HomeMy WebLinkAbout81-00750
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RECAPITULATION
^pprataad valuo_of PurRonnl, Pro(lurt)' tit; III" II; 11111 tll., It ,., "" ",.,'j'I I" .".,..,....11.1111.' I.III.If
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Apprp,tsud Y"lu8 of f(~_1 oatato Ilttltlllll""\llllllll.lIll1t1I.lIl1"".ItIIIlI."",ttltHIIIIIHllll.lflll
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'rotal apprahlod value '111'111""", tllllllllllll".,111111I'I'IIII" "".1111111'1 to ""'111111"'11"11""10
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cumberlan~FFIDAVIT OF PERSONAJ,. R~RF.SENTATIVE
COllnl)' otW~"1 '
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,-XraKWUlllK mhcko<JtXOUoCt, of, H"'I'~I!1.9.~J~ELII~.rlltl~:t.,t,t.'I~~,,",J?~t~.~f;l.f!Icr.~"-lIIllj ,''''"i1IlIl.lIl1l1ll1
l/ecat4sed, bCltlR d"1Y'llIlllIft~E>,F.I~liiIlIHII""""'I'!"'''"''''j!''IlIIlIlI' nccord1mt to law, dupolic and 8,(\Y that"thft
tema appearing In,the Inventury inclnde aU III Ihe persunal amts wherever sltllate a,nd all 01 Ihe
real ,estate III the, COlllmunwealth 01, Pennsylvania 01 said decedenl I thaI Ihe valuation plaeed oppoalle,
eadl Item or said Inventory representa Its lair value as 01 the dale 01 the deeedcnt's deathl and Ihat
decedent owned no real estate outside the COl11l11UnIVclllth,of Pennsylvania ,eKeept' thaI which appears
In a mcmurandnm al the,Cflll or the Inventory. .' ,
.' ."~W.fI,t;!:I."t;h'"."".",,,.,,, ~pd subscribed l ;;::/if' /"" ;/ /1/" , " tJ )
batur~r th,18""'A~'~?~';:'-,"""'''da~oJI \Z2f..-;(;tfl,k:if:l1~~~~~~!t'f:ji~rN;j""^\1-/
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_Itm 11- ...,ANril!l,,"h INSTRUCTIO~S
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'I. An Invonlbrl' musl be nled within three months a~er appolnlmenl at pmonal r6prelenlaUve,
8, A snpplsllleal8llnvSnlOry In UBI he nled wllhln tblrt, IIaYII ot discovery at sddltlonsl lI..e,ll,
a. Additions, Iheoll lilaI' bll Mlached es te poroenaUr or rsoUy,
4", ~6. /lt11.lelV, !'Idnnl.,l" Acl ot 1$41,
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qUESTIONS CONCERNING PROPERTY TRANSFERS
1, Old decedentl,w, \I~ln t,wo ya,ars of death, make any trans, ler of any material part of his estate without recelvln~ .
valuable and adequate consideration? (Answer "Yes" or "No" .) 'lea....
2. Old decodent, Wllhl.n two years of death, transfer PIOP,erty from himself/ hersalf to himself/herself and another parly
or parlles (Including a spouse) In lolnlownershlp? (Answer "Yes" or "No",) .1l2-
3. If lhe an\wer.to one oltwo abQve Is "Yes" and tho translers are claimed to be nontaxable, provide the followlna
Information:.,' , . . ' .
, a, Age of decedent a.ttlme ol\ransler,
b. Copy 01 death certificate.' ' ,', '
c, Affldavll by the attflhdlng physician Indicating the stato Qf decedent's health at tlma of transfer.
d, ,All other Information supporting nontaxablII ty of trimsfer. "
4, Old decedent,ln hlslher lifetime, make MY lransfer ,of property wlthoul receiving a valuable or adequate consideration
therefor which was to take effectln possession or enjoYOlant at or aflerhls/her deall1? (Answer "Yes" or "No",.) No
e, Was there any possibility that the properly transferred mlghl return to lransleror or his/her estate or be subject
to his/her power of disposition? (Answer"Yes" or "No".)
b. Whal was ths transferee's age at ,time of decedent's death?
5, Old decedenllnhls/her lifetime make any transfer without racelvlng a valuable and adequate consideration therefor
under which transferor expressly or Impliedly reserves for his/her life orony period which does,ln fact (lI1d before his/her
death: ' .
a. The POSsllsslon orenloyment of or the rlghl to Incomehom the property transferred? (Answer "Yes"or "No".) No
b. The right to deslgna(e thll persons who shall possess or enjoy the property transferred or Income therefrom?
(Answer "Yes':, or "No"',) _ '
6. If the answer to five b, alxlve Is "Yes," state whether tho right was,reserved In decedent ~I,one or 0lher5.
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7. Old decedent In his/her Ilfetll11e make a transfer, the consideration for which was transferee's promise to pay Incoma
to or \0( the benefit or care of trans,feror? (Answer "Yes" or "No".) No
8, Did decedent, al any \Ime, transfer prpperty,the bmeflclal enloyment of which was subject to change, beceuse of
a reserved power to al\er, amen,d, or revoke, or which coul,d revert 10 decedent under terl11s oftransfet or by operation of
law?' (Answe{ "Ye$" or "No"i.) No' '
9. lf the answ,or to eight above Is "Yes," was the power to alter, amend or r'evoke the Interest of tile beneficiary reserved
In the decedent alone 01 the ~ecedent and others? (Answel "Yes" or "No",) 'WA
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~ONS FOR COMPL.I!T1NQ SOHI!DULE "E"
Soh~d~le "E" ;'Wlt 1i1Qlude ell property, ro~1 end personal, owned hy tho dooedant jointly with enothor
party or partleanlolnt tanant8 w!\h right of 8urvlvorshlp, Both tdn\llbleand Intenglble property are to be
Included. LI8t real estale flret, .
" Oesorl.~e all real proporty aslndloated In Ihe Instrllotlons for Sohedlila"A", Desorlbe 011 Pllrsonel properlY
eslndloeted In tho InBtruollol\S for Sohool/lo "B", I nolude thu nomo, addross .end rolollonshlp to tho
deoodent of the oo,owner (81 and thll dolo tho lolnl ownorshlp wos eSlobllshoo,
2. Indloote the totolmorket value of the lolntly owned property,
3. Indloato tho peroantolle of the decodent's Intorost,
4. Inuloate the market value of the dooedenl's Intorest,
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~g~eL INliIH:lIT~t'lS;E T~X IblF9RMeT~
Uneatlsfled Ilabllltlus Inourred by thodeoedent prior to hla/her death are deduotlble allalnst his/her t~l<able eat8tll,
In addition to debts, Ino\l,rrod by tho deoede"t or estale, other Items 01'0 olalmablo Inoludlng tho 008t of adlnlnl8trotlon,
attorney fees, flduolary foea, funoral ond bur!~1 expenaes Inoludlng the oust of a burial lot, tombfttone or grave markor,
All dobts bolngOlalmod agall1atan ollote are subjeot to the approval of tho Register of Wills wllh whom tho
Inharl\anoe Tal< Ralllrn Is filed, Evldonoa to support Ihe docodent's or tho ostote'a,llablllty for the dabts being olalmed
should be ottoohed to thle sohodulo, .
A family oxemptlon of $2,000 moy be olalmed by 0 spouso of 0 decedent who died domlollod In Penn8ylvanla,
If there Is no 8pouse, or If the spouse hos forfeltod his/her rlghls, thon any chllcl of tho deoodent who Is 0 member (If
the eame household oan. olalm the ~XomrlloI1, In the ovent thero 10 no luoh spouse or ohlld, the exemption oon be
olalmed by a porent ar parents who oro membera of the aome hou8ehold esthe dooedont. The family el<ompllonls
ollowable only against usela whloh pass by a will or by tho Ponnsylvanla Intestate Laws, .
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INSTRUCTIONS POR cOMPLETING SCHEDULE "P"
1, If the family exemption IB~elng olalmed, Indloote the ololmont's nome, addreas o.nd his/her relationship to the
deaedenl, Enter "family exemptloh" ,In the remerks oolumn and the amount ololmed 111 the amount oolumn,
2, Assign oonse6utlvo numbera to, ,eaoh Item Ilated,
3. Enter the elote onwhloh eaoh debl was Inourred and/or pold,
4, Enter the nomes of eBoh payeC!,
B, Prpvldo.o brlefol<plal1atlon In the rel11arksoolumn for eaoh debt olelmatJ,
6, Enter tho omoUl1t of eeoh debt being olalmed,
7, The form must be signed hy the person who has Baaumod the responsibility for peylng the debts,