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: f!' .. " ,. 1 ~ II" " -'" ,. , .. , , . ,,,I' " , ' " , " '-' , ' , I' I' ." ,.,' -" I ~ , ' I' ',f' ",I' ,. I:' ~ " '~ :~ ~ ~ i ~ ~' ,. / .. 1'/' ,\ .,', d' ., , \I . l .~.. , , ., '! '~ '~ , ' ,I, "'J,_ I' " ," ,: ~ I I'" ,,' , {,. I!_ , " ~ ' ) , 'J ' ' ,f /, .. ..' " " ", ,. t. 'I" ,i' J " ~ L " "r 1'- , ' " " ; COMMONWEALTH OF PENN~VWAN1A DEPARTMENT OF REVeNUe BIIAEAU OF EXAMINATION OPPIOIAL NOTloeop INHERITANOE TAlC A.SSli8BMeNT '* .;...o~ TO: ':~1~. .~L_,,; .~ J?( ." J J L .- j':"';: j,.' ' :'."/~ .', ." ) , Ii" ' ) . .1" (/(,-/,Ir( / I. _...~.,T. " " / ..,.,.,." .(i ( l/..__ ) ._._of'/, /,'-11/,/1_. . h. DATE ''I ,-'-' , , ESTATe / , . V , ,j(4~"'~J / - -- l;:.J{.. ( - , ~ /'! . "J'- " .J ..' J.. (,I. \,) -,-. . COUNTvrlLE NO: "----....~'/. (J,I / d., / FILE NO, . '1' (, i /") . COUNTY (~~ J -}oJ' /;/ / t:'I~( "J-/.~( . ,,7.,. "". ,." --....-."" , ~ /',/YI DATE OP DEATH ./,/ ~ ,y,.,." J/,~ ,,(... I - . .. r~, ,. - ,/.. Apprnl80d Voluo of Bntniu: Rool aatnlo -- . ___+-,..u.~~u_..t.- Pureonol p,oporty + ,';, il:.. 'f' "1, ,r !. .. ,. Jointly Hold Propo'tyiTrnnefm Tolol OIOBB B.tulu - ,,-. -....P-.....'-.----... + - . :;:J ..V/I' /;~ 7 .-.' TOlol Approvud Deduotlono "j i'- ,r . v J" r I";") /.- , aloor Vnluoo! Estnln . u_... ..-.-~:.~_.--'p...,... ~e8a; App,ovod Chnrltnblc EKomptlon8 ..-_.~~---~ Cleor Vol~o of Eoloto BUbjuct to TOK . '....'........ Amount TOKnble @ 6% Rol. L . i '. (.'..' /:. ...%."1.... / ...._~ .' .' - _.' ,..'" ./I - - tOK dU'a/:>{',,~!t...t~.;<:il' . / "'/)'.:;{jI-/ ( tOK /Jue I .," , . /', """/ j' TOTAL PENNSYLVANIA INHERITANCE lrA~"~~,':~rJ:~/" i\; t ;').':.://0 ! ,. Amo~nt TnKoblo @ 16% ROlo . . . . . . A flvo pnr,cent dleoollnt totaling Will bo grnnte~ If tho Inhurllonoo, TOK la peld b~ LeBO Credlt81 DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST TAX CREDIT . + 1-' . . . + . + . Into rea, , aocruna at the rete. of el~ IS) percent per onn~m on the Unpol(I, bolonce cl Inharllonco TOK from ' '0 dnlo 01 'pnymont, Intor08t duo If paid by .. '__ '18 .,/ 1 .d'l/ /m;~_,/ BAlANCE OF peNNSYLVANIA INHERITANCE TAX ~\J!,/;~I:d~ .......(,-1':;.';}.,,)(;./,./1 " __/, . ,; \..;/::1. -- / Aueued by~>'" , "':J <:~/ St. 'nformatlon on R.vetn'Slde A lNf:JlRMAIJ.llti.. Yc ln8uro p~OpOf o.rodlllo your oaco'''''' Ih. ,nun\(! "f 11100&1010 anll 1110 numhu! ahoulll ho cluarlv'prlnt. od on tho ohock or monoy ord." Thl. o.ooa.nlOl\l I. '11:1<10 11\ o""orllol\oo willr 80111101\ '/l'O 0 IhO Inh~rhonoo Unll E.llilo To. Aut of 1901172 P.S.~ 2406.709) T. Iho ..Iunl thul i"holllllno. to. I. 1'0.111 within IhloO IJI monlh. ultor Iho dOOlh of Iho dricodont, 0 IIlnun\J1lt cf II". 161 pOl'..IIII.III1.wocl (72 [,,6. ij 2406-7,oj, ' Il1lretllunco Tu.. .Ihor tho II 10. UII U fUlllr. InloIO", Is clllO 01 tho 11010 of tho docl!donl'e d.olh and bocolnoa dollnquor' 01 Ih. ..plrollcn .1 nino (g) mOlltl,a ollar Ih. cloqo,'onl 'e d.olh (72 P.S. g 2486.711), 1,,1I.,lIonoe To. un a Illl~ro IiIl.rosl I. I,ovabl. wllhln thr.o (J),lnonth' .all., Iho Ilona lor lok.e .1f.cl I,npo..aulon ancf enjoym.nl .'nll Isdollnq".,,\ III.r.oll.r 112 P.6, 6 2406."11 21, C.'o~lnto 1I110rcol lrcm thl! dollnq~ont do\a ahown on tho loco ullhl8 loim 10 \ho dOlO of uuwnl pnym.nl ~alnO Ih. folloWing InlOru.t tuhln: ..___......_..._ ........ ___ ___..._ _ ................... _..... ..........._ _04 _ ........-.....- .-...-...... ...--.... _..~ .......... - ...-....- --...- - -.- -......- 1 mcmh ,006 4 montlls .020 7 mcnlho ,OJ6 10 month8 .060 2 momhs ,0\0 5 monlhs .026 8 munlh. .040 II monlhe ,OB5 3 monlha ,Ola QmuI'1hu .030 9 mcnlh. ,046 i I 2 month8 ,000 ----- ------ 1 d.ye .000\'/ 11 dayo .00100 21 daY8 ,00362 2 dava ,0003~ 1 2 days ,00203 22 doya .00309 3 ~.y. ,00061 13 d.y. .00220 23 dOY8 .Q03,80 4 dSye ,00088 14 tluya .002J7 24 d8YI ,00403 6 daye .00006 16 daya .00260 26 dSY8 ,00420 e dol" , ,00\01 16 days .00267 281l,Y8 ,0007 7 dsye ,00\18 17 daya .00284 27d8ye ,004&4 e day. .00136 18 daya ,00~01 28 d8yl ,00471, 9 d8ve ,00162 10 d.y. ,00310 29 dOY8 ,00488 10 doye ,001 eO 20 day. ,ooJJ6 30 d'V8 .00&00 __ ___...._....__~.__... ____........ ....._... __...... __ _:-"1" -.... - - -"1".-......- .......-... --~-- - -- -....-..-..-... -.......... , A,IV p.rty In Inwo8t, Inol,~dlng tho Corn"1onwo.l\h and 1110 pO'8annl r.prn80ntaIlVe, nct utlallM, With the .naoolnonl mny ob)ool Ihuroto within .I.IV (001 dny. oltot rocolpl cf thlO N.ollcn o. provided ijy8ectlon \001 cf Iho tnhorltunoo MU e.lat" T.. Aot 011901 t72 P,S. ~ 2406.10011, Make chock ot money otdor Iloyable tOI "Register of Wills, Agent'.' Mall to the address lIatad beloW; IIolST RUCTIOIolS - . ' TY P Ii OF A~,_ I ndlaoto wh~lhor Iho uuot la ,001 oatoto,~oraonol prOI,orty, tronafcr' 0' Iclntly.cwncd. pe5CRIPTION .. Llot oil o...utuwnod a.I.ly hy Ih. d.oodont 0' ownod lolntly with cnother parly or porll" a. t.nanlaln eommcn cr'filolnt lononl. with II~hl 01 aurvlvorahlp 01 tho limo of doath. Inol~do Iho dooodont e Pllccntcg. cf ownonhl~, thc namo(a) ond ,olallon,hlp 10 Iho d..od.nt of tho 'aurvlvlng lolnt owncraond thc callmatod markot Vol~o ol..th. doaodont'a Intor..t aa Of tho dOlo 01 dcolh. Incl~do Intan~lblo penonal p,oportytl",ud In tho nomool Iho docodonl h~t ppyohlo 01 docth 10 on.thor POtty CI'!' artr.. In.l~dlng b~t nClllmllod tc'P.O.D, ~.S' Saving. ~"Hla ond,ontotlvc Ir~lt cccc~ntl, I.llt any p,apo'dlY tran'forrn by tho dcoodant within 11'10 yoatl 01 d"pth fcr Y!hlah ho/.hc did nol tocolv. 'val~abl. and cdoq~pto can.1 orotlon. OOlcrlbo oil ,cui ..'iata locotad.ln pnnn.ylvanlo hy lot ond,h1aok n~mhar, Itrcot uddro.., 'numh.r af CelO' ondlncl~d. 0 gono,ol dloacrlptlon of tholond and b~i1dlng., AI,a, IlIclud. Iho book and pogo n~mb.r In wh,ch tho d..d la roaordcd and tho ..oct 'It 0 01 !.ndleot.d on Ih. d..d. ' F.liBTS & DlllWCilOHS ~ Unaatl,/Iad 1I0bllltloa Inautro,\ by thodoaodonl prlo, to hl./hot daoth c'r. dod~c!lbln ~gain.t ,~./hll tt "obi. ..101.... In addlllon to d.b" Inc~rrod hy Iho d.codonl, otho"lIom. ,"0 elalmoblo Including Ihe cc.1 of o mlnl.t1ttloll, oHornoy 100" /Id~el,ory foo., 1~lIorol ond b~~lolo"pcnao. Including Ihc cOlt. cf 0 b~rlollot, I.mb,ton. ot gro.,o m~', or. I.lat tho do to cn whloh "cah d~bl woalnourrod .nd/or pold ond tho nomo, of aoch pOY.O, Ptavldo u brlof OKp .cnct on of the nat~ra of ooch debt ololmed and Iho on,aunt bolng clclmod ," evidenCe to .~pport tho doaedont'. or tho 08tuto'.llohlllty for,thu dohh being clolmed .ha~ld ho uHaohod 10 'thla r.l~tn A family ",emptlcn may bo.lblmod by a apo~ao of 0 docodcnt who dlad.domlcllod In Ponnaylvanlc. If Ihero la no ,.po~.o, Cr If Iha 'pou.. haa farfoltcd hl./h.r rlghl', than ony child .f Iha duccdunl who I. . momhor 01 the aome houaahald oan alolm tho o"omptlo~. In tho .vont thato la no luch apou~o or child, thc o.ampllan can bo clolmod by 0 parant 01 paranl. who are m.mbo" .f lho .amo hc~..h"IJ u. thc <locadont. ' , ' .- 004 ~ ~ z r- -0 8 8 ~ ~ f!! ,fJ, ~ :;; i >- ~ I 1:1 <l'l ~ C 1:1 Ql < ,,, m I> m m ~ l'Q ~ ! '" m . 'Z !!l rn, 5 J II> g ? 'Z m . 11>, ? z 0 0 jt a 0 ." ." m ~ . :t; Pi ;;' c; ~ .... :~ " ~ ~ .;:> :>- Q ;;) '" Cl "'i, t.> ~ f11 ~~ ~ '" ~ z :>> I'> ~l ~ .... , , I :t, ~ Gl V1 .. ~ ~ ~ 'I . S ~ ... !!J '" 1".., 0 -< v' if- "" z ~ . C'l ,.~ ,i'iJ . . ;:J l'Q ,. t:l rJ -.; 1J f" '-i ~ Jt rij :i " :i' " "- , " ;:r u a .. ~ ~ i :c ~ ~ o z ~ !! F -< t Uif.Q RMA TION PLACE FOB. FILIHCl- Tho.ro'urn la to ho /Iiod III dupllcota with tho Raul.tor of Will, of tho county whor.l~tho doc:odpnt t..ldcd, ',' ~ FOdR "ILINdOb _ lho roturn I.duc nino .month. a/tot tho docodont'. dooth, unl... anOllt.a"alonfot flllag hdo boon appll.d or on gran.to . y Iho Soctotaty of Rovon~o within. tho nlno.n,onth parlod. FAII.UJi!.lO FILl! RETURN. _ Soctlon 791 of tho 1961 Slaluto ptovldo. that" , ' ,any pmon who wlill~lIylolla to 11100 roturn or cthot ,0po'rt'iOqijTtod of him .holl ho por.onallyliohlo , . .to a .ponalty of 25% 01 tho tu,.~ltlmatBly lo~nd to be d~o or $1000 whlthovot I. thc I... to bo rocovorod by tho Oopattmont of Rovanuo o. d.bhOf Ilko amounlar. teeovoroblo by law,'" I ' ' NOTE: ~ee~ paid to an eslat. repre8entatlve; namely, on e~eculor or odmlll18trator, lor a"tY'lcee performod In ad. ministering an "atate la repc.rloble for Penn.ylvat1lolncClme To. putp08ea, Thlalo.abl" .Incomeltem ahoud be IIlported on fotm PA'40.lndlvld~allncome To' Rol~rn,