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RCC-33 (4-73) COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
-&Wk'Fr~'/~V
RESIDENT DECEDENT COUNTY OF CUMBERLAND
IMPORTANT: This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re~enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE EST A TE OF } AFFIDAVIT OF
HENRIETTA M. BASOM EXECUT~IX
(STATE FULL NAME OF DECEDENTI
Late of Cumber land County ~
State of Pennsylvania } ..,
County of Cumberland
REBA B. PETERS Execut:AA<rix
Admini stra tor of the utale of the above-named decedent being duly sworn: depllse S and soy S :
Decedent died October 4-th , 19~t;utate leaving ~ lost will, copy of which is hereto attached. }
(MON THl \DAY) ( YEA Rl iJ(tJ{~9{
No.. 00' o"~" of 0"0".' 0, } Snelbaker. McCaleb & Elicker
other authorized ,epresentative to wham 4-4- West Main Street, Mechanicsburg, Pennsylvania 17055
all carres.pondence should be mailed.
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
( EX E CU TO R-ADMIN I ST RA TO R)
the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exception of the following: -
I
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
I
That the contents of said safe deposit box or boxes are itemized under Schedules of this return,
wi th the exception of the following, for the reasons hereinafter set forth:
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate pos ses sion, s tanding to decedent's credit in banks of deposit, savings
banks, trus t companies, or other institutions, whether individually, or in trus t for any other person or persons
giving also separately the accrued interest thereon, if any, down to the last interest day priOT to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, hors es, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever, kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of decedent's
death and other investment securities owned by the decedent at the time of death, with the.market value there-
of at such time.
In the case of securities of close or family corporations, the values reported are as far as
~9ssJl;>le sul;>stantiated by financial .statements of the, corporations, showing the assets and HabHi ties
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death in any co-partnership or business, and in support of the value of such interest there is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or l:J.usiness.
A copy of the co-partner'ship agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. It should also set forth in itemized form, together with the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers of property, real or personal, within two years of decedent's
death, in contemplation of decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transferred, the
relationship of the transferees to the decedent, the proportionate share received by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to
take effect in possession or enjoyment at or after death, there is also attached to the schedule a copy
of the deed, trust agreement or other instrument creating the trust. Ther'~ is also set forth in said
schedule a list of all property, real and personal, with its value, which passes at decedent's death by
virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule 0 attached hereto and made part hereof sets forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, andthe relationship of such issue to the beneficiary.
That Schedule E attached hereto and made a part hereof sets forth all property, real and per-
sonal, owned by the decedent jointly with another or others, including intangible, standing in the name
of the decedent and others, plus the date and place of record of instruments effecting the ~estiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for and on behal f of this decedent's estate, inclucling funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and f\ldiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing and unpaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A", "B", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ...........m....umU.U.....
u. uuuuu....um.ud '-I +-/-0 day of . /)1 t{~ .... ,u'u 19...?Y
,r"" :zz: ~ d ~
.u..u..um.... :. .u~/~tNi r~-1o~~/~I&rKRffl8iiC <':~~.
MECHAiJ:CS8URG BOROUGH
CI,MbE HWm COUNTY ',,-
MY CGI>'1MiSS!lJN U.PiflES APR. 6, 1982
.-W~L>.LJ&uu.uu...u....u.u..u............._..
(ExeC1.l.tor-Administrator )
u3.Y.-.lSu...L.amtL.PQ.S.tu...La.ne..u....u.u..u.uuu..u..u.....u.....u............
(Street Number)
. .Gi:l.'!lP...l.JJJ.l.:.L...?~.......u!.?Q.!.!u.uuu...u...... ...u........u............uu..
(City or Town and State)
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisted securities,
securities of close or family corporations or an interest in any co-partnership or business, that the
data and statements required under the pa.ragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
'RC C-34 (4-731
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "Au
REAL PROPERTY
*
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant,in common with another or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commollwealth of Pennsylvania should be (1) (2) (3)
described by lot and block number, street and street number, together with DEPARTMENT
a general description of the property, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a farm state number of 0- FOR YEAR OF ESTIMA TED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not writ.
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEA TH In this spoc.)
to be listed on Schedule "F" and must not b. deducted from this schedule.
NONE NONE
,,\~
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
RCC-35
HESIDEi1 DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
..~. ~.'..
,~'
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e. g. jewelry, wearing apparel, household
goods, nnd furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in anyundistributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No. List and describe fully VALUE MARKET VALUE (Do not write in
this space)
Investors Mutual, Inc. $9.01 $18,012.94- /'
l. 1,999.216 shares,
Uncashed social security checks 826.20 /
2. /'
3. Dividend, Investors Mutual, Inc. 269.89 /
4-. Medicare payment, Pennsylvania Blue Shield 17.00
--
Insert this total opposite "Personal Property", Schedule "B" in X X $19 , 126 . 03"" \ ct." ~ L.6 .(Y3
the "As Reported" column on the last page of this return.
I
RCC- 3S
Cl1MMl1\Wl.;'!\ LTII OF PEi\'i\~YL\'A\'I A
TH.A\':"FFi\ I \W:l\ITA\CE TAX
~ C IIEDTJLE It C It
TR\\'c:I'l<:llS
~~~'
/("~~.':!l
/j ",'1j'rilf: '., t\
, :;:,'(,":';~'<1t\';)o,l
~C,~
H.ESIDEXT m:CF:DF\T
(1) Did decedent, within t\>o years ofdpath, makp any transfer of any material part of hi" pstate, with()1:t
receiving a valuable and adequate consideration therefor? (Answer yes 01' no) No
(2) Did decedent, within two years of death, transfer properLY from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) NO
(:3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer
(b) State of decedent's heal th at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideraLion therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no) No
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subj ect to his power of disposition? (Answer yes or no)
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor lillcler whi ch transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from thlC' property transferred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) No
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) No
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which cOllld revert to rlecedent under terms
of transfer or by operation of law? (Answer yes or no) No
(9) If the answer to (8) aoove is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reservecl in the decedent alone or the decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions should be supporte<l by affidavit by the attewUng physician as
well as a copy of' the death certificate.
NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with
relationship of transferees to <lecedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of' facts on which said claim is based.
NOTE 3: List applicable property below in manner in which providerl in Schedules A, 13, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Depi. Only)
None
None
N~
Insert this tot''ll opposite "Trans:fers", Schedule "C" in the
"As Reported" colunm on the last page of this return.
..
COMMONWEALTH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
HARRISBURG
IvjAYZ 1979
RCC-43 14-69)
NOTE: TO BE SUBMITTED IN TRIPLICATE
Pennsylvania Department of Revenue
Bureau of County Collections
26 S. 4th Street
Harrisburg, Pennsylvania
Dear Sir:
/ .3 f .!:Ji~/1i .2/- 71-tJ.3.3/
Pursuant to Section 742, Pennsylvania Inheiitance and Estate Tax Act of 1961,
we herewith submit the following report: ~. 7/1"1/11
:(/- 77- oS71
NAME OF REPORTING
FINANCIAL INSTITUTION
CCHB Bank., II .A.
ADDRESS 331 Bridq:e Street. New Cumberland _ PA 17070
ACCOUNT NO. OF JOINT,
TRUST OR INVESTMENT DEPOSIT - Savings Acct. #006.-0444<32-5
NAMES ON ACCOUNT
OR INVESTMENT Henrietta Basom with Reba B. Bornder
DECEASED JOINT DEPOSITOR,
TRUSTEE OR INVESTOR Henrietta "Bason
ADDRESS
AND COUNTY 3314 Lamp Post Lane Camp Hill, FA 17011 County- Cumberland
DA TE OF DEATH October 4, 1978
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR Reba B. Bornder
ADDRESS
REl.ATIONSHIP TO DECEDENT
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $
Uny..llown
Daughter
August 22, 1969
6,738.00
R. s. Stephens
Si gnature
Deposit Opere
Coordinator
TITLE
April 30 1979
RCC-3~
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the <lecedent jointly
wi tl1 another or others, including intangibles, standing in the name of the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief description, as indicated tmder Schedule
"A", plus the date and place of record of instrument effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name Unit percentage Estate
Address and Relationship'of Co-Owners, and Place Value Share Valuation
of Record of Instrument, where Real Estate.
DEPARTllENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
1. Checking Account No. 142-132203-1,
Commonwealth National Bank, opened
10/2/62 in joint names of Henrietta M.
Basom (decedent herein) or Reba B.
Bordner, now by marriage, Reba B.
Peters (daughter). Date of death
balance: $216.95. One-half taxable
$
108.4~'
2. Savings Account No. 14-0008253-1,
Commonwealth National Bank, opened
4/5/60 in joint names of Henrietta M.
Basom (decedent herein) or Reba B.
Bordner, now by marriage, Reba B.
Peters (daughter). Date of death
balance: $2,077.52, with accrued
interest of $0.12. One-half taxable
,c>~ ;'\ ," . I
~ ~ 038 . 8 :J 1l.'U K-& ~~ fyf:'r.....tJ..,.c-
- ~~ /..'CC/JIf 5/,)2/'19
3. Savings Account No. 006-044482-5,
CCNB Bank, N.A., opened 8/22/69 in
joint names of Henrietta M. Basom
(decedent herein) or Reba B. Bordner,
now by marriage, Reba B. Peters (daugh~er).
Date of death balance: $6,732.10, with
accrued interest of $5.90.
One-half taxable
~/
3,369.0(
No.
25-794
25-795
25-796
25-797
25-798
25-799
4. The following Certificates of Deposits
were issued by The Commonwealth Nation~l
Bank on 2/4/78 to Henrietta M. Basom
(decedent herein) or Reba B. Bordner, ~
now by marriage, Reba B. Peters ~
(daughter) : Date of .~
Amount Interest Death Va!ue
$2,500.00 $ 124.85 $2,624.85
$2,500.00 124.85 2,624.85
1,000.00 41.15 1,041.15
1,000.00 41.15 1,041.15
1,000.00 41.15 1,041.15
1,000.00 41.15 1,041.15
Fully taxable
TOTAL
/~.
9,414.30
~$ "3 93~" \ L 1 S l{, \ .-1 ~
"-= ' ~v
\'-\ ~~ l.ie
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" colunm on the last page of this return.
.
,
RCC-37 (12-63)
CO~IMO~\\-EALTII OF rE~:\SYYL\NIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIAHIES
\
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP I
(If step-children or SU~VIVED DATE INTEREST OF
State full names and addresses of all who illegitimate children I DECEI?ENT OF BENEFICIARY
aye an interest, vested, contingent or other- are involved, set STATE YES BIRTH IN ESTATE
wise, in estate) forth this fact.) OR NO
Reba B. Peters DauQ:hter Yes Ent ire residue
3 4-18 Lamp Post Lane
Camp Hill, PA 17011
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
E
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Heal Property
Personal Property
Transfers
SUMMARY
(Sch. "A")
. (Sch, "B")
.. (Sch. "C")
( 1 )
(As Heportl'd)
$
$
$
$
$
$
(2 )
(.'\s ])t'krmined)
$
$
.$
$
$
$
Gross Taxable Estate
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R~C-39 (8-77)
Cou'nty, Number and Name
File Number
Date of Death
Estate Name
Basom
21 - CUMBERLAND
21-78-577
October 4-, 1978
Henrietta
(FIRST NAME)
SUMMARY
M.
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
(LAST NAME)
(IN ITI AL)
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the values set forth opposite each item in the last column to the right in Schedules "A", "8", "C", and "E".
Dated:
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect-
fully report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WILLS
INVENTORY
V ALUE AS APPRAISED
$ -0-
19 126 3
13 930 60
-0-
33 056 63
ADJUSTMENTS
ODE (HARRISBURG USE ONLYI
00+
10+
20+
30+
REMAINDER APPRAISEMENT CODE
Real Property (Schedule Al
Personal Property (Schedule BI
Joint-Held Property (Schedule EI
Transfers (Schedule CI
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE FI
CLEAR VALUE OF ESTATE
92+
40-
93-
Valuation of life estates or
~
PRINCIPLE
FACTOR
VALUE
CODE
,
annuities.... ........... .... .._ $
~
t=
ESTATE TAX ASSESSMENTS _ $
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
CODE
COMPUTATION OF TAX
2%
6%
15%
$
$
$
$
$
*
TOTAL TAX
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
$
t=
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 months after death
$
$
BALANCE OF INHERITANCE TAX DUE
Add interest at rate of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED
Estate tax paid
$
$
$
$
c
BALANCE DUE
Add interest at rate af 6% from
to
$
$
TOT AL TAX BALANCE $
PAID $
Supplementdl Codes: (FOR USE IN HARRISBURG ONL Y)
48-Adj ustment
49+Adjustment
56-Annuity
6O-Life Estate
92+Remoinder Appraisol
93-Remainder Deduction
93C-Charity
94-Remainder Residue
96-Success i ve
Li fe Estate
FOR USE OF REGISTER ONLY
ADJUSTMENTS
NOTE: Whe~e subsequent adiustments are made to the above computation of tax by the Register of Wills, for proper reason
same should be noted below, with short explanation. I
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REV-518 (3-79)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P. o. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
I nvestigation Division
NOTICE OF FILING OF APPRAISEMENT
Reba B. Peters
3418 Lamp Post Lane
Camp Hill, PA 17011
(Executor or Administrator)
In Re: Estate of
Henrietta M. Basom
Cumberland
County - File No. 21....78....0577
Dear Ms. Peters:
You are hereby notified that the original
appraisement in the estate of Henrietta M. Basom
has been filed in the office of the Register of Wills of Cumberland
County on July 16 ,19-Z2. Said appraisement reflects the following valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
none
$19,126.03
none
$12,891. 78
$32,017 .81
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 after nine (9) months (fifteen 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 after 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.
,(1 r
Date
July 16, 1979
Signed
Title Administrative Officer
NOTE: This is not a bill.
R-::::V""~-~t1. (~"'7P~
C;,u.nty, Number and Name 21-Cumberland
21-78-0577
SUMMARY
,;: . (J ~'Iumber
')'~ie IIf Death October 4, 1978
:;!ott~ Name Basom
(LAST NAME)
Henrietta
(FIRST NAME)
M.
(INITIAL)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
REPORT OF INHERITANCE TAX APPRAISER
!, the undersigned duly appointed Inheritance Tax Apprdiser in and for the County of Cumberland
Penn5ylvonia, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the volues set forth opposite each item in the last column to the right in Schedules "A", "B", "C", and "E".
DO'b:-[~: _
July 16, 1979
'-Q r-----,
C.) 0-::-
,....
.
.-.j ,
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
rhe undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect-
ful", report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WILLS
Rea! Property (Schedule A)
Personal Property (Schedule B)
J');llt,;,'"ld Property (Schedule E)
Transfors (Schedule C)
TOT;\L GROSS ASSETS
'-ess Dehts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
$
none
19 126 03
12 891 78
none
32 017 81
ADJUSTMENTS
ODE (HARRISBURG USE ONLY)
00+
10+
20+
30+
REMAINDER APPRAISEMENT CODE
INVENTORY
V ALUE AS APPRAISED
92+
40-
93-
Valua;;,:)n of life estates or
~
PRINCIPLE
FACTOR
VALUE
CODE
1-
annuit1e,s.................. ......_ $
t=
L-
t=
ESTATE TAX ASSESSMENTS _ $
FOR USE OF REGISTER ONLY
CODE
COMPUTATION OF TAX
Tax on $
Tax on $
Tax on $
2%
6%
15%
$
$
$
$
$
Tax 0;1 S
Tax on $
Exemptions
Total Estate
*
TOTAL TAX
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
$
t=
Less tax previously paid
BALANCE
Less 5% "f tax if paid within
3 months affer death
$
$
BAUd; .:: OF INHERITANCE TAX DUE
i\dd ,,,:,, rc::, at rate of 6% from
$
r__~~,._..,.<.__ "~O
$
Es~ari.: tc:x paid
$
$
C=
AMOUN':' OF ESTATE TAX ASSESSED
BALANCE DUE
Add k",cs~ a'! wI", of 6% from
to
$
$
TOTAL TAX BALANCE $
PAID $
Supp!em~'ntal Codes: (FOR USE IN HARRISBURG ONL Y)
48-Adjustment
49+Adju5tment
56-Annuity
6O-Life Estate
92+Remainder Appraisal
93-Remainder Deduction
93C-Charity
94-Remainder Re5idue
96-Success i ve
Life Estate
FOR USE OF REGISTER ONLY
ADJUSTMENTS
NOTE: Where subsequent adjustments ?re made to the a~ove computation of tax by the Register of Wills, for proper reason,
same 5hould be noted below, WI1h short e'!xplanatlon.
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REV-451 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
COUNTY
FilE NO.
July 16, 1979
Cumberland
......~..~."-~'<.... '''-..r~
21-78-0577
Whereas, Henrietta M. Basom late of Borough. of Mech:'lnicsb~rg____
in the County of Cumberland Commonwealth of Pennsylvania, having r)il'C~ ~.r
the 4th day of October 19 .1a.., seized and possessed of an ,,:.,La e
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti , an appraiser duly appointed according to ~,n,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix the cash
value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the ex c.r"".>:1
of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawlll' cn"d'rJl
rate on any such future interest.
DESCRIPTION OF ASSET UNIT p,ppra'1S"E
VALUES Made for ! n tl ~
TdY Purr> )
$ ~
Real Estate nnnp [
Personal Property -1
19.1261
Joint-Held Property 12.891.~
Transfers none
Total Assets 32,017 r
,
-~
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Have been duly sworn according to law, I do hereby c;..efliify that the above appraiserpent is made in confonwL;
with the law on this 16th day of (:', . Jti:l:y '._,)_~ 19 .l!l._.
J
AU,lt;J.';i
Harrisburg
(Number and Street)
.1-'811111.
(post Office)
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'" MMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
TO:
( Ii)
\
\
L-.-
,/
DATE
ESTATE OF
~~,,'"
FILE NO,
COUNTY OF
For County Information purposes only
COUNTY FILE NO:
. .
:~'1/
DATE OF DEATH
-------------------------------- -- -- ----- -- ------ ------ ---- - - - -- --- - ---
Appraised Value of Estate:
Real Estate
Personal Property
Jointly Held Property ITransfers
1"': '
$
" /.1 / .;/ , - I-:
.' /
d r:: :t'.
$ l ., / .~
Total Gross Estate
Total Approved Deductions
Clear Value of Estate
$
Less: Approved Charitable Exemptions
.'f .;
Clear Value of Estate Subject to Tax
$
Amount Taxable @ 6% Rate
J I
$ (,
\~~t:<~ ~. /
tax due
$
Amount Taxable @ 15% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
$
r -', .':~'1
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
$
(.
+
$
$
$
+
+
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
$
{It
" ~.....'"
1
.~ .
In~erest will accrue at the
Inheritance tax from
rate of six (6) percent per annum on the unpaid balance of
to the. ,1ate of /p~yment.
"",""..j f""' j
Assessed by: ;"; " i ~ 'J .~.
Agent for the Commonwealth
-I
SEE REVERSE SIDE FOR INSTRUCTIONS
REGISTER OF WILL'S COpy
ed on thj"'
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
09-10-19
REV 554
ESTATE OF
d!-,uz 1.C~ Y /12c e.a.ili---cJ.-- ~-l/dli ~
? f it~ /~AWz..d:b,
fl..J '1 CS'..l'"
7~e1L~-4~/ . I
HENRIETTA M HASGM
10-04-78 0.0.0.
FILE NO. 21 78-Q?77
A review of our records has disclosed that you are responsible for the settlement of the above estate
or, in the alternative, that you represent the responsible party.
Section 701 of the Inheritance and Estate Tax Act of 1961 requires the personal representative of an
estate and/or a transferee to make an inheritance tax return. In addition, Section 711 states that inheritance tax is due
at the date of the decedent's death and shall become delinquent at the expiration of nine (9) months after the decedent's
death.
Our review shows that this estate remains open because:
_An inheritance tax return has not been filed;
~Tax in the principal sum of $ 6~. 33 plus six percent (6%) annual interest from
07-04-79 remains due and unpaid.
Inheritance tax returns and tax payments must be filed with the Register of Wills of the county in which
the decedent resided at the time of death.
Our records indicate that action on the items checked above is now past due. However, we are extending
to you a ten-day courtesy period from the date of this letter to permit you to settle this estate. If you fail to do so, the
Department of Revenue will make a formal demand on you or your client(s) and, if necessary, institute legal action.
Very truly yours,
/;?.J. dfu ~ ~ ~U!/ ~
i:~t:i::- iL<~e~u,LO ~..uLJHV
~Cel.3'f;
Af$ ~4 ~ti:Iuc..J.J
"-eA~.J~
BUREAU OF FIELD OPERATIONS
INHERITANCE TAX DIVISION
LOORESS RFPlY :-C
Cj~B[RLAND COUNTY
P'Ji-ilP.ITMJCE TAX OFFICE
1846 BRCCKWCGD 5T
H .41-< K I S 3 'J R G P A 1 7 12 7
717/787-9868
~ I
-~,~':;".
~.
-134 (10-75)
ONWEAL TH OF PENNSYLV ANIA
DEPARTMENT OF REVENUE
. BU9.EAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
OFFICIAL NOTICE OF INHER ITANCE
TAX APPRAISEMENT AND ASSESSMENT
OF ASSETS NOT SUBJECT
TO AD MINISTRA TION
TO:
Reba B. 80rdner
Date:
23 May 1979
3814 lamp Post lane
Camp Hill, Penna. 17011
County
Cumberland
County File No.
.~./ - rll?-
,
3~~/
Bureau File No.
We have received notice that, as a result of the death of Henrietta M. Basoun
on 4 October 19 78 , you came into ownership of certain property through right of survivorship, which
was formerly owned by the decedent.
Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable
and the liability for the payment of the inheritance tax due is imposed upon you, as transferee.
The property on which tax is hereby assessed consists of: Joint Account #14-0008253-1 held
at the Commonwealth National Bank in the decedent's name and her Daughter, Reba
~. Bordner. Account established 4-5-60
appraised by the Commonwealth, as of the date of death, at $ 2~077.52
50 % of this amount is taxable at the rate of 6 %
DATE OF ASSESSMENT
TAXABLE AMOUNT
LESS: ALLOWED DEB TS
NET TAXABLE AMOUNT
ORIGINAL ASSESSMENT AMENDED ASSESSMENT
<-2,-/-lc,
$ 1,0 'S8"'. ~lt) $
110 ? \1 ') (p
/-? -;-
c't.. ))
AMOUNT OF TAX DUE
If you pay the above amount within three (3) months of the
date of death of the decedent, or on or before
19_, you may deduct a discount of
5% of the amoun t of tax due, or
-----------
This tax became delinquent nine (9) months after death
(one year if death occurred prior to December 22, 1965
and fifteen months if death occurred on or after
December 22, 1965 but prior to June 17, 1971) and in
addition to the tax, statutory interest at the ~9te of 6% of
the tax per annum is also due as of * 7- '1" 19 71
in the arno un t of
*If the tax is not paid by the above date additional
interest is due at the rate of 6% per annum until paid
iPL.B $ ~
. -. 'I
vll~ ~,-" J.L/J "
(Agent for the Commonwea Ith)
TOT AL AMOUNT DUE $
APPRAISED BY: ASSESSED BY:
(Inheritance Tax Appraiser)
INSTRUCTIONS TO TAXPAYERS
Make checks or money orders payable to:
To insure proper credit to your account
this Official Notice must accompany
your payment. Mail or bring it to:
NOTE: Any party in interest who is aggrieved by this notice may object thereto within sixty days after receipt of
said notice as provided by Section 1001 of the Inheritance and Estate Tax Act of 1961,72 P.S. 2485-1001.
TRIPLICATE-MAIL TO THE SECRETARY OF REVENUE IF THE TRANSFEREE CLAIMS DEBTS AND DEDUCTIONS
If you have already paid this tax to an executor, administrator, attorney or other personal representative of the
decedent for forwarding to the Commonwealth, list below the dote paid, name and address of the person to who'lh
you mode payment, their official title and the amount.
Dote Paid
Nome and Address of Payee
Official Title
Amount Paid
Under certain circumstances, if, after the date of death of the decedent, you personally paid funeral expenses
or other iust debts of the decedent, with funds derived from the property herein taxed, such amounts expended
by you may qualify as deductions against the gross value of the property in the computation of tax due. If any
such expenditures meet 011 of the three following tests, it is recommended that you itemize the payments be/ow,
execute the affidavit, and return this notice. The Register of Wills will examine the debts claimed and allow
those which he determines to be proper. The tax will then be recomputed and you will receive an amended
assessment of tax.
THE THREE TESTS WHiCH MUST BE MET ARE THAT:
1. You were personally legally responsible for these debts, and
2. You actually paid these debts and can furnish proof of such payment, if required, and
3. These same debts ore not also claimed, for tax purposes, by an executor, administrator or other
personal representative of the decedent handling the \1dministration of the general estate of the
decedent or any other tran sferee.
Date_ Paid
NaIT;e__9} Pay~~_
Amount Paid
[____n _ _p_.___
---"---..--- --~-
----.~....._" -.-.-.-.-.-
----~- --~ i
: - ---- -- --- - --- -- -- ~~~ - -~~ ~=-~~~--~ ~- ==_:==~-=~~--=_:--==--=-~=-
I- --- ______hn___ - - ------
f------- --.- --- -- -----~-- --- ______u___
~-----_---L---~--- _____ _ _____ _. _____ __ __ _~ ____
_~~--~==~i-~ ~~_------~- -~-~~
TOTAL $
(attach separate sheet if required)
COMMONWEAL TH OF PENNSYL VANIA)
SS:
COUN fY OF__
I, .___ hereby certify that the foregoing is a just and true statement of funeral expenses
and other debts of the decedent, __________ , for which I was legally responsible and
which I did payout of the property herein taxed. I futher certify, that to the best of my knowledge and belief,
these same debts wi If not be cloimed by any other person, for inheritance tax purposes.
SWORN AND SUBSCRIBED BEFORE ME THIS----_DA Y OF
19__
Signature of Taxpayer
REPORT OF REGISTER OF WILLS
I, the undersigned, duly elected Register of Wills in and for the above county, do respectfully report that I
hove allowed deductions listed above in the total amount of $
Date of Approval:
Register of Wills
..
..
~ c;.~~""~
(('.~ ,oJ'" '-1',
./ . .' -' '\
, ~ .'
,... .:..}('U~'
COMMONWEAL TII OF PUJNSYL V At~IA
DEPARTMENT OF r~EvE~WE
[lUREAU OF COUIHY COLLECTIONS
, n'70
If.- 1
.J j; ",.'
.
RlC-...J.t S-7~.)
/'lOTE: TO BE WBMITTED II'l TRIPLICATE
REPORT1~C FINA~CIAL INSTITUTION
ADORE 55
ZIP CODe
17108
~ennsylvania Department of Revenue
Bureau of County Collections
Gable Building, 3rd Floor
411 S. Second Street
Harrisburg, PA. 1?127
r.nmmnnwP~ltn N~t;nn~l R~n~
10 South Market Square
Harrisburg. PA.
Pursuant to Section 742, Pennsylvania Inherltanco end Estete Tex Act of 1961, w.
her~with submit the follo....ing report: .
ACCOUNT 1-10. OF JOI~T. TR:JST OR
I~VESTMENT DEPOSIT
1114-0008253-1
(Statement Savings)
NAMES ON ACCOUNT OR
INV E~ TME NT Henrietta H. Basoun wI Reba B. Bordner
DA T E 0 F DE A TH _ ___..J...0-4-78
DECEASED JOINT DEP0~I;C? TRUSTEE
OR INV ES TOR Henrietta M. Basoun
ADDRESS 3814 Lamp PostJ.an.e.
Camp Hill. Pa.
COUNTY
ZIP CODE
CnmherlA.na
17011
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
Reba B. Bordner
ADDR ES5
~s \.w.
?~
L~ \:. '
L- 0.------
RELATIONSHIP TO DECEDENT
Daujihter
DATE INVESTMENT WAS ESTABLISHED
,",'ITH THE SURVIVING C'EF'OSITOR,
BENEFICIARY OR It-IVUTOP .___
4-5-60
~
B A L A ~ C E. IN C L U :> I ~~ G I tH ERE S T
PAYABLE, AT DATE OF DEATH S 2.077.52
Accrued Interest - $1.14
\?7<-i lo"lo
I( L- .
-? ~.i/rAA
~~.~
RCC13'4(10-75)
CO'MMONVlt-:ALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BI<REAlJ OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
OFFICIAL NOTICE OF INHER ITANCE
TAX APPRAISEMENT AND ASSESSMENT
OF ASSETS NOT SUBJECT
TO ADMINISTRATION
TO:
Ref.:::t r~ '}ordner
Date:
23 "'1~y 1979
])14 larlp Post l~n~
f) ~71
).I-/~ ."
County
County File Nh.< /
---~_.".. --,_. ',-
C!Jmberland
C~mp Hill. Penna. 17011
,;/ I ~
! '
:.....-_._.~.-..--.~,-~.
/
Bureau File No.
We have received notice that, as a result of the death of ~ienrietta M.
on ,,1 j)ctot,er 197e, you came into ownership of certain proper y
was formerly owned by the decedent.
1
Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable
and the liability for the payment of the inheritance tax due is imposed upon you, as transferee.
The property on which tax is hereby assessed consists of:
,:rt U:~~ C{F\;~lOmtrea Hh Aatiolla 1 z,ank in the <iecedf~nt' s nar!!e and her :l/lughter. Rena
Joint Account
1t14-:}J{),1~!5]-1
held
:cQr'in"'r. '-\C.-11'mi' "~$t.abl1sI1"').'! ~-S-f.)
appraised by the Commonwealth, as of th e date of death, at $ 2, ')77. '02
)J % of thi s amount is taxable at the rate of 6 %
ORIGINAL ASSESSMENT AMENDED ASSESSMENT
DATE OF ASSESSMENT
TAXABLE AMOUNT
LESS: ALLOWED DEBTS
NET TAXABLE AMOUNT
'-J - I
$ I, , , ( $
,
I
.' , i""t:-
AMOUNT OF TAX DUE
If you pay the above amount within three (3) months of the
date of death of the decedent, or on or before
19_, you may deduct a discount of
5% of the amoun t of tax due, or
This tax became delinquent nine (9) months after death
(one year if death occurred prior to December 22, 1965
and fifteen months if death occurred on or after
December 22, 1965 but prior to June 17, 1971) and in
addition to the tax, statutory interest at the r<;rte of 6% of
the tax per annum is also due as of */.~f 19!!
in the amo un t of
*Jf the tax is not paid by the above date additional
interest is due at the rate of 6% per annum until paid
TOTAL AMOUNT DUE
$
$
APPRAISED BY:
ASSESSED BY:
~ \:
(Agent for the Commonwea Ith)
(Inheritance Tax Appraiser)
INSTRUCTIONS TO TAXPAYERS
Make checks or money orders payable to:
To insure proper credit to your account
this Official Notice must'accompany
your payment. Mail or bring it to:
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NOTE: Any party in interest who is aggrieved by this notice may object thereto within sixty days after receipt of
said notice as provided by Section 1001 of the Inheritance and Estate Tax Act of 1961, 72 P.S. 2485-1001.
QUADRUPLICATE - REGISTER OF WILLS COpy
If. you have already paid this tax to an executor, administrator, attorney or other personal representative of the--
decedent for forwarding to the Commonwealth, list below the dote paid, name and address of the person to Whb~:J
you made payment, their official title and the amount.
Dote Paid
Name and Address of Payee
Official Title
Amount Paid
U"der certain circumstances, if, after the dote of death of the decedent, you personally paid funeral expenses
or other just debts of the decedent, with funds derived from the property herein taxed, such amounts expended
by you may qualify as deductions against the gross value of the property in the computation of tax due. If any
such expenditures meet 011 of the three fol/owing tests, it is recommended that you itemize the payments below,
execute the affidavit, and return this notice. The Register of Wills will examine the debts claimed and allow
those wh ich he determines to be proper. The tax will then be recomputed and you wi 1/ receive an amended
os sessment of tax.
THE THREE TESTS WHICH MUST BE MET ARE THAT:
1. You were personally lega Ily respons ible for these debts, and
2. You actually paid these debts and con furnish proof of such payment, if required, and
3. These same debts are not also claimed, for tax purposes, by an executor, administrator or other
personal representative of the decedent handling the administration of the general estate of the
decedent or any other transferee.
Dote Po id
Nome of Pa ee
DlJ.LE.QF DEBTS
De.s~.r:i~11 of Obli 9<!tio!1
Amount Paid
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L.__..____________ ----- -_.- ._-_.~_. .-'-----.------.------.,.--.__.~____.___.."____~____n_,__~ ------~-.--.---.---------__,___"'_______._.____1.
(attach separate sheet if required)
COMMONWEAL TH OF PENNSYLVANIA)
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-_. ----'----------~--,--_.~-_..-._-
5S:
COUNTY OF__
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i,_ hereby certify that the foregoing is a just and true statement of funeral expenses
and other debts of the decedent, _ , for which I was legally responsible and
which I did payout of the property herein taxed. I futher certify, that to the best of my knowledge and belief,
these same debts wi II not be claimed by any other person, for inheritance tax purposes.
SWORN AND SUBSCRIBED BEFORE ME THIS
--- 19__
-DA Y OF
Signature af Taxpayer
REPORT OF REGISTER OF WILLS
I, the undersigned, duly elected Register of Wills in and for the above county, do respectfully report that I
have allowed deductions listed above in the total amount of $
Date of Approval:
Register of Wills
!ItU~_
IJ'RCC 4 (11/78)
~NO'JOOlamO~~1
If
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:; RECEIVED
~,
:=' From:
;..:
11'
!~ Address
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~ XachanJ.czaburv, Pa. 17055
~ 'NO. 21-78-517 Dote o. Deoth 1G-t,,1911l
I Date of Payment AuqWl~ 11, 1979
----------------TWO RORDRID S~ . 25/100---------------
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
- ...da.1J.n rs
Snelbaker, McCaleb,. Blicller,
(Reba B. petera)
4. W_ Maill .~r..t:
Att
.
2 9'~ Tax on
$
Name of Decedent
...1......\ M. Rase.
% Tax on $
Estate Tax, Act of
May 7, 1927
$
$
$
$ ~
$
$ 272.2.
$
6% Tax on
$
15 % Tax on
$
Cou nty
Cn-"-rlllDd
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
_ % from
to
$
Remarks:
il
I
"PAID 011 ACCQUft.
IJOO ~ ~ [L~ @illlJ~
SEA L
TOTAL AMOUNT PAID
$
~72.25
I
NOTE: This Triplicate Receipt to be retained for audit purposes.
Received by
NOTE In accepting the transfer inheritance tax on future estates, prior to the death of the life
tenant or tenant far years, as evidenced by this receipt, it is understood that the Commonwealth shall
not be precluded or prevented from hereafter assessing additional inheritance tax at the death of the
life tenant or tenant for years whenever it appears that such additional tax may be legally due and
collectible for any reason whatsoever.
II:~ RCC:~i'>m"-' ;v;, ~ -- "If
~No'J003416
I~! OF
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,~' RECEIVED _________________...A.......I--...~ -
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I F;I. No. 21-78-577
I Date of Payment
..~T
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Al
LTH OF PENNSYLVANIA
REVENUE
NIA INHERITANCE AND ESTATE TAX
AI"
33 II OO~~_"- ..._........_....____..______________""=>110 rs
. representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
Date of Death
10-4-1978
15'f~ Tax on
$
$
$
$
$ ~
$ ..
S:
$ 62.33 I
$
44 W.
2'f,Taxon
$
x.c:hanicabuq.
Pa.
17055
6% Tax on
$
Name of Decedent
D1IIlDftA M. BMCIl
% Tax on S
Estate Tax, Act of
May 7, 1927
..-~r 27, 1979
"PAm IK J'ULL"
TOT AL TAX CREDIT
Less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
_%from
to
$
County
c."-r1aad
Remarks:
lJOO~w[L~@&lJ~
SEA L
TOTAL AMOUNT PAID
$
~4Ll~JJd2\Y\C 0,11 I
Haroili!j~ u~;- ~~t.Y
llaCIi.t.er of willa
(Title)
62_~~
NOTE: This Triplicate Receipt to be retained for audit purposes.
Received by
NOTE, In accepting the transfer inheritance tax an future estates, prior to the death of the life
tenant or tenant for years, as evidenced by this receipt, it is understood that the Commonwealth shall
not be precluded or prevented from hereafter assessing odditional inheritonce tax at the death of the
life tenant or tenant for years whenever it appears that such additional tax may be legally due and
collectible for any reason whatsoever.
~,
--~~~--~-~-~-~~-~ HURDRBD DOLLARS-~~~~--~--------~~---~---~~
RECEIVED dollars
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
From:
a1 b I: E 1eur Att a
(Reba B. Petera)
" weat Main 8trett
Mechanicaburl,fa.
2o/~Taxon
$
$
$
$
$ I
$ U
$ 300.00
Address
17055
6% Tax on
$
o. 21-18-5T7 Date of Death 10-4-1918
of Payment July 16.1919
15% Tax on $
Name of Decedent HnRIE'l"fA II. MSOM
% Tax on $
Estate Tax, Act of
May 7, 1927
County
Cumberland.
TOT AL TAX CREDIT
Less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
_% from
to
$
Remarks:
$
lJ 00 ~ [p [L~ @ illl]T~
SEA L
TOTAL AMOUNT PAID
$
]00 nn
NOTE: This Triplicate Receipt to be retained for audit purposes,
I
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\ C).C:',A.,.
RiChard (j,e.naw~ .6n
Re<<i.ter or~ItI:
(Title)
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Received by
NOTE: In accepting the transler inheritance tax an luture estates, prior to the death 01 the life
tenant or tenant lor years, as evidenced by this receipt, it is understood that the Commonwealth shall
not be precluded or prevented Irom hereafter assessing additional inheritance tax at the death 01 the
lile tenant or tenant for years whenever it appears that such additional tax may be legally due and
collectible for on~ reason whatsoever.
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I~i RCC 4 (2177)
U COMMONWEALTH OF PENNSYLVANIA
~ NO. H 0637 42 DEPARTMENT OF REVENUE
I~! OFFICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE TAX
ill:
5i RECEIVED ----------------------oBE 'lB0l1SAND
'l
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!~i FI:.--1Reb& B. peteJ'8)
IW'
U~ A ess 44 V.at ....:in stree-t
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I File No. 21-78-577 Date of Death
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DC>I.I.A.RS -..~--........---..-....,.., _...-_..~ do II a rs
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
2% Tax on
$
$
6% Tax on
$
$
Mechan1eaburg.Pa.
11055
10-4-1978
15% Tax on
$
$
County
CUlIIlMrlan4
TOT AL TAX CREDIT
Less five percentum of tax if
'paid within three months after
date of death
Plus interest 01 the rate of
_ % from
to
$
1,052.63
~
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I'"
I:
if
Name of Decedent
January 4 .1919
BEHRIB'l"rA M. BASOM
% Tax 0 (1 $
Estate Tax, Act of
May 7, 1927
$
Date of Payment
$
$
52.63
RI'"
PAID OB ACCOU1f.t'.
$
1'~1
i
~
I
uOO~[p[L~@illum
SEA L
TOTAL AMOUNT PAID
$
NOTE: This Triplicate Receipt to be retained for audit purposes.
. I
I
t
Received by
NOTE: In accepting the transfer inheritance tax on future estates. prior to the death of the life
tenant or tenant for years, as evidenced by this receipt, it is understood that the Commonwealth sholl
not be precluded or prevented from hereafter assessing additional inheritance tax at the death of the
life tenant or tenon! for years whenever it appears that such additional tax may be legally due and
collectible for any reason whatsoever.
Richard 2n aon
Rea1ater o~ Will.
(Title)