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LAW\' Wll,LAND TlilS'l'AMl'JNT 01,1
,TOHN D. B1M'I"I'm
'I. JOJ'IN D. HlDA T'rrID, HI nglo mun. of 11 0 HI g Spring A vonUl1 In thr,l
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Borough of Nowvlllo, Cumhel'hllld CllUpty, PonnH,ylvl\nla. ht'llng of sound und
dlspol-llng mind, momrwy undunderstundlng, do hUl'oby mako, pllhllHh und
deolare this us und for my IUHt Will und Tustumont, horohy revoking und
malting void any and all Wills by me at Hny time horfltofol'a made,
1. I direct my hOl'einuftol' nHmed J~x(Joutor to pny l\lI of my JUHt tlobtfl and
funeral expenfllHI as soon ufter my death IHi may bo found convonlont t(l do so.
I dirent that my body be Intflrl'od on my h\II'.lul lot In Spl'tng Htll Cometory,
Shlppenshurg, Pennsylvania, and 1.Il1o\t the yeul' of my rhmth he Inscribed on
the monument now sta.ndinf.l on my lot.
2. I give und hequeath to my niece, Mury lUllen Hibbitts, of4085 Ii'M
'Road, Manlius, New Yorlt, whatever automobllo I may own at the time of
my denth and the sum of One 'rhousand ($1,000.00) Dollars.
3. I give and bequeath to IUdith Beattio, wife of my brother, Harper BeatU ,
of 14 Pursonage Stroeet, Newvllle, Pennsylvania, all shares of stock in any
cprporatlons which I may own at thl) tOne 01' my death together with tho sum
of One Thousand ($1,000.00) I)ollars.
4. I give and bequeath to my nieee Haehel B. Sullivan of Bremen, German,
the sum of One Thousand ($1,000.00) Dallal'S.
5. I give and bequeath to my nIece, Mal'y B. l<ossler, of Chatnbersbllrg,
Pennsylvania, tho sum of One ']'housand ($1,000.00) DoUat's.
6. I give and bequeath to my nophew, Aloxalldol' D. Beattie, of Chambers
., Pennsylvania, tho drop~leaf table located In tho fl'ont room of my residence
together with tho SUIn of One Thousand ($1,000.00) Dollnrs.
7. I give and beque(1,th to my l1ophow, Mervin Heattle. of 12751 Elm Street
BlllOIslancl, Illinois, tho sum orOne Th<lullund ($1,000. DO) Dollars,
w
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OATil (W HlJIlSt:HIIIIN(j WITNI\SS
COMMONWllM:m OFI'IlNNSY,",VANIA/ HS:
COUNTY 01' CUMUURI.ANI) ,
This....... '. ~~nrl ~nlj ?8tl1. "'--duy. of . Onl nhl'll' A,1),,19 III ,
boforo mo, Roslstor for Iho l'rpbnlo of Wills nud SrRRllnslollors pf Mllllul~ll'Rlloll/u 1I1ld for slIlQ COl1l1ly of ~UQlborll1l1d, In
tho C\lnlmol1wol1lll\ Of Pllllusylvlluln, l?or~oUlllly cnlllo Ropel'! M, lel'ey n 1]r1 ,Inn '1 , n, I1'l'Y'
· ..~. -~.11 Il.ll _.IJ
tho sub~cr/bhlalYltnossos 10 tho fOlogolllglu~lrllrylolll of wrllltla PlInJOr'tlllg 10 bo Ihq'ln~t Will nlld Toshlmonl of
,
JohnO. BeAttie 1)"IOd ....JUly 20. 1070 And NovelUbel' 30. 1 f.l7~.
respeotlvely,' ','
Into ot....... HornUflh of Newville -_Cumhorlund County Pu" dooousod who bolna Quly
~orn uooorQllISI\l II1W,doposo und suY, thnt. HIRY "''''I'll
prosolll, und snlY I1nQhourd Iho losln tor
.Tql1h OJ TlAQttle SISR, sonl, publish, prOnOllROO und <looll1rO.lho sl1ld
. .' . 'l'l~'fiU" 0.1111._' ,
,'ln~trllITlOIlI oNrltlng us aud fpr his . TOSII11l10RI,"nd Last Will, nnd "t the tlmo ofsodoln8 oJ phn D. n~aHI\'I
WRa of sOIl~d and dispOsing mlnQ momory I1nd undorstnndlRg,lo Iho host of
~nowlodlio, observlItlo.n Rnd bollef.
thAi!'
--
sworn
,lIl1d sllbsorlbod boforo'
I",... ...... / 1-.
r"f<-:-- ......./
Rbef.t M. lCl'ey
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Roalstor
AFnl>AVIT OF DEATH
~6~:N;E:::E::~~NSYLVA~IAr 551
Mal'y E~len Hlpbltts
SWOlin
, sUY,s thul 115 nellrly 115 cnll be nsocl'lRllloct Ihe said dccQQon't.....--1..ohn O.
'bolng duly
l3eattle
--..-'
TtI~sdayH
111 or Rbout
died on
:A.D"I~.JU..,
SWqrn
20th dnyof,
o'clock, ~M\
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Octobel'
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, . 22nd duy of, Octobel'
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Renunciation and Request
~...............
In tho, Mittor or tha:n'hlto of ...",,,..,,.,,.,,,T,Qh,n,,J~.t..J"'.p.t~11J.9.,..,,..,,,,,,,.,..,,.,,..,,,.,,""""...."..........,,,,,,'.'''......''...''..1....
To li,t,......."......"M~);'~..Q,~....l,.~,w,\I;I...;.~.....,""'"..."",,.."",,,,,,,,,,,,,,,,,,.1111....,,.."'."'1 nsqll R08htor (Ot- tho ,Probate of
'WUI.' Ind Sr.ntinll Lottol1 of Admlnl.tr.tlon. for the CQu nly of Cumberland, In tho CQmmooViOlllh of Ponlllylv.nll,
....,1....., iho "ndolslanod, being the ..".":w,1;I;~,p..\lt,r.,I~.,p.,!,\m.9.fl,,.I.\1JI1,\t,9.m,1!.~.I~,,~R,.M~~J~!~!H..W.m..~.m.t"
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'l'Gat\\msllt of ,John D. ]jet\ttla, .Wllloh Codlcllla dlltelHuly 20,1979 and the
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WI11 to .Whloh It III a CocIlo\1 la duted Novl:lmbor 3D, 1073,
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do her~by renounce .,,,.,,,..,,,.,,,....,,,m~......,,,....;;..,..,I..........rIBht 'to have Lettor, ...,..,"'~:,\?4~tJlm~,O~#i\ry."......"......,..
..,,,.,.....,........i.,,,,,....,....,,..........,...........,..........,. on .ald Dstl'to J.&ued to ""....,.,'"..."........ro~,....";....:;.j...,.........,,.,,"""'1
...,...............,:\!),~.I,t.I.'\.,a,lilF.\tU,lil"..,......."..,..,:..,""',......,........ ,..........., ,...... "............. , and do hereby'request yO" /0 sr.llt
th~ ...ruo to .....;;,.m~.;~~9.s~~~~.r.A...M!?:r.Y.,,~,n.~.QJ:l.t.~.RJ~'~~. ,,,,,,...,. ,..,...,.......................""..i;"-,:.-".,.j,..',j"...,,.;i...".
.Wltness",... .m.Y..'.... hand. ...........,.' .and seal...-.,........" .thls.....,..,-...,.,~.~ .tl~.,.t.........."."...,.." ,..,if,., ."....., ..;", "..".... ""
day of ..'..,"jj...Q,9J.g,1~1~.r...jj.,h".,",.";.".,.,,...,.A'. D. 19.~,~...
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, . .' INHURITANOe TAX RllTURN
. ("MlKr~\oj/JII'.':AI~Q,IW"". ' .... Jl.ll..8.IIP.~NT p~..?IiPe~:r - .' -.
,*~!)}'r.'.1 .., , fi ...... II ~j~' S .:}!J - I PII, NUmbOr.~
0, dllll'I NIIII' Il..I, PI II, I1d Mlddloh 1111 . OUOOIIOl1t'I Addru I '.
PEo,~..o,...,~~o...\..\...~..i.L..,.~Q~I.,...~L._--~ I\DS,' &iQl ~M'~ ~rJt.t')ut.
ullut'fsbourftvNlllliln" lllIoof Do'lh . . . U P AI U
._~,,_... \'1C',"~~:"~J.oS..,.,,,,,.1()~..~Q,:.iL---..._.- N~~vU~. I ialJ,.\
OHIUK '.' Ollulllll nIIU';' IX] 2, BUPllloOlollt11 (11111111 D 3, Rumllndlr(luturn 0
. 4, LIIu ~lIllU [J .. 8, Fudlrol BlIBlo TOK D
Rulutll Roqulred,
6,..11.101. dll.'1 dl.".I.II.lt....I... r. 'V--". . " . 7, Olcldunl 1II0lril,IIIud IIIvI110 0, e, Tntal NlImbur of IIfu 0
, J~J!!'lI!nll~Y!!t\YIJI!.JdkL._,~__.!LI!!!.LAttlah CUI'Y 01 tr~!!!-.. dOllnll1 !)OKIlI Invuntorlod
All oo""llIll1dlnul Mild oUlllhlunlll1 I'K IlIfurrl1ll1ulllhDUld hu dhoclld tOI
00""1,___ ... ,-_.~ ... ,,~_'''''_-e.._''_''_~'_~_ --- ._-,,--
"ONO~NT NIIlII(\ " ~ . - ,.. 'Alllltot;----. __~
;f,ii;;ilQ~?~dc__.ff\'L p.~~_____._ 8t1t'\\~~~~~6~~ To
_~_.. ":"Cc~'i'O.:.,-~~ ~~ ~= SIIII
"...pllullllulI
1. (1.11 nile In ISchldlll1 AI
I" Slockmd PUl1dl ISchadule 81
3. Ololuly Itlhf Slauk/Pnltl1lJ1hllllntornl( (Sohldulo C)
4, Mungngllllld NotullSchldul1 01
9, Ollh a Mllc,lIanuolII Peilunal "tallurty ISoholflllc E)
0, 'Jullltly Owned Prullurly (Bohedlllu P)
7, TIIIIIIII1 (Sohndllln 0)
8, 'futll Orull Allltl (tulel. 111111 1<7)
O. Pullerll 8~lIunlOl Admll1lllrltlvu CUIU/MllColloncall1
EKll,nlullSohudul1 HI
10, lllbtl/Murlg,gOl/Llonl (80hldllllll
11, "ulll Olduollonl (tutllllnOl S& 10)
'I, Net Vllul uf Bltilu (11111 B mlnuI IIno 11)
OAlOU. 13, Ohlrlllble Oequeltl (80hldulu J)
ll\TION 14, Nel Vellll IlIb/uct tu IlK lIIno U,mlnulllnl 131
"p,no,
'"I"TI
'LOOK'
nIOAPIT;
ULATlON
AND
TAX
. Zit)
( 11_~~.5!l.Q,OO
( 21__
( 31
I 41
(6).. \\1, Sc?'''1,If~
( 0) ,
(11
, I BI J94~O~I"/,I-\-~
( 9)
(101
m: \i~~l~~
(13) '.' "_
(14) ~1.1 ~G\Q\,l...r
Cll\1putlllon uf TiK
\6, Amuunt of line 14 Imblu 11'8% retl lIB)
(lnoludl Vlhlll f,ram SChld"le K)
10, Amolllll nl IInl14 tmble at 16% ratl (lBI1~~~%. ~ '"
(llItlllrle vl!lIOlfrum Sohudulu K)
17. Prlllolllul tlK dllO larld ilK from line 1811hil tlK from IInllBI
IS, Tntllllrlur pnymonlll
(,) Amount Paid
, (b) PluI Ollcuunt _
(01 MlnllllnlltOlI (\81
10, P~llncu 0110 IIIno 11 mlnulllnllB)
M,ku ChlOk PlYlblu lu: Augllllr of Willi, Aount
· · · PLEASE RECHECK MATH · · ·
K,OB~
K,18~ 0
(17) ~j'j 0
(19)_
---""'<'-'<,~ ,~"""-"-~",,,-~-,,,--,"------'--_.
Ullder PUIIIIIIII 01 lIerlury, I doellre Ihlll have mmlnud thllJUturn,lncludlllo occOlnllonylng I8hoduloland l'ltlmuntl,lnd tu thl bell of mv knuwludgl
.nd h.llol,illl Iml, riil 001, IlId camllllte, Doolmllun of IIroplretathur thlll thu penonal rOllrol8ntlllvll1 bUlud un IlIlnformlllan uf whlah rePlllr hlt
10Y knuwlldO,. '
ADDRESS
'iiOiiATiiiili of.""AiiiiAIlERoTHER-rHAN-fl n PR ESENT A TIVE
'i I V~.I 'lI I . t Itl-~f'l
rOMMONWfAI. Tit or PBNN$YLVANIA
OEt'Alln<\eNl' or RBveNue '
TRAN$I'UIlINliBllITANCP TAX
RESiDnNT occeoeNT
SCHEDULE "B"
PSJlSONAL PROpeRTY
(11IItt/1Clt11111S 01/ 1IIIVUWi 5/(/01
B81010 of
John IJ, ,HulltJlu
---
It~~
DBSCRIPTION
vUfL'J fl
I, Bulanoa oheoldl1g accouut #014-207-2, 'rhe
JlIlrat Nanoltnl13nnl< ,of Nowvllle
2, Medloare Chellk dated ,July 16, 1981
3, The followlng Certlfloatea of Deposlt, The
li'lrat Natlonal Bank of Newvllle:
#AR1050
Accrued lnterest to Octobel' 2b, 1981
#AR2146
Accruedlntere~t to October 20, 1981
#AR694
Acol;ued lnterlilst to OlltClber20, 1981
HAR69p
Accrued lntere st to Ootober 20, 1981
#AR696
Accrued lnterest to October 20, 1981
HAR699
ACQ,t'ued lnt t;lr E!,stto October 20, 1981
#AR700
Accrued lnterest to October 20, 1981
#.'\R701 "
Accrued lnteres,t to October 20, 1981
#AR702
Aoorued lnterlilst to October 20, 198.1
#AR964
Acorued lnterest to October 20, 1981
#A1\2138
Acorued lnterest to October 20, 1981
#AB 1484
Aocrued lntel'est to October 20, 1981
#AR1031
Aocrued lntereatto October 20, 1981
#AR2094
Accrued Interest to October 20, 1981
#AR 1498
Accrued lnterest to Ootober20, 1981
4. 1 shar~ Cumberland,ValleyCo..O!l. Asn.
pfdi stock <1il ] 0
TOTAL
If additional .poce laneceuorYI use aW' K 11" sheef$.
BSTIMATB, D
MARKI!T
VALUB
4,394,86
2!l,OO
6,000. pO
196. 00
1,000,00
32.33
20,000,00
1,05~.66
20,000,00
.1,01\6,66
20,000.00
1,066.66
1,000,00 .
52.6.3
1,000,00
62.63
1,000.00
62,63
1, Dad, 00
62.63
6,000,00
262,60
6,000.00
262.60
6, 000. 00
261.66
6,000,00
417;33
6,000.00
21\6,33
2,000,00
100. 00
10,00
,
'"
,~
, r,'1-"t,., i
i <",,..'
DflPARTMflNT
VAI..UATION'
IOF/'ICIAL lISE all/L YI
ItI!V.."ht Ua (~~~O)
COMMONW8A~ TH OP PEI'l1'l5Y~VANIA
.. pePARTMl!I'l'T OP ReVENUe
TR/lNSPER II'lHERITAI'lCE TAX'
RESIOEI'lT ,PECl!PENT '
8CHEDUL~ "~"
PBRBONAL PROPERTV
IImtfllor/PIII un HOVorso S/,lo)
e,tatu of _ John D. Beatt le
I~~~
DBSCRIP'tIOM
UMIJ
VAL ia
. eSTIMATED
MARKeT
VALue
DBPARTMeMT
VAl.UAT10M
IOFF/dIAL USg ONL YI
I'l. ltedsJnptll;m of 60 shares Chal'.lestown' Haolng
Asn., Ino. oommon stool~
92.60
6. prooeeda sale oUuel oil and alr condltlonel'
1,000,00
7. Oros's prooeeds public eale of per al nall:Jroperty
B. Dl'o'p~leaf tabl. and mlsoellaneoutl houeehold
geode not sold atpubllo sale
4,269,20
1,000,00
9. ltefuridj Swaim Hea1th c~nter
10, 'Helll estate'tall. pro-ratIon
503,53
111?39
TOTAL
117,587.43
......--_..-------
\I ~4,dltlonal spaco 1& nocoaaaty, uusYl" ~ 1)" .huots.
IWESTIONS CONCERNI~G P~OPERTV TRMiSFERS
1. Old,d,9cedent, W,I\h, In !woyems of <<euth, maKe any transfer of any materlnlllart of his estu\e wlthou\ recolv1nn
valuable and adequate conslderotlDo? (Answer "Yes" or IINo" ,) No ",
2. O,ld dec, edent, within two year,s eldllOth,' \ransferproperty from himself! herself to hlmsolf!herself and another party
or parties (Iocludlog a spouse) In!olntownershlp? (Answer "Yes" or :'No",)...tl2-.
3, If the aoswer to one or two alxlvels "Yes" and the transfers are claimed la, be non\axable; provide the fellowlng
Information:
a, Age of decedent at time of transfer,
b, Copy of death certificate. ' ,
c, Affidavit by the attending physician Indlcatlog the \ltate of decedent's health at time of transfer.
d; ~I\ other loformatlon supporting nontaxablllty of transfer. '
4. Dlddacedent, In his/her lifetime, make any transfer of property without receiving a valuable or adequate consideration
, therefor Whl,ch was to take effect In possession or enloyment at or after his/her death? (Answer "Ves" or "No".) J~o
a. Vias there any possibility thai the property tra(lsferred 011 ght return to transferor or hi s/her estate or be subject
to his/her power of disposition? (Answer "Yas" or "Ne".)
b. What was the transferee'S aRe at lime of docedent's doa\h?
5. Old decedent In his/her lifetime make ariy transfer wltheu,\ receiving a valuable and adequate consideration therefor
under which traMferor expressly or ImpliedlY reserves for his/her life or any perled which does!n fact end before his/her
death: '
a, The possession orenloymei1t of or the right \e locome from the property transferred? (Answer "Yes" or IINo" ,) NIL
b. The rl ght \0 deslllOate the persons who shall possess or. enjoy the properlY transferred or Income, therefrom?
,(Answer "Ves"or IINo".) No
6. If the answer \0 live b, above Is lIVes," was the right reserved In decedent alone ( ) or decedent and othels ( ).
7, Dld,decede(lt In hls/h~r Ilfe\lll1e make a transfer, the consldera\lon ,for which was transferee's promise topny Income
\0 or for the benefit or care of transferor? (Answer!'Ves" or "No" ,) No
8., Old d~cedent, at any \lme, transfer property, \he booeflclalenjoyment of which was su~lectte change, because of
a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of traosler or by eperatlon of
law? (Answer "Yas" or "No" ,y No . '
9. If the answer to eight above IS "Yes," waS the power \0 alter, amend or revoke \he Intores\ of the beneficiary reserved
In the decedent alone ( ) or deced(m\ and others ( ), '
ItIV.4bJ 1)(1 110.UOI
COMMONWPAL TH 01' p~NNeVWANIA
DBrAl\TMENT OP ReVENUH
TIIANarlA INHBRITANPe TAX
nHalDENT DHCHDeNT
E8tate of ...
.John p, Ul)(\1.lla
SCHEOUl.E "0"
PI!NIlPIOIAI1IIlS
1I/lIIrIl~r/rlll' till RUVtlf'l1 Sldll}
BBNBPIOlARIU8 AND ADDRB881l1l I11lLATION9HIP SURvlVEP DATE OP INTUR68T OP BI!NI!PICIARV
DIlOEoeNT PII1TH
Mnry Inll.lWJllbbltt~,,--,._-,,-"...__ ______.......--__.~_T~+..........~_~_. ......_,,...._~-<'~=._T.~_~ ~~~.........._,..K__ --
49fl5 Ji'nyatlev llle Hond .
-_...............--~.~ . ~....- -.---
Mnnllua, New '{orl< 13104 nlece YOH $1,000,00
- -
.
~. -..-..----.......---- ------' --
r~d lth BllattlC:l, sUl'vlvlng fJ\>ouaB t f 11 lll'lIol' }3ol\ttlo , All ahal'ea Qf ,stab 1<.
-14 1'111' sonage Stl'eet $1,000,00, IJlus 7 tWo
, .... 17241 alalel'-lll~ll\w yeHI of l'ealdUe pf
NewvLUe. PR, e atate
-
..
Rachel B. Sulllvan
936 Wallace Avenue ,
- ijll, 000, 00
Chamber sQurg, I'll. 17201 nleco yes
, .
---~-_._--_.~.,..,,;.~_.~.....-.,....-.,--~...--- --~- .-....,---....,.--, _ _____~___~_.~Uh_ ~_.~_. ~...~~_._n .._._._ --~~~~,-~,~,--,-,,",--., -.
Mary B, Keasler
-'
1000 WaUace A venue
, -
Chambersburg, Pa, 17201 nllloa yaa $1,000,00
-- -- ,
, ,
, Alexander D, Beattle ,
--_._-~.._..- ._________._'"~m_.~___~..~ _.........-.-.....~- .-...., ..._~--~--,....--~,... ...~-.-...~~---_._~_._._...._. --~
700 H 19h la,~d A venue _..._._.~-~~,~_. -~~-~------_._._... ---~---~......~ --.-. ._."...-"~~-~ ,,--...-".. ~ .-.-..--.-,..,-- .--.."" ,- ..... ..---..~ --"-... .-....-.---- .......
Chamberaburg, Pa. 17201 nephew yea $1,000,00 ..
.. ' "
. --
.. " -
Mervln Beatt le ,
12751 Elm .
Street ,
..-
Blue Island, llllno la 60406 nephew yea $1, 000, {)O
.. -
, .
Jane Kutsch .
2111 Dunhlll Hoad ..
,
- ---
Wllmlngtonl Dela,wnl'e 19810 11 Loce yes $1,000, {)O.
- ,.
- - , -
The above beneflolerllll were living et the time ~f the decedent's death axcept for the following:
NAMe
If additlonallpaoB Ilnaoamry, UIU BW' n 11" Ihuutl,
DATe O~ DIlATH
I' .
ISch~dule "E" mllst Inolut1ooll propertY, rool and personol, owned by the dooedilnt lolntly with el\otl1er
'partY or p~rtles ellolnt tel1entswlth right of survlvorahlp, Both tangible ancllntonglble propertY ore to be
InolUded, Lilt real eltetellrlt,
1, pelorlbull real propurW el Indloatod In the Inltruotlons for Sohedule "A." Delorlbe ellpereonalpropertY
ol.lndloated In the Inl\ruotlohs for Sohodule liB." Inolude thO nama, addrossand relatlonlhlp to the
deoedent of the oo.ownar(s] ond the date the Joint ownership wos ostabllshed,
,2, Indloate the totel market vallie of the lolntly owned pr\>pertY,
3, ,Indloetetha peroentage 01 tha deoedent's Interelt,
ltiiI~UCTIQNS FQR COMPLETING SCHEDULE "a':
.
..
4, Indloetethe market valllo of the deoedent's Intorest,'
~ ~ ~ 8 ~ ~ Z ~ Z ~
fil ~ Cl t::l
~ ~ 0 p
Z 11.: ~ ,
p 0 , ~ 0
, Z ~
P 'Tl
~';l, 5
Z
"
c.
,
"t:t
r..,}f ... "
Ljjl ;,i;: l:,.'
(:.,1 ~5 '-'.,\:':'i
0';:(1:'
~t3 .l..i"""
T,,"-'
~ '.,., __J ~ S
(r. I~~l~.:'
<.1
~
~L INHpRITi\NCE TM INI'OAMATIO~
Un,atlsflud liubllltllJS IllolIlTlldby thu dUlHlllont prlol'l.o his/lwr duul.h 111.0 dmlllotll11lJ uUIIIIlSt hls/hor ~al\ubi'" ostate,
In adrlltlon 10 dobts ImanrlJcI by IhlJ dUGodont or 11111.010, olhur Hornsuro 010111101110 Inollldlnu tho 90st of oclfnlnlslrotlon,
altornoy fous, f1duclury hHlII, fllnMol unci bllrloluKpOll8US Illoludlng thu oost of u bIll 101 lot, tombstono,pr oroVo markor,
All drlbls boll1oclnlrnod ogolnst on oslo to uro sublont 10 tho opprovul of tho Ronlslor of Wills wllh whom the
Inherlll11100 TI1K Rutum Is film!. EvldoncUIO support tllU docodol1t's or Ihu usWlu's IlllhlllW for thu duhls bolng clolmoo
,hould be etlucherJ to this schouulo.
A fomlly oKemptlon t1f $2,000 mny bo clolmod by II spall so ofo decodont Who diad domlolled In Pennsylvania.
If there Is no spousCt, or If tho sl10use hilS forlultecl hls/hqr rlghls, Ihan OilY ohlld of the docodont who Is 0 membor of
the &lime housohold con,clalm tho QKomptlon, In'thoQvont thoro Is nq auoh spouse or ol1l1d, tl1e oKomptlon oan he
olalmed by aPorent ur pnl'ents wl10 oro rllombors of tho somo housol1old us tho dooedont.
,,' I I '
,~
I , II
I""' r<' 8 ~ ~ ~ ~' ~
I - ~ 0
z :--l z Z
lT1 S ~ I:l P I 6
t'I1 r.1 ~
z z ~ ,
P 9 >-l VI
, Z 0 VI <:1
P ." ." ""-
II I ,I 0
1,1 \ ~
t,
" Z
i"\' ,
~. I""'
C'''-l I d
ll_1 ,
C'1 1::. (,I 1'l
...1 Q::V
O'~ .., : ' ':i'; ~
(., i
~tJ~1 I.,:.
c:;t>, ~ j~F:';; g
t.._J S ~
;.'f
INSTRUC1'IONSFORCOMPLETING SCHEDULE '~F"
1. it'the, family oKe'llPtlol1ls bQlrig clnlmod, Indlcata tho claimant's nomo, address and his/her relatlol1shlp to the
docodon~" Enter "family eKomptlon" In tho romorks colllmn and tho amount clalmod In the amount oolumn.
2., Assign cpnaeclltlve numbors to each Itom listed. '
3. Enter tha'doto 011 whloh ooch, debt was Incurred al1dior paid,
4, Enter tho nomos of Gaol1 payeo.
6. Provide ebl'lef ol\plilnlltlcJllln tl10 remarks column for~aoh dobt ololmad'.
6, Enter tl10 arnollJll of 00011 dobt bolil11 olalrnod,
7. Tho form must be algnud by thu porson WI1,) hosllsslIrned tha responsibility for paying the debts.