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RCC.I03 (2.64)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX DIVISION
21-78 -449
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES ONLY
OF RESIDENT DECEDENTS
.}-/,/-11
'*
COUNTY OF
CUHBERLAT\TD
rhis return m'Jst be corif,!eted in detail and filed in duplicate, with the Register of Wills in the County where the decedent resided within one
yeor dte-f dc,re of :Jeath, unless an extension is granted by the Secretary of Revenue.
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~, No.______19_____I,
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boJlng tkdy sworn according to law, deposes and says that he is the
Edward G. Smith
(Name)
of R.D. #1, Box 70A, Carlisle, PA
(Address)
Executor
(Exec., Adm., Le!jlatee, etc.)
Hampden Townsnip
(Ci!y,-{ BoroulWt, or Township)
}1ay 2 u, 19/0,
(Dote)
C\'ills~:;t<:d <If the assets listed below and that allowable debts and deductions exceeded the fair ma'rket value of the assets and
of the ~,,,,'tQte of _ Ra!ph S. Doebler
late of
d<:'ceasedl, and that the whole of the estate of said decedent, who died on
IHi Penn5.ylvania TrC'nsfer Inheritance Tax is due.
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5-.,'.'", and subscribed before me
Qb4 iA
fhe ._._~___ day of ~V.;l1
~~!:..~;zt ~';~Tri
T'~' ;;:~ -of Asset:
R.."l Estote, Pers.
f', "~ert}', Jointly
He!c; Pr.~p. or
Tctmsfers
.,,~>,;/-
ASSETS
(Attach additio~ sheets if necessary)
Description of Asset
Pers. P~rop.
Pers. Prop.
1976 f11C Pickup Truck - sold 8/25/78
Check: Phoenix Hutual Life Insurance Co. -
disability payment
Check: First Federated Life Insurance Co. -
excess credit life lns. over debt payoff
Check: Pa. Blue Shield - prior medical expenses
IRA - State Farm Ins., Life No. 4329-253
C1. No. 564227
Misc. personal effects including clothing and
costume jewelry - given away
Check: Internal Revenue Service -
Refund 1978 Fed. Income Tax
Pers. Prop.
Pers. Prop.
Pers. Prop.
TOTALS
Executor
(Title)
Estimated
Market
Value
Departm";nt
Valuation
CAUTtON
(Do not write
in this space)
4,000.00/
,/
90.00
44 . 04/'
86.00/'
-:,/
1,284.56
50.00/'
409.40
5,964 . 00
S ~\oL{.()C
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REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the above COlJnty do respectfully report that I have
apprais.ed the real and personal property as reported in the foregoing schedu.LeCl~.the"vci.\lu,e()s~t fQrtholf~bs:i!~ each item in
the lasl' colum,n to the right. ,_ :' "'.' ,~-\ \. . .
L/- -' ."3~ T) Ct -
Dated:. Inheritance T'CriC"Appraiser
,
DEBTS AND DEDUCTIONS Amount Amount Approved
Name of Payee Nature of Claim Claimed by Register
ryL. Doebler Family Exemption 2,000.00
sslernan's Funeral Home Funeral Bill 2,436.40
Gingrich Memorials Grave marker and lettering 500.00
General Motors Acceptance
Corp. Debt Due 1,169.84
andis & Black Attorneys fees 210.00
andis & Black Costs Advanced 56.65
eserve for Closing 100.00
TOTALS 6,472.89 c::, '11 'iA . Y!?
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REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for the above County, do respectfully report that I have allowed
deductions in the amounts set forth in the above schedule as claimed, except where I have set forth a greater or lesser amount
in the' last column to the right, which greater or lesser amount represents the sum allowed as a deduction.
Oot. of A..'OVOh_~l 4. _tl-'Z2 (2X;~,J, 'Z Q~1>O~'"\. r'.~
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R E V-5IB (B.i~)
COMMONWEALTH OF PENNSYLV ANIA
DEPARTMENT OF REVENUE
BUREAU OF FiELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY Pl.EASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
Edward G. Smith
RD 111, Box 70A
~i8le, PA
(Executor or Administrator)
In Re: Estate of
RRlp~~-DQPnlpr
CumberlaruL
County - File NO._2L-78-449
Dear
You are hereby notified that the Insolvent
appraisement in the estate of Ralph S. Doebler ______
has been fi led in the office of the Register of Wi lis of r.llmnprl (;:mil -------
County on 3 April ___, 19~ f Said appraisement reflects the following
valuations:
Real Estate___ None
Persona I Property _____5.964.00
Tronsfers____ None
Jointly Owned ______None
T ota I _______________~L~64. 00
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22,1965 to June 16,1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 p, S. 2485-1001, P. L. 373.
Date
3 April 1979
Signed
Title ____ Administrative Officer
Note: Tllis is not a bill.