HomeMy WebLinkAbout10-09-81 (2)
REV-455 EX+ (J.BO)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
*'
Estate of JACOB H. HILLER, SR. Date of Death Jan. 13,1981 File No. 21-78-121
WHEN CLAIMING THE FAMilY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant
None
Reiationsh ip to Decedent
N/A
Claimant's Address N/ A
ITEM NAME OF PAYEE REMARKS AMOUNT
NO.
1 4/15/81 Internal 1{evenue Service 1980 Federal Income Tax 3 663.87
7 ld I' SIR' VA n", , ORo VA ToY "'-7 07
3 5/7/81 MYers Funeral Home Funeral Bill 3 74fl.30
4 5/7/81 Robert J. Wolf Grave '1arker ,7.00
5 5/7 /81 'KN Pharmacy !men Accmmt 7 98
6 5/7/81 Carlisle Hosnita1 !mpn ^~~n"~t Riln
7 IU7/Q1 V D ; += M n ""=~ ' 070 00
8 5/7/81 F. S. Bryan, 'I.D. ()Pen Account 225.0fl
9 5/7/81 Carlisle Radio1oQY Associates Onen Account 43.00
'0 C/77/R1 1:>=1 Mn"; ~o1 ~ ""=~ . hO 00
l' 6110/81 Ho1v Snirit Hosnita1 linen Account 180.00
12 Landis f, Black Probation Costs Advanced to T)a te 132.47
,-.~_~U v Mn~~; on~ l'on";~p "yp~,,+n~'o rnmm;oo;nn C 7", <;,
Landis & Black Attornev's Fees 5 231.53
Reserve lior r:losing and Filing e1eases 15fl.Ofl
I
TOTAL THIS PAGE I 19 997.6fl
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts. funeral
expenses and expenses of administration submitted to the~t _e as ded;uctjoO fo):, Inheritance Tax purposes..:. .. .. _
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SIGNATURE OF ATTORNEY FIDUCIARY DATE I
OFFICIAL USE ONl Y
DEBTSANDDEDUCTIONSAREALLOWEDINTHESUMOF$ /'19tJ1.~/) AT b<L /-!5-
/
PERCENT.
&1+ e~
.' d// REGIS~ER F WILLS
//-d5---.71
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxable estate.
In addition to debts incurred by the decedent or estate, other items are claimable including the cost of administration,
attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone or grave marker.
All debts being claimed against an estate are subject to the approval of the Register of Wills with whom the
Inheritance Tax Return is filed. Evidence to support the decedent's or the estate's liability for the debts being claimed
should be attached to this schedule.
A family exemption of $2,000 may be claimed by a spouse of a decedent who died domiciled in Pennsylvania.
If there is no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of
the same household can claim the exemption. In the event there is no such spouse or child, the exemption can be
claimed by a parent or parents who are members of the same household as the decedent. The family exemption is
allowable only against assets which pass by a will or by the Pennsylvania Intestate Laws.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the family exemption is being claimed, indicate the claimant's name, address and his/her relationship to the
decedent. Enter "family exemption" in the remarks column and the amount claimed in the amount column.
2. Assign consecutive numbers to each item listed.
3. Enter the date on which each debt was incurred and/or paid.
4. Enter the names of each payee.
5. Provide a brief explanation in the remarks column for each debt claimed.
6. Enter the amount of each debt being claimed.
7. The form must be signed by the person who has assumed the responsibility for paying the debts.