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OATH Qt' PlmSONAL REPRESt:NTATIVE
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COMMONWEALTH OF PENNSYLVANIA iSl
COUNTY OF CUMBERLAND
Before me, tho ROlllstor forlho' Probato of Wills and lIranth\a of Lotters of Admin Is Irati on In and for Iho Counlyof
Cumberland, pmonRlly call1e
who, \lelnaduly awot.\,!
(Wlloe fl. Orl'!n
,do 9 R depose and say that as
gxeo\ltrix
of Ihe IIISI Will an<j,Toslamont of Bpi 11ton m. H He
degellsed
p he will woll and truly admlnlsler the aoods and challols, ,rlahts and mdlls of said deceased accordlnalo law. And
alsowlll dlllaentlycomply wllh Iho provisions of Iho I\lw relal\nalo Transfor,lnherllances. SWOl'n !lnd sUbscrlbo,d before mo,
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DECREE
[)~"ased, Letters Te/ltllmentary were aranted to
Wllnoss m)' hand Rndofflclal seal tho day and yoar aforosald,
,A,D..19 81 ,there was probated and
lale of
, Cumberland counlY, Pennsylv~nla,
Qrnoe H. OrI'ls
Be II romombered that on the ] 7th day Qf NovembAl'
recorded tho last Will and TeslUment of Bl'i h:f;ort In. n He
Penn Township
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965- ' Jf C. ,,' .L~~
. . Register
Ill!NIIFIOIARIl!a
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BeNEFICIARIPS AND AD(JllESSPS
(Sluto full numo, dnd .ddn'".' 01 nil 'MHJ huvo nil inturuu
ottlHH VOitod. ounung.nt Ol-glliltr Intllf,,'t)
I1S\,AlIDNSHIP
TO DPClEDeNT
SURVIVED AOE OF LIFE
DECEDENT TENAN'fS OR
S1'Ats'VES ANNUITAN'fE
OR NO AT DPATH OF
,~+ ,.,.~.., ,.._.~.o~,C.l!,e..e.~!_._
INTBRSST OP
aSNEP IGlARV
IN ESTATE
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Or aO..L Ih,.9E.!'~_~__~.~~ ,.s:1.f4.t(}!~_m _X~IS u_ ,~.u_._,__~_+ J:~IJ() ~ t hh'd 0 i'
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\'lil ton Jut:,fl tl9..l}..J+Io~'fL_..___..__.c__.-"... .~~.. ,__,~,~,_+'_ __~_"'_~'_"_ ~~..,,-,,_..-+'- ,...ws t~ta
Floranoe Gurland 13:Lut,er' Yo 1,1 OIH"..thlt'd of'
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INFORMATION
PL"CI POR PILINQ _ The te""n I. to be flied In dupllo,le wllh the Regl.lel 01 Willa 01 the oOlllllY wherein Ihe deoedenl realded:
TIMI POR PILINQ _ lhe relurn la due nine monlha eftet Ih, deoed..nl'a deelh, IInle" on ..tonalon tor filing h.. been eppll.d lOt end grenled by Ihe Secretary
ot Ravenu. wllhln Ihe nlne.monlh period, '
PAILURS to PILI RITURN ... Secllon 791 ollhe 1981 SIAlulO provldea Ihol ", . .ny pOrion WhO wllllully I.lla 10 file , relurn or olh.r feport reqUired of him
. t,. ahell be per,on.lly lIebl. ,,' too pen.lly 01 26% ollho lex ulllm.lOly 10u',1d 10 b. du.or $1.000 whichever la IhO I....r to b. t.oOvered by Ihe
Dep.rtmenl 01 Revenuo e. deble ~f like 8IMunl ore 1000vRloble by lew,"
DIOl,lOTIONS _ Uhaell.lled lIeblllllea.lnollrrod by the dooed.nl pilar 10 hl./hor deelh oro deducllbleeg.lnal hlilh" t.xeble e.lolo, In eddlllon 10 detilllncurred
bY.lhe deo.denl 01 e.I.,e, olhe, lIema .re olelMeblo Inollldln9 Ih. 00.1 .~I edmlnlalrellon. altorney I..a! ftduolery f..., funeral end bu,lal a~p.n.oa
Inollldlng Ih. coat of . butlallol, lomb,tono or greyO "'Blko" olld olher lolalod bllrl.1 o~pell".'
FAMILV I)(BMPTIDN _ A (omlly ...mpllonmoy bo clolmo\111Y n.po"so ot ndncadonl wlio'dled dOllllolla\llnPonrtlylYioio If Ihe.. "llQapouso, or Iflh.
epol"O healortoll.d hlalhor rlghl., Ih.n .IlY ohlld ollhO dooodonl who I. 0 momho, ollhe ..moholl.nhold Den ololm tho ...mplloD In Iha event tM"I.
1l0\ auoh ,po"a. or ohlld, Ih. ..empllon oon ho ol.lmlld by II pniolll orplllll"" who 010 momhorl of Iho ume hOlllehold ellhe deoodant. Tho fe,nlly
o)l;ompUon II allowahle onlv 8galn~t U'O'B which IHtB9 by (t will or hy thU PnnllRyl1/61\ln Intostato Law..
PIDUOIMV OOMMISSION .. Compon..llon 11.ld 10 IIIl "1010 101".aolllollvo; nllllloly, on o'..lIlor or odmlnlillOlor, for a"vlo.. p.,fo,mod In admlnlatellng.n
, oatoto Ii fopottnllle fOI fienMvlvonl11 l"como Tnx PUtPUfIOB ThIs hliinhlo lncomo nom ehmlld bo rOllmlod on Form PA.40, Indlvld~flllnoom8 Tltx Return,
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~AL INHeRITANce TAX INF9.RMATION,
Unsatl,sfl,d lIabllltln Incur,.d by tho docedent prior to hls/hor death aro doductlble against his/her taxable
utatCl, In addition to debts Incurrod hy tho _Iocedont or ostatCl, othor ItClloS aro claimable Including the co.t of
admlnlatratlon, attorn,~y fen, f1duclory fou, lunoral and burial oxponsos Including tho coal of a burial lot, tombatonCl
or grave D1~rk9r and other rela,,~burlfl ,xponsu,
All debtabelng claimed agalnatan salale are sublect to the approval 01 the Reglstor of Wills with whom the
Inheritance Tax Return la filed. evidence ,to aupport tho dllcCldont's or thllllstate'. liability for the debts being
claimed ahould be att.oched to thlsschodule.
A Iqmlly exemption maybe claimed by a spouao 01, a decodent who died domiciled In PIAnaylvanla, II there la
nil spouao, or II tlul apause haslorlel,ted hla/her rights, then any ohlld 01 th,e decedent who la a member 01 the same
hovsllhold can claim tho exempt,lon, In the event thelllls'no auch spouse o,r child, the IXlmptlon can b, ,clo,lmed by
p parent or parenta who are membera of the aame hovaohold as tho decodent, The family exemption la allowablCl only
qgal~at aaseis which pall by a will or by the pennaylvanlo Intutato Lawa, '''\ f
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NOre, Compensation paid to an utatorepreaontatlvol namely,' an ex'ecuto r.or admlrilatrator,for ~ervlcn
, . performed In admlnlaterlng an eatqte Is r,portoble for Pennsylvania IncomeTok purpos~s, This tax'Obl,'lncome
Item should be report,don form PA.40.lndlvldual,.lncome Tax Return." " \" \
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INSTRUCTIONS FOR COMPLetiNG SC~eDUL.E...::E"
1. If the lamlly oxemptlon labelng claimed, Indicate the claimant', nome, address and hla/her relationship to
the decedent. enter l'famlly .umptlon" In the remorks ,colvmn and the amount claimed In the amount column,
2, ASsign consecutive numbers to each Item IIstod,
3. Enter the date on which each debt was Incurred and/or paid.
4. Enter the names of each payee,
5, Provide a brief explancitlon In the remark-. colunln for Clnch debt claimed,
6. Enter the amount of each debt being claimed,
7. The form muat bulgned by the person who haa assumed the rClsponslblllty for paying the debll,
IF ADDITIONAl,. SPACe IS NECESSARY use BY/" x 11" SHeETS.
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RE"V..~. 'U<+ t....OI
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
fill. Numb.r _ll..~1".6P8
Ihtot. Nom. ....:.-..IIr$.ll~l'I S.
Rit,
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,
iii Orl91nal
o Supplom.ntal
D R.mal~d.r
Dot. of D.oth
Oo~o"r as. 1981
Soolal S.curlty Numb., 804..01..0680
RepORT op INHERITANCI! TAX APPRAISER
I, th. und.ralgn.d 4ulv .ppolnt.d Inherltono. TOM Approlll' In and 10, the C.untv.1 CUIIbIl"1IDd
P.nn.vlvonl., do ....p..tfullv "port that Ihv' .pprol..d th. 11.1 .nd pII'on.1 proper 01 'iiiiOfiic'lfI"'. fo,.g'ln~
llturn oUh. v.lulI ..t Iorth .".,It. ...h It'"' In th.IOI,.olumn to' 'Igh~n ,.h. . "A' , "B '/ "1;:", .n~ I I"
Oot.dt JIII~ 4. 11181 1./4J' "
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IHVIHTORY
R.al P,op.ny (I,h.dul_ AI
P",on,il Property (Soh.dul. 8)
JolnloH.ld P,ap.ny (hh.dulo I)
Tlln.t", (hh.dul. C)
TOTAL OROU AUITS
L... P.bi~and P.dultlon.
(ICHIPULI~)
CLIAR VALUI OF IITATI
o Llf.lI.tot.
o Annuity
VALUI AS APPRAlIlll cOal (HAR~iWe\\I~UONLYI RIMAIHOIR APPRAIfIMIHT cOal
00+
10+
11I+
10+
.
40.
n.
Rill
PACTOR
PRIHCIPLI
VA\.UI
-
COllI
-
FOR UAR o"P RI!OISTIR ONL V
Ta. on $
To. on $
Ta.on I
Ta. on $
To' on $
I~.mptlon'
To'ol B.tot.
~
COMPUTATION OP TAX
I
$
$
I_
S
611
1611
---
-
TOTAl. TAX
INTBRUT PROM
BALANCB
TO
$
$
1-
L... C,.dll.
DATI OP PAYMINT
AMOUNT PAID
I
OIICOUH'T INTERIST
-~
+ S $ .
+ .
BALANCl! $
TO S
$
INTIRUT PROM
8ALAHCIIlUI