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REV-483 (8-78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPE RA TIONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASSESSMENT OF PENNSYLVANIA
ESTATE TAX
/[J-! !5'~ S-
TO: DATE: /O-/J'~79
ESTATE OF: :-T;<~~'~ 4- /!//1U:;/ftCZ4'1
FILE NO:?-L- 7~' ~ 7C;~
COUNTY OF: (T X' /5--1/c~J( ~
DATE OF DEATH: _~---,-? _;;2~_ 7Y
---',._----------------------- ------------- ----------------------- - .....-. - --- ------------ --- --
h. DETERMINATION:
I. Taxable estate based upon:
~ United States Estate Tax Return (Form 706)
The communication from the Federal Government
confirming the acceptance 01: or changes to the
Federal Estate Tax Return
2. Amount of credit for State death taxes (os verified)
3. Pennsylvania inheritance tax assessed
(excluding any discount and/or interest)
4. Normal inheritance tax paid to other States or
Territories of the United States (excluding
any discount and/or interest)
S. Total inheritance tax credits (line item 3 plus line item 4)
'J. Total liability for Pennsylvania estate tax (line item 2
minus line item 5)
$
$
-...;-
-u-
$.rL/d~</3
/'
$
'-' --
$
5 YCJf 513
$
--u --
NOTE: Complete line items 7 and 8 ONLY when determination
is based on Federal Closing Letter
"'
,
, .
Amount of Pennsylvania estate tax assessed on determination
doted
Addition (reduction) to Pennsylvania estate tax (line item 6
minus line item 7)
$
8.
,-- - -.,-- ----- - -------- ---------------- -- ----- ---- -- ---- --- --- ----- -------- ---- --------- - ---
/--7
,/", L ~~$
Determination prepared by: ~L-Zc ?'eci;&; A" _-"--
Dote: /' I' 0 '-(','";2 - 79
/ .
B. ASSESSMENT:
Pennsylvania Estate Tax reflected on:
line item A (6)
line item A (8)
2. Less credits:
DATE OF PAYMENT
$
AMOUNT PAID
INTEREST
($ )
($ )
($ )
CREDIT
=
=
=
3. Balance of Pennsylvania estate tax due
$
Interest is due at the rote of si x (6) percent per annum from
to the dote of payment.
Assessment prepared by:
AGENT FOR THE COMMONWEALTH
Dote:
SEE REVERSE SIDE FOR INSTRUCTIONS
.
Form RC C .10
OF CUMBERLAND
COU NTV
~ j- / cF r-- if' 7/
STATEMENT OF DEBTS
AND DEDUCTIONS
DEDUCTIONS ALLOWED IN
DATE APPROVED
OFFICE OF TME
REGISTER OF' WILLS
AND AGENT OF THE COMMONWEALTH
'I
. 9f cR ~J / f 7
ESTATE OF
DATE OF FILING APPRAISEMENT '::;--o1r-- 5
Irene B. Hausman
LATE OF
Borough of Camp Hill
I NO. 01' I
DATI!: NA"'1i: OF PAVEE REMARKS AMOUNT
VOUCHE"
Linda Darlo Nursing care 12 75
Frances Dripp Nursing care 180 00
Darlene Jones Nursing care 51 00
- ,
Myers-Hall Funeral Home Funeral expenses 1975 00
Thomas Bowman, M.D. Medical bill 35 00
Cowley Associates Medical bill 145 00
Holy Spirit Hospital Hospital expenses 77 00
Rolling Green Cemetery Grave marker 725 00
John C. Hausman Spouse's exemption 2,000 00
Patriot-News Co. Legal ads 15 00
Cumberland Law Journal Legal ads 18 00
Register of Wills Probate costs & short certfs. 66 00
Arnold, Slike & Bayley Attorneys' fees 5,250 00
John C. Hausman Executor's fee 5,250 00
Register of Wills Filing inventory & deductions 9 00
Register of Wills Short certificates 10 00
Register of Wills Reserved for account 45 00
15,863 75
-
f?7?
DATE OF DEATH
July 27, 1978
COMMONWEALTH OF PENNSYLVANIA
I,
CUMBERLAND
John C.
1
ls.:
Hausman
COUNTY OF
NV KNOWLEDGE AND BELIEF. THE FOREGOING IS A JUST AND TRU E STATEMENT OF DEBTS. FUNERAL EXPENSES AND EXPENsa OF
ADMINISTRATION SUBMITTED TO THE ESTA,TE OF Irene B. Hausman
INMERITANCE TAX PURPOSES.
HERE8Y CERTIFY, THAT. TO THE BEsr OF
78
DAY ~---;y;f~ c;,,~/YM(""
DECEASED. A. DEDUCTIONS FOR
(L. S.l
Th"elma S. .MtCauslin, Notary Public:
1y CommtSSlon Expires iuly " r9'20
Camp Hill PA
. Cumberland County