HomeMy WebLinkAbout95-0334- r.- '~
This is to certify that the certificate hereunto attached is a true and accurate copy of the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is
subscribed thereto, was at the time of subscribing the same and now is Director, Livision of Vital
Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed
and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L.
304.
AUG 18 200r
Date
HIOS. f a3 RBV. 2fB7
TrPErrnN~r
M
, NAME OF OECEDEM Ifew. Mipda, Lea
KA«~ ,. Ruth M. McCaleb
AGE(Lrle:n,paq LINDER,rE
M•nIM r D
96 rn
cDLAVrr oP DEAR
,~ Cumberland
of aL,eLTALOCeLwm
f~' (LL~.Iwrpdaodr parr
d.wNrgwa; ao nA ur raia0
~ .._ Homemaker
1700 Market St.
Camp Hill, Pa 17011
TER'S NAME(fiw, Mippa. Laary
Charles Woods
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYWANIA • DEPARTMENT OF HEALTH • VITAL RECORDS U 3 6 ~ O '-F
CERTIFICATE OF DEATH
311QE FLLE NUMBER _ _
SEX SOCIAL SECVMTr NUMBER DATE l1F DEAH(MpM.OVr Yrr)
:Female ~. 177 - 24 - 5684 .. 4-26-1995
Ld,DEA,rsLr D.vE DFBWTN BNffNPLACE (Ca,sM
kAMa
MYxaas IMdgh, Day, reap SwarFdeipn CdnWl PLACEOP DEATN (Chad.oMrons-ra.rmucforrmcawr
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I
12-2-1898
,Cedar Co. , Iowa on,ER:
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CRr,BW,p,TWPOF DEAN FACKrTr NAME(a nntinwawicn.3iua wraatan0 nnaarl ra13 DECEDENT OF HIS(MNIC OTi161N9
W
t RACE •AmMCan lrrdW, BNtk, LrhNa,w
es
Na~ `ha^Byaa.•WMYCiEar4
Cam Hill
P r
Leader Nursing and Rehab Center ^~•n•~~•
•~
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aNDOPrN>sB,ES3ANDUSrRr NUM,4S D ~~ T7ECEDENr3 Ed1CATgN ~
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10. BURnVNW SePOVBE
(a a~aa
Qivamrpan namal
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`M ^ N• ~{ •M9•oorMa7 CNapa DNan:W (Spacq.)
,,,, Own Home ,,. ,:.g ro,~ (t-aa5+1 ,~
4lidowed .
.
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°raM,N
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°"°"""°" Cumberland M""^""P' ,,.,® ~,~ Cam Hill
,m.
. MOTNER'8 NAME (FaaL LaidrM, Mrdn Surrwrr)
„.Bessie Shank
err.IC~ crwawl•n^ R.mow„dr,gao.^ I(M«~a,_oaxKw)
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n.waw h ar,I LABr
a
- raL6 AN AU,OPSr rrERE AUTOPSY TgNDSg3 MANNER OF DERN DATE OFINJURr TMEC
PE/WDMIEDT neLILABLE PRIOR TO (MW1p1, D,v. 1br)
COMPLETTDN OF CAU3E ,.,/ ^
OP OEATH7 Naldw L7 NonYCiO.
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Caaaa(a)ana rnwararY rabd .....................................................
W 'mM~aU~NCAI,q AND CfRTiFYMMiTNIr81CW,(Ph rq ca~M~G b<auaad paalh)
ary Id^wl•pM. dMh eaeurM r th. Brn., p.r, arW Ww. aro ew b tha ura(tl.nd mrxrrr wbp ......... .................~
'l1ED,CAL E][wBlER/COROIIER
On Wa baala d aaal,dnallan anNa invaripatlon, N my aDlrMarr. death acwrrad r Bra tlma, dab, and
mannw r Arad........... plaeq and pw b tM ewaa(q and ^
a,.. ............................................................................
...........
RE 'S SIGNATURE AND NUM~B/E/~} ~ /,/}
37. O'"~L Qhl~. /\ /'C.~LI_FA~ !17 . » ..'f' : ~ a~-
Ipd.r. oar. ww)
:>d
MEDICAL EXAAwNERIppgONER,
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na ^ No ^
f G K _~
..
~ REV-1500 EX+ (7-941
HARRIS
ALTH OF PENNSYLVANIA
KENT OF REVENUE
iEPi. 280601
JRG, PA 17128.0601
'S NAME (LAST, FIRST, AND MI
~ McCALEB, RUTH M.
.~-
FOR DATES OF DEATH AFTER 12131 /91 CHECK HERE
INHERITANCE TAX RETURN POVERTY CREDIT IS CLAIMED ^
RESIDENT DECEDENT FILE NUMBER
(TO BE FLLED IN DUPLICATE
WITH REGISTER OF WILLS] 21 95 0334
_ COUNTY CODE YEAR Al tlueon
19 Colt~mbia Drive
ATE Of BIRTH (,amp Hi 11, Pa . 1701 1
12/2/98 ~,..,.,.. ~.._,__--, - -
W SOCIAL SECURITY NUMBER DATE OF DEATH
177-24-5684 4/26/95
W
p (If APPl1GBLEl SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL(
~ [~ 1. Original Return
]C C y
o o ^ 4. Limited Estate
=
~
a m [~ 6. Decedent Died Testate
(Attach copy of Will)
LA ~
W Z
W
C ~
O Z
V d
^ 2. Supplemental Return
^ 4a. future Interest Compromise
(for dates of death after 12-12-82)
^ 7. Decedent Maintained a Living Trust
(Attach copy of Trust)
LINT RECEIVED (SEE
^ 3. Remainder Return
(for dates of death prior to 12-13-82)
^ 5. Federal Estate Tax Return Required
_8. Total Number of Safe Deposit Boxes
.+~~ wRR~~rvrvuetvc,t: E-tvu cvNFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ' d -
s '
NAME COMPLETE MAILING 4DDRESS
N. 17ean (;ass 19 (;Oltimbi a Drive
TELEPHONE NUMBER (;amp H1 11 ~ Pa , 17011
---
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1. Real Estate (Schedule A) (1) (') t j
2. Stocks and Bonds (Schedule B) 2 9 ~ ~ , g ~ ~ ~' ~ ~~ ~
3. Closely Held StocklPartnership Interest (Schedule C) (3) 4;'
4. Mortgages and Notes Receivable (Schedule D) (4) c
5. Cash, Bank Deposits 8~ Miscellaneous Personal Property
(Schedule E) { 5) ~5~' $~~ ~ I
6. Jointly Owned Property (Schedule F)
(6 ) u:~
7. Transfers (Schedule G) (Schedule L) . (7) _.-.~
8. Total Gross Assets (total Unes 1-7)
~ f ~ ~ :~ , O i-~ ti° l
.~-(:8) ~ ~D ~ '] 6 ~~, ~,0
9. Funeral Expenses, Administrative Costs, Miscellaneous
Expenses (Schedule H) (9) ~y,~~-
10. Debts, Mortgage Liabilities, liens (Schedule 1)
1 1. Total Deductions (total line
9 $ 10 (10) I,.) ~ ~ y ~ ~~
s
) i '~ o~~_
(1'1)
12. Net Value of Estate (Line 8 minus Line 11) ~ ('ly ~y , (~ (12) ~'~-G}~~~
13. Charitable and Governmental Bequests (Schedule J) (13)
14. Net Value Subject to Tax (line 12 minus line 13) ~(~ ~( (i` -~ ! 6 (14)
15. Spousal Transfers (for dates of death after 6-30-94)
See Instructions for Applicable Percentage on Reverse (15)
Side. (Include values from Schedule K or Schedule M
:
) x __
{ ! ~
.
,~ ~ 4 5 .
16. Amount of Line 14 taxable at 696 rats ~'' I ^~ ~ .3
` ~ .~ ~ y ~ O~
(Include values from Schedule K or Schedule M.)
17. Amount of Lins 14 taxable at 15Di6 rate (17)
(Include values from Schedule K or Schedule M.) x .15
18. Principal fax due (Add tax from Lines 15, 16 and 17.) (18) 3 , 474 _ O5
19. Credits Spousal Poverty Credit Prior Payments Discount Interest
+ + 173.95 _ (lq) 173.95
i'.0. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20)
! 1. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) ~ r '~ () 5 1 t7
A. Enter the interest on the balance due on Line 21A. (21A)
B. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE. ~ (21 B)
~ ~ 0 5
~9
Make Cheek Payable to: Register of Wills, Agent
~~~~ __
-
psryury, ec are t at avs examined this return, including accompanying schedules and statements, and to the bes
it is true, correct and complete. I declare that ail real estate has bean reported at true market value. Declaration of preparer other than
based on all information of which preparer has any knowledge.
SIGNATURE PERS RESPONSIBLE FOR FILL RETURN A DRESS
• a-sal-/ ~~ sf ..A ~~.s% ,.....~ .0' ~ Q /i~ - /;' A ~ !~ /~ + -
/-7~!'
-t my knowledge and belief,
le personal representative is
DATE
~ WL-e ~ l
D
Act 848 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for
the use of the spouse. The ra#es as prescribed by the statute will be:
• 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
• 1 % (.O1) will be applicable for estates of decedents dying on or after 1 /1 /97 and before 1 /1 /98
• Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (~) IN THE APPROPRIATE BLOCKS.
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred, . ......................................................
b. retain the right to designate who shall use the property transferred or its income, ...............
c. retain a reversionary interest; or ....................................................................................
d. receive the promise for life of either payments, benefits or care$ .....................,,.................
2. If death occurred on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate consideration$ If death occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving
adequate consideration$ ...................................................................................................
3. Did decedent own an 'in trust for'. bank account at his or her death$ ......................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
MCCHl'" ,
~ ~~
TES~~M£~ `~°wrsr be =~
~r1ZLI' ~B ow e~ Aller zUmert ~o
S,p'ST o~ L yrst
~cC.PZEB ~ 1 ar e try5 ollovz ytiq ~ and G o ~_
T~ t1 ~ dec r~` ~~ 115
Z ~ R~ rrSYl`~arya' rep and ~° oke all Wy
tY 4 e it mar z eV -1.Z
Co'~`r t stame~,t ~ exp~esslY es ~° pad a s''~
and T e I reY e1~Y me . BXe~r~z yc ort ° f mY e
1 oze made by dyYect mY erses
red eto ~ bed eb`1 a~ iv e eXP der o ~
2 . Z d admyr~stz dear . ire ~ emayr
1 ar mY atr
f`~neza ale after and revue ,~~'~ • -=`_
Pxaotyca de`~yse ~o mY d Sty pes
3 ~ T eaf ue peY
,~~ tnee iss rater
~ .E 5
al~ez e~ !~y,~yz~q' ~ne~eo~i~~e5 ~ ~~~,~e~
1 ~
~ riot tr ore i 5ue 'Qe 5 olrt mY da~~1s ,cam
B o rez and aPp ces o~
and romirate ~xeortr y tre~1 SY''a~
t
~ • S. Cass f a5 YeCt tra Yy~V yY, -~~~
ra ~ . 5 ear ~UZtrez dy rd or se°~` ~~ e~s,~
`~, m t ~ and of £illr~ ~F ' S rav
~ er
. reces s ytY Z~~~ss ~r11~E 19 81.
. Z~ W ~ ~,aY ~ ~~
~~
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-- ------ --- _ gyn. W1.
•
REV-1503 EX+ (4-86)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS AND BONDS
DIcC;aleb, Ruth M.
FILE NUMBER
21 95 0334
Ilan property jointly-owned with Right of Survivorshia must be disclosed a~ S~6e.l~~1e ~ i
~ REV-1508 EX+ (2-87(
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEQULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or
ILE NUMBER
McCALEF3 Ruth M. 21 95 0334
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F)
ITEM
NUMBER DESCRIPTION VALUE AT
DATE OF DEATH
1. Dauphin Deposit Trust Co. - Checking Account
balance 4/26/95
2. Interest on checking account - April 14-May 15
1995
3. Legg Mason - final interest check
4. Checking Account interest - May 15, 1995 to
date of transfer to estate account
5/19/95
5. Leader Nursing Home - refund of unused days
$58,967.12
77.29
185.09
8.49
598.41
TOTAL (Also enter on line 5,
(Attach additional 8Y~" x 11" sheets if moro space is needed.)
S 59,836.
, REV-1511 E%+ (7-68)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or T
McC:aleb, Rttth M. 21 95 0334
ITEM
NUMBER DESCRIPTION AMOUNT
A
•• Funeral Expenses:
~• Rolling Green Cemetary - Memorial Marker
X287.00
2. Hatdings Restaurant - Funeral Meal 281.39
3• Myers Funeral Home, Mechanicsburg, Pa.
Extra charge for Saturday interment 84
65
(funeral prepaid) .
B• Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees
3. Family Exemption
Claimant ~ ~ Relationship
n~
~~ ~ `~
t..) J ~~ e Vv
~
-
~~
Address of Claimant at decedent's death
Street Address 7 9 Cn 1 i~mh; a l~r i vo
City ~a~ttg-I`~i~ ~ State }~.~ . Zip Code ~ 7~1 ~
4. Probate Fees
131.00
C. Miscellaneous Expenses:
1.
2.
3.
4.
5.
6.
7.
8.
TOTAL (Also enter on line 9, Recapitulation) I $
~7Ra na
(If more space is needed, insert additional sheets of same size.)
i
1
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5
Y
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47 •~y
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~~ X17 ~ ~~ !...., 7r_ I u.
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DATE~~tt,, ,ggs RECEIPT" ~ "" B E R
RECEIVED FROl~1 ~!. ~~ P1Lh CA S S
-------
,~+ Address
I ~ ~~ ~ ~ d D ~.yrt
` ~ oo~uRS $~
FOR _---~~J2ni,.~~+ 1
ACCOUNT
~ BEC:INNIN(; HUW PAID .~
BAUNCE CASH
i AMUIINT
PAID CHECK _
MADE M U.S A. BALANCE
°~b`~O1''1~° DUE MUNEY
URDER BY
.PROFESSIONAL SERVICES & FACILITIES`
CASKET
VAULT
CASH ADVANCED:
CEMETERY CHARGES
MINISTER
ORGANIST
NEWS ITEMS
CLOTHING
FLOWERS
CERTIFIED COPIES
CEMETERY EQUIPMENT
TRANSPORTATION
~~~
50.00-
-- -- 780.00
--- - --- -- ---------- - --? ~ 00_
~j/i / IS ~ b ~OnJ e ,[ TOTAL
~l,t.~ A-L ~- 4917.00
CREDITS y g a~. 3s''
srZZ~ss~ by ~~s c,~fs ~ ~,
Received Payment
"7-7 i~ - c`~ 's - - 2 Z is fs
n~~.r~lr•1• ruts YHY.I"l.~N'1'
Cumberland County - Re aster Of Wills
Hanover and High Stree~
Carlisle, PA 17013
MCCALEB RUTH M
File Number 1995-00334
Remarks N JEAN CASS
Distribution Of Receipt
Receipt Time 509333958
Receipt No. 1004687
Transaction Description Payment Amount Payee Name
LETTERS TEST ISSUE
EXTRA PAGES 115.00
3
00 CUMBERLAND COUNTY GENERAL FUN
RENUNCIATION EXECU
SHORT CERTIFICATE .
5.00 CUMBERLAND
CUMBERLAND COUNTY
COUNTY GENERAL
GENERAL FUN
FUN
JCP FEE 3.00
5.00 CUMBERLAND
BUREAU OF COUNTY
RECEIPTS GENERAL FUN
& CNTR M.D
Check# 2933
Total Received......... $131.00
$131.00
r
McC:ALE~3, Rtzth M.
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
1.
MAXINE M. HALVERSON
153 River Hill Drive
~3ermuda Rtin, N.C. 27006
2. N. 17EAN CASS
19 Cc~ltxmbia Drive
Camp Hill, Pa. 17011
REV-1513 E%+ (2.87)
- ~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
1.
FILE NUMBER
21 95 0334
RELATIONSHIP AMOU TN OR
SHARE OF ESTATE
DAUGHTER ~ $28,339.53
DAUGHTER ~ 28,339.53
AMOUNT OR
SHARE OF ESTATE
- TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) $
(If more space is needed, insert additional sheets of same size)
l
~/ ~ ,
. 21•-95•-334
LAST WILL AND TESTAMENT FO.R RUTH M. McCALEB
I, RUTH A4. McCALEB, o.f Lower Allen Township, Cumberland
County, Pennsylvania, declare this instrument to be my Last Will
•and Testament, in manner and form following:
~- ~ 1. I hereby expressly revoke all Wills and Codicils
heretofore made by me.
2. I hereby direct my Executrices to pay all m_y just debts,
funeral and administrative expenses out of my estate, as soon as
practicable after my death.
3. I devise and. bequeath the remainder of my estate as
follows:
A. One-half thereof to my daughter, Maxine "4.
.Halverson; and to her issue per stirpes if she is
not then living.
B. One-half thereof to my daughter, N. Jean Cass;
and to her issue per stirpes i.f she is not then living.
4. I nominate and appoint my daughters, Maxine Ai. Halverson
'.and N. Jean Cass, as Executrices of this my Last Will and Testa-
ment; and I further direct that they shall serve without the
necessity of filing bond or security in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this 6th day of May, 1981. ~
~~ /y/• //1 ~~Q.t"~ SEAL)
Ruth M. McCaleb
WITNESS:
~- ~~ ~1~
~,. ~ . ~~
- 1 -
L+- ~_-_w_._
COMMON~ALTH OF PENNSYLVANIA :
COUNTY OF CUMBERLAND ~ SS.
I, Ruth M. McCaleb, Testatrix
attached or. foregoing instrument ' whose signed to the
accordin name is
executedgtIie iaw' do hereb ~ having been duly qualified
nstrument asynacknowledge that I signed and
willingly; and that I signedyitaas Will; that I signed it
the purposes therein expressed, my free and voluntar
y act f_or
Sworn or affirmed to and acknowledged before me
McCaleb, Testatrix, this 6th day of May, 1981.
, by Ruth M.
Testatrix
JANICE . H~FRT7~_Ft2., 1anTgRY PURI_IC ~ ~
Cum r~nnd (,rnm+~~ (;n~!isle, PA ~~'`'J
My Com fission Expires )aniiary ~] 1983 -
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND s SS.
We, Tom.H. Bietsch and Ro er M.
whose names are signed to .the attachedoareforeloin
bein g the witnesses
g duly qualified accordin g g instrument,
were present and saw Testatrix to law' do depose and sa
rthe instrument as Ruth M. McCaleb y that we
that she executed itrasast Will; that she si sign and execute
poses therein expressed;hthatrbothnofvoluntagned willingly and
of the Testatrix signed the Will as w• y act for the gur-
us in the hearing and sight
best of our knowledge the Testatrix wasnatsthatand that to. the
years of age, of sound mind and under no constrainteor8 or more
influence.
undue
Sworn or affirmed to and subscribed to before
Bietsch and Roger M. Morgenthal, witnesses
lggl, me by Tom H.
this 6th day of M_ay,
'~
Witness 'n n
I~ ' V(~
Witness
JANICE
My
H~ERTZLER, NOTARY PUBLIC ~ ~ I
land County Carlisle, PA ~ J~
lion Expires January 27, 1983 ~ ~--
- 2 -
- - -
REV-1547 EX AFP (12-94)
CON~DNWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ACN 1 O1
BUREAU OF INDIVIDUAL rnxES ApPRAISEMENT, ALLOWANCE OR DISALLOWANCE
DEPT. 280601
HARRISBURG, PA 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX DATE OS-14-95
ESTATE OF MCCAL M FILE N0. 21 -0 34
DATE OF DEATH 04-26-95 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO '•REGISTER OF WILLS, AGENT'•
REMIT PAYMENT TO:
N JEAN CABS REGISTER OF WILLS
19 COLUMBIA DR CUMBERLAND CO COURT HOUSE
CAMP HILL PA 17011 CARLISLE, PA 17013
Amount Remitted
CUT ALONG THIS LINE - RETA_IN LOWER POR_TION_ FOR YOUR RECORDS ~
-----------------------------------------
---------------------
REV-1547 EX AFP (12-94) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MCCALEB RUTH M FILE N0. 21 95-0334 ACN 101 DATE 08-14-95
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule Hl
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests (Schedule J)
14. Net Value of Estate Subject to Tax
(1) .00
t2) 931 .80
(3) .00
(4) .00
(5) 59.836.40
(6) .00
(7) .00
(s) 60,768.20
(9) 4,284.04
clo) 00
(12) 56,484.16
(13) . 00
(14) 56,484.16
NOTE: If an assessment was issued previously, lines
reflect figures that incl
d
t 14, 15 andior 16, 17 and 18 will
u
e
he total of
ASSESSMENT OF TAX: ALL returns assessed to date.
15 . Amount of L ine 14 at Spousal rate (15I . 0 0 X . 0 0= . 0 0
16. Amount of Lins 14 taxable at Lineal/Class A rate (16) 56, 484.16 X . 06. 3, 389
05
17. Amount of Line 14 taxable at Collateral/Class 8 rate (17) .00
15 .
18. Principal Tax Due X .
. .00
TAX CR (lg) 3,389.05
EDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST (-) AMOUNT PAID
06-06-95
08-07-95 AA047840
REFUND 169.45 3,305.10
.00 85.50-
TOTAL TAX CREDIT 3,389.05
BALANCE OF TAX DUE .00
INTEREST .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A '•CREDIT•' (CR), YOU MAY BE DUE
... _
REV. 1470 EX (6-88) INHERITANCE TAX
COMMONWEALTH OF PENNSYLVANIA EXPLANATION
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES OF CHANGES
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME
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