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SUPPLEMENTAL
INHERITANCE TAX RETURN
FOR ESTATES WITH GROSS ASSETS
UNDER $10,000.00
Commonwealth of Pennsylvania
Department of Revenue
Transfer Inheritance Tax
Resident Decedent
Rev-464 EX+ (1-80)
Estate of
Henrv J. Lodek
Date of Death
Aoril 26. 1978
Last Add ress
6280 Carlisle pike
Social Security #
Mechanicsburq. Cumberland Co.. Pa. 17055 Bureau File #
(City)
(Sta'te)
(Zip)
County File #
1. Decedent died:
o Intestate (without a will)
[iJ Testate (leaving a last will - copy attached)
2.
o Executor/Executrix
5CJ Administrator/Administratrix
.Name
Janet A. Rpineh"rt -
6280 Carlisl~ Pike, Box 524
Address
Mechanicsburg, Penna.
17055
(City)
(State)
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3. All correspondence should be mailed .to GQ Attorney 0 Fiduciary.
4. If an at~orney is representing the estate, indicate':
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.
Name
Paul L. Zeiqler~Esquire
"'',;;:/
P. O. Box 966
f ._,
Harrisburq, Penna.
(CitY)
17108
Address
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(State)
REAL PROPERTY - Identify real property located in Pennsylvania by lot and block number, street address and
include a statement of mortgage encumbrances as of the date of death.
,
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'-NONE
Total
21-78-0275
(Zip)
(Zip)
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Estimated
Market Value
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Department Valuation
(Official Use Only)
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Date
Name of Payee
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DEBTS AND DEDUCTIONS
Nature of Debt
Funeral expenses paid
Family exemption {will not be allowed unless decedent died
residing with a parent, spouse or chlldren.l
Administration Expenses
Counsel Fees
Fiduciary Commission
,
(Other Debts and Claims)
Amount
$75.00
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1/27 81
Goldberg, Evans &
Katzman
-
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Total
75.00
Under penalties of perjury, I declare that I have examined this return, and to the best of my
c2-ltJ-tf/
Date
-tI/M//)J'1'fb~il/lj )
w Appraiser Date
~ In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration of any
..J estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral
<( rote on any such future interest.
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I do hereby certify that I have appraised the assets contained here n in conformity with Pennsylvania" law.
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Debts and deductions are allowed in the sum of $
15H at /6-"
97;~ste(!;'Wi~
4-1-f' /
percent.
1"'-/3-?1
Date
BENEFICIARIES
BENEFICIARIES AND ADDRESSES
(State full names and addresses of all who have an interest
either vested. contingent or other interest)
RELATIONSHIP
TO DECEDENT
SURVIVED
DECEDENT
STATE YES
OR NO
AGE OF LIFE
TENANTS OR
ANNUITANTS
AT DEATH OF
DECEDENT
INTEREST OF
BENEFICIA'RY
IN ESTAT'E
I
Mrs. Emma Marie Reeves
701 Winton Street
niece
over 21
entire
Yes
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INFORMATION
PLACE FOR FILING - The return is to be fileo in duplicate with the Register of Wills of the county wherein the decedent resided. I
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TIME FOR 1'1 LING - The return is due nine months after the decedent's death, unless an extension for filing has been applied for ahd granted
,
by the Secretary of Revenue within the nine-month period. :
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FAILURE TO FILE RETURN - Section 791 of the 1961 Statute provides that ". . . any person who willfully fails to file a return or
other report required of him. . . shall be personally liable. . . to a penalty of 25% of the tax ultimately found to be due or $1,000
whichever is the lesser to be recovered by the Department of Revenue as debts of like amount are recoverable by law." i
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1
INHERITANCE TAX SUMMARY SHEET
(SQREAU USE O[l(L Y)
o Original
[!] Supplemental
o Remainder
REV-484 EX+ tHO'
File Number
21-78-0275
Estate Name
Henry J. Lodek
1
Date of Death
April 26, 1978
Social Security Number
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Cumberland
Pennsylvania, do respectfully report that I hove appraised the real and personal property os reported in the foregoing
return at the values set forth opposite each item in the last column to the right in Schedules uAu, fiB", "e", 'and ueu
.,
Dated:
April 1, 1981
PA>A'./<1 J-IfbfioHJ )
INHERITANCE TAX APPRAISER
ADJUSTMENTS REMAINDER APPRAISEMENT CODE
INVENTORY VALUE AS APPRAISED CODE (HARRISBURG USE ONLY)
Real Property (Schedule A) $ none 00+ 92+
Personal Property (Schedule B) 465 00 10+
Jolnt.Held Property (Sc:hedule E) nnne 20+
Transfers (Schedule C) none 30+
TOT AL GROSS ASSETS 465 00
Less Debts and Deductions 40- 93-
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Estate
o Annuity
PRINCIPLE
VALUE
CODE
RATE
FACTOR
FOR USE OF REGISTER ONLY CODE COMPUTATION OF TAX
Tax on $ 6% $
T ax on $ 15% $
Tax on $ $
Tax on $ $
T ax on $ $
Exemptions
Total Estate.
TOTAL TAX $
INTEREST FROM TO $
BALANCE $
Less Credits
DA TE OF PAYMENT AMOUNT .PAID DISCOUNT INTEREST TAX CREDIT
$ + $ - $ = $
+ =
BALANCE $
INTEREST FROM TO $
BALANCE DUE $
.' ........-. ...
REV-518 FO (7-80)
.
NOTICE OF FILING OF APPRAISEMENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELO OPERATIONS
Janet A. Rhinehart
6280 Carlisle Pike
Box 524
Mechanicsburg, PA 17055
RE: Estate of
County of
File No.
Henry J. Lodek
Cumberland
21-78-0275
Dear Ms. Rhinehart:
You are hereby notified that the supplemental
appraisement in the estate of Henry J. Lodek
has been filed in the office of the Register of Wills of Cumberland
County an April 1 , 19 81. Said appraisement reflects the following valuations:
Real Estate
Personal Property
Jointly Owned
T ran s fers
Total
none
$465.00
none
none
$465.00
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 alter nine (9) months (filteen 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
alter 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 April 1, 1981
Si gned
Jlhvo'd / -J?//I)"d)
Title Chief Appraiser
NOTE: This is not a bill.
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REV-457 (l-BO)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
INHERITANCE TAX
APPRAISEMENT
Estate of
Henry J. Lodek
21-78-0275
File No.
County
Cumberland
April 26, 1978
Date of Death
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent aftel' the expiration of any
estate for life or for years. the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral rate
on any such future interest.
PROPERTY REPORTED BY THE ESTATE
DEPARTMENT'S
APPRAISED VALUE
1. TOTAL REAL PROPERTY - SCHEDULE "A" . .
2. TOTAL PERSONAL PROPERTY - SCHEDULE "8"
3. TOTAL TRANSFERS - SCHEDULE "C" . . . .
4. TOTAL JOINTLY OWNED PROPERTY - SCHEDULE "E"
none
465.00
none
. .'
none
TOTAL REPORTED PROPERTY $465.00
PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH
d'
TOTAL UNREPORTED PROPERTY
TOTAL GROSS ASSETS $465.00
LIFE ESTATE OR ANNUITY CALCULATION
I do hereby certify that the above appraisement is made in conformity with Pennsylvania law and has been filed this day
with the Register of Wills. . )
D~/d/1?I'L'JIJJ _ April 1, 1981
APPRAISER DATE
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