jJ(l12J:l\l(IlL._~ ,...~., oll.JJ.a.t.olll::q:__d., ]9 Gl._
(Holno 01 po..do"l) (Dol. .1 ".olh) .
who was late 01 Ij () HOQr.w..:m..:L.Av.::,llUc..""..C;u:1J.u.lu....CUlilbl.ll:1Ullu..ClJl.1,Ilty.,.,.1'4lnn$yJ,lJan l.
(Str.., .nd Numb.,) (Po,t Offl..)' (Co"nty) (\1<11,)
Tho lecurltles Ore rClolltorod as 101l0wll_~.-'._.,_J~~\Y.'i.L:,_)h );,tlill'!"rJnBP." .,.,____n
, (Hame Dr "'I",OJ In whl~h cortlflcntDI f1fU rrwl,tnrfJd)
) .,
~N~' "i6" l\ C"',i"(,,.,..' ~O~" i.,,,.I.,,t. "tr".',t, "'''lOp 111'1 "a ',""".
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EXECUT~:< (Horn,) " (A"d,''''') .
NAME OF APPLICANT .... ..1.Uouc..\t._c.t'QaqOl:'
, 20311 Ml\rket Street
COUNTY FILE NUMBER n r1] 61.'l.ADORESS OF APPLlCANLn..Cilmp-lli.'\.1,~.I?a.,_~11JUl
BUREAU FILE NUMBER ,. SIGNA TUR E OF APPLICANT .~C;G~-"'(,~4d''::'L.C.~c......H~:r '--
HOTlce. IF YOU PAIL TO PROPIlRLY PILL IN ANYPORTIOH OF THIS APpLICATIOH, IfwlL.L. HQT ae
CONSIDeReD COMPLBTIl AHD WIL.L BIl RIlTURNBO TO YOUPOR COMPLETION,
,.,....'.....-....
COMMONWEAL THOF PENNSYLVANIA - DEPARTMeNT OF REVENUE
, " CONSENT TO TRANSFER_~gg~RITJEJ. .' OAT~~,~~,.L'1..J?a
I hereby ponlOnt to the,tr~nllerol tho aboyo socurltlos now roglstorod In the noma 01 tho olorosold
DeQedentond wolye .the filing 01 a cO,rtlflcote c:ertlfYIi1U'totl;o poymonl 01 tho lton~lllr InhqritOllCQ tax Wwhlch
tho property 01 .old Oocedenll. made subject pursuant to Ihe provisions 01 tho Act aIJuno~O, 1919, P.L. 521',
a"omendad ancl the Act 01 June 15, 1961, P.l.. 373, OS oll1undod. This Is nlsa In t1ccorclonco with tho provisions
of the Act 01 April 9, 1929, P.I.i343,
. This ConlOn,t to Tronslor ,tho heroin dOBcr,lbed proporty oporntos only In roloront:o to tho estate 01 th~
. obove.ndined DecedClnt.
*'
SIOnod lor tho SocrotlJ?Y of RovOI1Qo
~,Y:. ,Yl,.., -Q!'~- ..Q~.Jp,~, ;;:-,1" ,','," -'4k .>.AN-.\>...LM\. L
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<lI (Tlllo), (County)
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OATH m'I'lmS()NAI, RltPRt;sltNTATIV~
COMMONWEJ\LTH OF PENNSYLVANIA 8NI
COUNTY 011 CUMIlIJRI_ANI)
n~for~ m~1 the Roslstor, for Iho Probato of Wills and llrunlln80f LO,t\Qts of Adllllnlslnlllonln and f(lf the County of
Cumberland, personlllly Clll110~ . M,Ic:'B ?. (,.Fl~IIClr.n.
Who, bOl"S duly, flworn I do_~~doposo and say that as--1WeC1\lt r. b:
~
of the last Will and Testamont of
, bl\YflIF. n. ~~MMI~ml1\N,
deceased
\lh~, _will well and truly admlt)l.ster the 800l\s and ohattels. rlshls and orodlts of s~ld dooeased uooordlnlllo luw, And
plso will dlllllently eomplywlth the provisions of tho law relatlnsto Tr.ansforlnherltllnoes, fll~orn nnd sublorlbed bofo,e me,
nn~nhAr7,'t
1\'.0., 19 91
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D1!:CREE
ne It remembered thllt ,on tho
7th day of
ootober I
"
;A,O,,19 R 1 I therewuspr\lbated and
reoorded the lust Will undTostamcnl of
the nOrol,\9h ofQllrliB].o,
Daoeas~d, Lottcrs Testamentary woto srallted to
Wllness m)' hand alld offlolal scnllho day and year aforosald,
bllYAIE R. ~!MME,m~lIN.
latc of
i Cumberland County; Pel1llsylvanla,
IIl,Icr,: Z, CIUU\Olln.
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I;ulli.I/.1 {, ',I' ,
INFORMATION
Thil ~aQum.nt la Ih. Nolle.requlr.d 10 bt glv.n und.rl1'Qllon 709 of lh. I~h.rlt.nat .nd elllt. T.~ Act
at leel (72 P,S, "Cllon 24811),,' ..
if th, \lK lap.l~ ,within Ihr.. (31 month, .fter Ih. ~.o,~.n\'. duth, . dl.oount of so/, of Ih, ,laK p.ld I. .Uow.d,
Inh,rU,no. T.~ bioom.. d.llnqu.nl nln. (9) mantha ,f\lt th, ~.o.~'nt'. dUlth, Inltr.1I la Oh'tg.~ .t the
1I1.0f II~ (s) p.ro,nl p,r ,nnum on th, .mountof un 'aid tax, ISee eXAMP~eBe~OW) i
aXAMP~el If. b,ltno. of t'K due of '2,000,00 I, In . d.llnqu,nt al,lua from 3~3~80, and p.ymanl la m.d.
" On s" 23~eOi Ih. Int.r,al I. o,loulal,d u In~le,"d btlow:
IUP 1
o.termln, Ih. nit of
Inter,.t, from th. lib Ii bilow,
snp g
Mulllplv, the bal,ne, of
I.. du., bV th. ral. of
Interut,
ITlP a
Add th. inter"t
to th, balane. of
ilK ~ua.
Int,r.,t Horn 3~30~BO 10 6-23-BO
R"lllla In:
" 2 Monlh. . , ,010
, 20 oav. .,.. '%'lm
R.1t ,0', Int.t," · ,
Bel,ne. 0 f IIx' due
Relll of Int~nlReBT
'2,000,00
~ ,01~3e
. 2 ,70
8.I.nO. of I.~ dUe
PIU. Int.rtll 10
~t ~f PeY~".nl (+)
TO IK .n
Inl'rtll 10 Oil'
of Plvm.nt
'2,000.00
. 28,711
$2,028,70
~-~----~~~~~~~--~~-~---------~-----------------~--------,-------~-----
1,montll ,006 4 month. ,020 7 month a ,,03S 10 monlha ,OliO
2 month. .0 I 0 8 monthl ,025 B monthl ,040 1 I monthl ,osa
3mbnlh. ,0'8 8 monlh' ,030 9 monlh, ,048 12 monthl ,080
--------~------------------~~-----~----------~------~~-~-------~-~~--
I daV ,00017" II dm ,001B6 2' ~.va ,003\12
2 daVI ,00034 12 d.va ,00203 22 diva ,00~89
~ ~iVI ,00081 13 dlvl ,00220 23 d.ya ,00$8
4 d.v. ,00068 I 4d1V' ,00237 24 d.v, ,00403
8 dIva ,00086 III dm ,00280 28 ~'V. ,00420
S d.v. ,00'0\ 18 dlVI ,00281 2 e diva ,00437
7 ,~aV' ;00',8 I 7 diva ,00284 2? d.V' ,00484
~, dly. ,0013S 18 ~m ,00301, 2S diva ,00471
d'vl ,00182 '19 ~m ,0031S as d'V' ,g04$$
10~.V" ,001ee 20 dlVI ,00338 30 ~IY' , 0800
Anv petlv inlnlllt.", Inoludlng Ih. CommonwtlUh ~nd ,the p.rlonl! r.pr...nt.Uyt, nol ..1111!ed With th,
'PPr~I"Il1'nl .nd ......m.nl mav obj.ct Wllhln IIKlv(60) d'YI .H.r ree.lpl 01 Ihl. NoUIl. .. ptoyldlld bv
Seollonl 00 I, of Ihe Inh.rlt'ne' 'nd hi." T~~ AOI of 196 I 172 P,S, ..e, 24S0 ~ 1001),
MAKI QtlIQK 01\ MONIV oRDIR PAVAI\.! TOI "RIGUnR,OP WI\."S" AGINT"
DST ACH THS TOP POIlTION OF THIS FOIlM AND SUllMIT WITH VOl,lR PA VMSNT to THe RS01$TGIl OF WILL' "OR
THe COUNTY SHOWN ON THE RSVSRSE. seE THe INHERITANce TAX INSTRUCTION BOOK POR ADDRl!SS,
'SJ.aaHS 1111 x ,,1,\8 asn A~VSSa::laN SI a::lVdS 1VNOIJ.IQOV:J1
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