HomeMy WebLinkAbout88-00259 Y
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of IDA F. BLESSING No. �� -'00 -"'v��/
also known as To:
Register of Wills for the
. Deceased. County of Gumberland in the
Social Security No. 160-05-5966 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut �r named
in the last wil�of the above decedent, dated August 3, , 19 83
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberlanrl County, Pennsylvania, with
h Pr last family or principal residence at_ 1124 Columbus Avenue, Apt. 5, Lemovne,
Pa.
(list street, number and muncipality)
Decendent, then�years of age, died March 24, , 1988 ,
at Holy Spirit Hospital, Camp Hill, PA. 17011 ____ .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $1,500.00
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows: , ���
WHEREFORE, petitioner(� respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters Testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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b.o Lemo ne, PA. 17043
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA � 5�
COUNTY OF Cumberland
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well t ly adr�ster the e te according to law.
Sworn to or affirme�THd subscribed , �
before me this day of �
A IL 1988 ! �
�
�
RY LEWIS Register �
.._,� r_
7 � � �;r� -- q ��r -- I � r�l : ;.�_r�
NO. 21 - 88 - 259
Estate of IDA F. BLESSING , Deceased
DECREE OF PROBATE ANI� GRANT OF LETTERS
AND NOW APRIL 5 , 1988 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated Au�ust 3, 1983
described therein be admitted to probate and filed of record as the last will of Ida F. Blessing
;
and Letters Testamentary
are hereby granted to Robert D. Blessing
WILL BOOK #106
PAGE 812 ETC. Register of Wil
__ RY C. LEWIS
FEES � �
Probate, Letters, Etc. $ 18. 0 0 �//.� _ �('
Short Certificates(5) . . . . . . . . . . $ 10. OO ATTORNEY(Sup. Ct. .D. No.) 06263 �
Xe�ages n . . . . . . . . . . . . . . . . $�� 3001 Market Street, Camp Hill, PA.
$ • ADDRESS
TOTAL $ 32 . 00
Filed . . . . APRIL, 5 �„1988, , , _ „ _ „ _ _ . �717) 761-5041
PHONE
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1..� "- �� L.C':..�
Mailed letters to Executor on 4-5-88 .
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- ---- � MAR 2 5 1988
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COMMONWEALTH OF PENNSV LVANIA
DEPARTMEN'1'OF HEALTH
VITAL RECqRDS
CERTIFICATE OF DEA1'N
(Physician)
STATE FILE NO.
, Name ot deceAent (First) (Middle) (Lastl Sex Date o(death(Mo.,Day,Yr.)
, Ida F. Blessing 2Female 3 Mar. 24, 1988
I
� Race-(e.g.,Whrte,Black, A9e las�birth� If under 1 yr. If under 1 day O�te of birth,Mo,Day,Vr $tate or foreign country cf County of birth Ciry,Boro,or Twp.of birth
I Americar[��t'3r��c.� day '�[� Mos. � Days Hows � Min, l�"17-13 b''�h Penna. Perry Penn TWFJ,
4. 5A 58. 5C. 6A 6EI �. gp,
ICounly ot death City,Boro,or Twp.Of death Hosoit�l or Institution Ilt not enher,give�ddress) If hosp.or inst.indicate DOA.
� Cumberland E. Pennsbora T Holy Spirit Hospital OP/ER,oi inpatient(spec�tyl
� �^ 7e �� _ ,o. Inpatient
�. Decedent's Mail�ng Address(Street or R � No.1, (City or Townl IStstel (Z�p CoAel Mantal Status Surviving Spouse(lt wife,give maiden name)
; 81124 Columbus Ave. , Lemoyne, PA 17043 9Married ,o Robert D. Blessing, ,Sr,
Ciliaen of what counlryT Was decedent ever in U.S.Armed Forces? Social Securi[y Number Usual Occupation IKind of work done dunng most Kind of business or industry
of wwkm Idr.)
USA v°' "° 160-05-5966 �lerk Pa. Dept, of Transport;.
� 11. 12. 13. 14A 148.
' Wneredld C �ns��vania
� decedent ���State Did decedent Lve 15c.�' Yes,daceJer�i h�ed�n township.
attually hve? �5b.Coun�y Cumberland in a township? 15d� No.decedent Gved within actual limrts of Lemoyne clry or boro.
15.
Fathe�'s name IFust� (Middle) ILast) Mothe�'s maiden narne IFirztl IMiddlel ILastl
's John R. Fritz Mabel Beam
,
i s. n
Informant's name IType or Prind Informant's �Sveet or RF�No.) ICity o�Town) (State) Rlp Code)
Robert D. Blessing, Sr. Ma�lingadd�ess 1124 Columbus Ave. Lemo ne PA 17043
i 18A. 188. / y I
(-]Burlal �Removal Date of burial,etc N�me of cemetery or crematory Locauun (City,boro,twp.) (State)
��
19A. QC�emation �o�ne, �se.3-26-88 �� R.ollin, Green Memorial Park 19D L. Allen Twp, , PA.
Signature ot f direcror and lice numbe ��-�-�-�- Narr,e and address ot funeral establishment
20A. F�-1 01 11 11 11 RI n�-0 r9yers-Hall Funeral Home, Inc.
� flegisnar's$ignature Date received by reyistrar 1903 Market Street
2�A. ''� � "a �� t�e..3�'�S'�� zoe Camp Hill, Pa 17011
To the best of my knowledge,death occ ed at the ume,dale and piace and due to
m the causelsl state��.
3 \�4`. �+
$. Signa�ure \�� `�TJ�N-- \�•�Cb��\'�^� o O.
a t� 22A.and title
�0
e_'O �te Signed(Mo.,Day,Vr.l Hour ol (��1 Q
> \ �,m Death A.M.
Y= Y
m` �78. � l, \�SJ 7�C. P.M.
�v Name and Addres:of Cenifier IPhysiciao,Medcal Exammer or Coronerl(Pri t or Type) � Name of Attending Physici� '
za. �v��\� `. ,���U. �-�1� ��� ��v�'�F �� ���v� ��' r, a5.� �'\1J�� i,�u., �
26. IMMEDIATE.CAUSE�. Enter only one cause per line tor(A)(B)and(C) . Interval between onset and death
IA1 �---- v � - - � � v"` '
Due to,or as a consequence oC � �Interval between onset�nd death
PART # , 1 \ _C� ���(�w„_ I
1 Iel �R���.J\1rV W.�Q���n�Vv"��
Due to,or as a rnnsequence of�. . IMerval between onset and drath
ICI �:�� � N�V�/�5�.-v, �4� �',� ���' 1,;As �'�j`j �
PART II Other$igniticant Condi(ions-Condilions contributing to death but n t rela d to cause grven in Part I(a) Autopsy Was use referred to Mediol Ex-
n 1 \ amine�or Coroner?
�1�^ �"V W'�U � �'y��` ` ❑Ye
�'�'� 17 �No 28. ❑Yes �Nq
If Acc..$uicide,Hom.,UnAeL or Da�e of Injury(Mo.,Day,Vr.1 Hour of A r� qescribe how m�ury occuned�.
Pending Investiyabon(Specily) Inlury
29A. T9B. 79C. V.�1. 2UU.
n�ury at work Place o Injury At home,larm,street,etc. '� Lowtion Sueet or RFD No.) (Cny,Boro,or Twp.1 (Sta�e) �
YJL ��Nn �_�Yu� 2NF,
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�
LA.ST WILL AND TESTAMENT
OF
IDA F. BLESS ING
I, IDA F. BLESSING, of Lower Allen Township, County of
Cumberland and State of Pennsylvania, being of sound mind, memory and
understanding, do hereby ma.ke, publish and declare this as and for my Last
Will and Testament, hereby revoking and making void any and all other Wills
by me at any time heretofore made.
I.
I direct that my Executor, hereinafter named, shall pay all my
just debts and funeral expenses as soon as conven�ently may be done after my
decease.
II.
All the rest, residue and remainder of my estate , whether real,
personal or mixed, and wheresoever situate, I hereby give, devise and bequeath
unto my husband ROBERT D. BLESSING, if he survives me by a period of thirty (30) days.
If he does not survive me by a period of thirty (30) days, then this gift to him
shall be divested, and I then give , devise and bequeath my entire estate, including
real estate , personal property or mixed, and wheresoever situate unto my children,
ROBERT D. BLESSING, JR. and JAMES A, BLESSING, per stirpes.
III.
I hereby nominate , constitute and appoint my husband, ROBERT D.
BLESS ING, as Executor of this, my Last Will and Testament. If my said husband
should predecease me, not qualify, or cease to act as such, then I hereby nominate ,
constitute and appoint my sons, ROBERT D. BLESSING, JR. and JAMES A, BLESSING, as
alternate Executors.
IN WITNESS WHEREOF, I, IDA F. BLESSING, the Testatrix, have unto
�n ��
� �
this, my Last Will and Testament, set my han3 and seal this �1�� day of
�� �(�5� � , 1983.
�
C�t:. ,- (SEAL)
Ida F. Blessing f
SIGNED, SEALED, PUBLISHED and DECLARED by IDA F. BLESSING, the
above named Testatrix, as and for her Last W ill and Testament in the presence
of �zs who have hereunto subscribed our names as witnesses at her request, in
the presence of the said Testatrix and of each other.
! ��� . � > L-�(. ,�
�/ _
✓�y' � /`� )
ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA:
, SS:
COUNTY OF CUMBERLAND:
We, IDA F. BLESSING, WILLIAM A, YOCUM and HAROLD C. MATTERN,
the Testatrix and witnesses, respectively, whose names are signed to the fore-
going instsument, being first duly sworn, do hereby declare to the ��.nndersigned
authority that the Testatrix signed and executed the instrument as her Last
Will and that she signed willingly, and that she executed it as her free and
voluntary act for the purpesses therein expressed, and that each of the witnesses
in the presence and hearing of the Testatrix, signed the Will as witness and that
to the best of her knowledge the Testatrix was at that time eighteen years of age
or older, of sound mind and under no constraint or undue influence.
� � �"v �",:_ �����-d�'� (SEAL)
Testator
�, � �� (SEAL)
'---�--� `--T f �
Witness
�
,�.✓�. ' � � Gf� - SEAL)
itness
Page two of three pages
, ,:_,i f�
Subscribed, sworn to and acknowledged before me by IDA F,
BLESSING, the Testatrix, and subscribed and sworn to before me by WILLIAM
� �� y 1983 e
A, YOCUM and HAROLD C. MATTERN, witnesses, this da of ,�"y,�fkS�;
t���,y�"��,�F^�: I % ��r G_,;t�, �._.
Notary Public
y WINIFRED P.WILBERT, Notary Pubiic
My Cotruniss ion Expires• Camp Hill,Pa. Cumb�rland County
� ..y Commis�wn -xpfres Uctober 18,1985
�
,_, .' 2�.
REV-1500 E�+ (6-85) �� ��� " FILE NUMBER
INHERITANCE T�X RETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA (TO BE FILED IN DUPLICATE
DPOSTOFFICE�BOX8327E WITH REGISTER OF WILLS) 21-8$-259
HARRISBURG,PA 17105-8327
DECEDENT'S NAME(LAST,FIRST,AND MIDDLE INITIAL) DEGEDENT'S COMPLETE ADDRESS
F-
W BLESSING, IDA F. 1124 Columbus Ave. , Apt. 5
u�+ SOCIAL SECURITY NUMBER DATE OF DEATH Lemoyne, PA. 17043
V
W
� 160-05-5966 March 24, 1988 co„�,Y
W
~ ❑ 1. Ori inal Return
Q g' 2. Supplemental Return ❑ 3. Remainder Return
N
W dV ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise ❑ 5. Federal Estate Tax
V�� Return Required
�0� ❑ 6. Decedent Died Testate
d ❑ 7. Decedent Maintained a Living Trust _8. Total Number of Safe Deposit Boxes
a (Attach copy of Will) (Attach copy of Trust)
ALL CORRESP�NDEN�E AND CON�IpEMTIAI'�AX INFORMATIQhI SHU'LLD BE';DIRFCTED YOc '
1 F NAME COMPLETE MAILING ADDRESS
N Z
� c William A. Yocum, Esquire 3001 Market Street
� O TELEPHONE NUMBER P.O. BOX 643
� 717 761-5041 Camp Hill, PA. 17011
1. Real Estate (Schedule A) ( 1) ro `'
v,
2. Stocks and Bonds (Schedule B) ( 2) -
3. Closely Held Stock/Partnership Interest (Schedule C) ( 3) -
4. Mortgages and Notes Receivable (Schedule D) ( 4)
5. Cash, Bank Deposits&Miscellaneous Personal Property( 5) �
(Schedule E) `
Z
O 6. Jointly Owned Property (Schedule F) ( 6)
�
J 7. Transfers (Schedule G) (Schedule L) ( 7)
� 8. Total Gross Assets (total lines 1-7) ( 8) 0
� 5,417.00
Q 9. Funeral Expenses, Administrative Costs, Miscellaneous ( 9)
W Expenses (5chedule H)
oc
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10)
11. Total Deductions (total lines 9 & 10) (11)
12. Net Value of Estate (line 8 minus line 11) (12)
13. Charitable and Governmental Bequests (Schedule J) (13)
14. Net Value Subject to Tax (line 12 minus line 13) (14) n
15. Amount of line 14 taxable at 6% rate (15) � x .06 = g
(Include values from Schedule K or Schedule M.�
16. Amount of line 14 taxable at 15% rate (16) x .15 =
(Include values from Schedule K or Schedule M.)
Z
� 17. Principal tax due(Add tax from line 15 and from line 16.) (17) e
�
fa„ 18. Credits Prior Payments Discount Interest
d + - (18)
p 19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT. (19)
V A.❑Check here if you are requesting a refund of your overpayment.
x
� 20. If line 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE. (20)
A.Enter the interest on the balance due on line 20A. (20A)
B. Enter the total of line 20 and 20A on line 208. This is the BALANCE DUE. (20B) �
Make Check Payable to: Regisfer of Wills, Agent
I�/�: Nli- BfiSURE T#�ANSWER AL�QUE5TIQNS OI�i R�VERSE SIDE AND'i'O RECMECIC NtATH t �M '
mm _�_
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true,correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is
based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FIIING RETURN ADDRE55 1124 Columbus AV2. Apt. S DATE
Lemoyne, PA. 17043
SIGNATUR€OF PREPARER OTHER HAN REPRESENTATIVE ADDRESS 3��1 d�Y C�2t�t. DATE
1'� ' Camp Hill, PA. 17011 �-�` -- ��
� William A. Yo � ��1��%L/. ��-L ���.���"'
!
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (✓) IN THE
APPROPRIATE BLOCKS.
YES NO
l . 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? ........ X
.........................................
3. Did decedent own an 'in trust for' bank account at his or her death?...................... x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
REV-1508�EX+ �,_83� SCHEDULE "E"
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS AND
INHERITANCE TAX RETURN MISCELLANEOUS
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
IDA F. BLESSING 21-88-259
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule "F")
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
�' THE FOLLOWING ITEMS OF PERSONALTY WERE OWNED IN THE JOINT NAMES
OF IDA F. BLESSING, THE DECEDANT, AND ROBERT D. BLESSING, THE
SURVIVING HUSBAND AND ARE CATEGORIZED AS OWNED BY TENANTS BY
ENTIRETIES AND NOT TAXABLE.
l. Household goods and furnishings. �
2. 1986 Buick LeSabre �
3. Pennsylvania Power & Light Co. Stock 18 shares purchased 3-11-64 0
4, " " " " 12 shares purchased 4-28-64 0
5. CCNB Corporation Stock - Purchased 9-20-74 �
6. United Utilities, Inc. , Stock - 35 Shares purchased 1-25-65 0
7, " " " 35 Shares purchased 4-28-64 0
8. Commonwealth National Bank - Certificates of Deposit as follows:
No. 26000-66259 issued 1-4-88 0
No. 26000-64756 issued 3-3-86 �
No. 26000-65395 issued 4-1-86 �
N0. 26000-62245 issued 1-5-85 �
No. 26000-65404 issued 4-4-86 �
9. Commonwealth National Bank Checking Account No. 2621-0999-5 0
10. " " " Money management Investment
No. 260-70078 �
11. " " " Statement Savings Account (Christmas
Club: No. 218-1353 �
TOTAL (Also enter on line 5, Recapitulation) $ Q
(If more space is needed insert additional sheets of same size)
REG•1511 EX+ ,5.e5, SCHEDULE "H"
FUNERAL EXPENSES,
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
IN RESIDENTED CEDENTRN MISCELLANEOUS EXPENSES Please Print or Type
ESTATE OF FILE NUMBER
IDA F. BLESSING 21-88-259
ITEM DESCRIPTION AMOUNT
NUMBER
A. Funeral Expenses:
�. Myers—Hall Funeral Home $ 3,085.00
B. Administrative Costs:
1. Personal Representative Commissions _ _
Social Security Number of Personal Representative: 160 05 8941
Year Commissions paid
2. Attorney Fees 300.00
3. Family Exemption $ 2,000.00
Cloimant Robert D. Blessing Relationship Husband
Address of Claimant at decedent's death
StreetAddress 1124 Columbus Ave. , Apt.5
City Lemoyne State PA• Zip Code 17043
4. Probate Fees 32.00
C. Miscellaneous Expenses:
1.
TOTAL (Also enter on line 9, Recapitulation) $ 5,417.00
(If more space is needed, insert additional sheets of same size)
anventory of the real and personal estate of
IDA F. BLESSING deceased
THIS IS A NO ASSET CASE. ALL PERSONALTY AND INVESTMENTS ARE IN THE JOINT NAMES 0
IDA F. BLESSING AND ROBERT D. BLESSING, HER HUSBAND.
1. Household goods and furnishings 0
2. 1986 Buick LeSabre 0
3. Pennsylvania Power & Light Co. Stock 18 Shares purchased 3-11-64 0
4. " " " " " 12 Shares purchased 10-20-78 0
5. CCNB Corporation Stock - Purchased 9-20-74 0
6. United Utilities, Inc. , Stock 35 Shares purchased 1-25-85 0
7. " " " " 35 Shares purchased 4-28-64 0
8. Commonwealth National Bank - Certificates of Deposit as follows:
No. 26000-66259 issued 1-4-88 0
No. 26000-64756 issued 3-3-85 0
No. 26000-65395 issued 4-1-86 0
No. 26000-62245 issued 1-5-85
No. 26000-65404 issued 4-4-86 0
9. Commonwealth National Bank Checking Account No. 2621-0999-5 0
10. " " " Money Management Investment No. 260-70078 0
11. " " " Statement Savings Account (Christmas Club)
No. 218-1353 0
✓
COMMONWEALTH OF PENNSYLVANIA '�
ss:
COUNTY OF CUMBERLAND J
William A. Yocuni'-
being duly sworn a�'ccording to law, deposes and says that he _�-s_ executor's attornev
of the Estate of Ida D. Blessin�
late of —___ ____ Lemoy_ne__ , Cumberland County, Pa., deceased and that the
within is an inventory made by Robert D. Blessing __ _ , the said executor
of the entire estate of said decedent, consisting of all the personal proparfy and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
and subscribed before me, � � �� '•�
Execulor - S t y`'L-��J`
19 /
3001 Market Str_ee�_____ -_
Camp Hill;.'PA. 17Q11
------- --
Addross
Date of Death 24 March 1988
Day Month Yeer
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. $ee Ar4icle IV, Fiduciaries Act of 1949.
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ftEGI3TER OF WILLS OF CUMBERLAND COUNTY �'
REPORT OF STATUS OF ADMIWISTRATION
(For Resdent Decedents Dying After July 1, 1984)
ESTATE NO. 21-� �S q _
Name of Decedent: IDA F. BLESSING
Social Security Account No,;_ 1 h0-�5-59��
Date of Death: March 24, 1988
Name of Personal Representative(s�:
Robert D B1 �G;ng
Capacity Executor g
__________ Administrator c.t.a.
(check one) Administrator ---
Administrator d.b.n.
Is the administration of the estate compiete? yeS X
___—__—_ No
_ • f,
If "yes", how was the administration ended? (check one)
By court accounting
By account stated to parties in interest ,
Did the parties release the
personal representative?
Other (explain) This is a no asset estate.
Total amount paid to date to creditors and for funeral and
administrative expense $ N/A
7'otal value of distributions to date to beneficiaries
$ N/A
[f administration is not complete, estimated value of assets
still in administration $ N/A
NOTE: This status report is due no later than the due date fur filing the Pennsylvania
Inheritance Tag Return or, if no Inheritance Tas Return is required, nine (9) months
after the date of death; if the administtation of the estate has not been concluded,
a summary report shall be filed annually thereafter until the administration is complete.
I certify under penalty of perjury that the foregoing information is correct to the
best of my knowledge, information and belief.
�
Da t e'-- �'"- ��—, 19_� /. ,
1 �,
� �e
, A t orney for F.s ate
� This report must be signed by the personal representative, or one of them when more
� than one, or by counsel for the estate.
REV-1547 EX (12-87) ��
COMMONWEqL7H OF PENNSYLVqNIA
DEaqRTMENT OF REVENUE
� BUREq� OF INDIVlp�q� 7qXES
� P.o. aox saz� � NOTICE OF
HAfiRISBURC, pq ,>>os-sa2� APPRAISEMENT rNHERITA►�CE �.,qX
ESTAT� �F DEDUCTIpNS ��p NCE OR DISALLOW,qNCE
OF BLESS,��;� ASSESSMENT pp TAX ACN
DqTE OF DEATk IDA 101
NOTE: 03' 4- F
TO 2NSURE PROPER �ATE 11_1 _88
PAYMENT TO r�E CREDiT TO YOUR FILE N0.
REGISTER pF ACCOUNT, SUBMIT COUN7'y 21 88-0259
wI��s' MAKE CHECK p THE UPpER pORTION CUMBERLAND
AYABLE 70 "REGISTER�F THIS NpT=CE WITH
OF WILLS. qGENT��, YOUR TqX
WILLIAM A yOCUM ESQ REMIT p
3001 MARKET gT AYMENT TO:
P� BaX 643 REGISTER OF
CAMP HILL CUMBERLAND WILLS
PA 17011 CARLISLE, C� COURT HOUSE
PA 17013
CUT qLONG <+mount Remitted
- - - _ THIS
REV-1547 EX (12-87 LINE - - - -� RETAIN LOWER P
NOTICE OF INHERIT - - - - - - _ ORTION F
ESTATE pF �CE T,qX qppRAISEMEfV'f, - - -�R YOUR RECORDS '�
BLESSING A��OW�INCE OR DISALLOW
IDA F FILE N0. �CE OF DEDUCTIONS
21 88-025g '�� ASSESSMEIYT pF T,q)(
RESERVqTION rAX RETURN
CONCERNING wAs� � � A�CEPTED ACN 101
APPRAISED FUTURE AS FILED DATE 11-15-$g
VALUE OF RETURN g INTEREST (X ) �
ASED pN: - SEE REVERSE HANGED - SEE ATTACHED
�• Real Estate (Schedule q) �RIGINAL NOTICE
2• Stocks and RE2iIRN -
Bonds (Schedule B)
3• Closely Held ( 1) --;
4 Stock/Partnershi .00 �
Mortgages/Notes Receivatrle p �nterest (Schedule �) � 2�
5• Cash/gank pe (Schedule D) ( 3) •�0
6. Posits/Misc. Personaf Propert •�0
Jointly pN,ned P�op��t Y fSchedule E) � 4�
�• Transfers y fSchedule F) � �� •�0
(Schedule G) .00
8• Total Assets � 61
� �� •00
APPROVED DEDUCTIpNS •00
'�� EXEMPriONS; ( gJ
9• Funeral Expenses/qd .00
Expenses (Schedule H���strative Costs/Miscellaneous
��� Debts/M
ortgage �iabilities/�iens (Schedule I)
> >• Total D t 9)
�2 eductions 3,417.00
Net Value of Tax ����
13. Charitable/ Return .00
�4 Governmental Bequests lSchedule J) �� >>
Net Value of Estate SubJect to Tax 3 417,pC
NOTE: �12} ,
ref 1 eC}Ssessrr��t was i ssueci 3 417.OU-
4SSESSMENT Op f�9ureS that p���aus1 (13} '
T�. inciude the Y, Tihes �q, (14} •00
total of q�� hetur5 ana/°� �s .00
15. Amount of IiRe 1 ns assessed tpd 17 wi 11
�g, 4 taxabie at 6q, rate date.
Amount of line 74 taxable at 15% rate
1 7. Principai Tax Due �15)
'� CREDITS: f1 gJ •00 X.06=
•00 X.15= •00
PA1'MENT •00
DATE RECEIPT (17)
NUMBER DISCOUNT (+) •00
INTEREST (-� AMOUNT pq�p
TOTAL T,qX CREDIT
►'AID AFTER THIS
F ADDITIpNAL INTERESTE SEE REVERSE FOR C BA�'�CE OF T,qX DUE
ALCULATION � �
��F BALqNCE INTEREST •00
DUE IS LESS THAN $1 OR IS REFLECTED TOTq� DUE
•00
AS A 'CREDIT" {CR) NO pAyMENT is o�.,,„__�0
I REV-1470 EX (2-86) �
COMMONWEALTH OF PEa11NSYLVANIA
DEPARTMENT OF REVEIVUE
BUREAU OF INDIVIDUAL TAXES �NHERITANCE TAX
P, O. BOX 8327
HARRISBURG, PA 17105-&327 EXP�NATION OF CHANGES
f
DECEDENT'S NAME Ida F. BZessin�
FILE N0. 21_$�_�
iTEM ACN 101
SCHEDULE NO.
_ EXPLANATION OF CHANGES
�i B3 Reduced ta zero. F y �
amil - exe;n tion can oniy be clazr�ed against probate
ass�ts, :
TAX EXAMINER: Delores 'y1 nd r
PAGE
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