HomeMy WebLinkAbout01-29-79
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R C C-33.( 4-' 3)
, .'
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
\
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RESIDENT DECEDENT
COpy Or- \'J\Ll MUST
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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.)
ADEN E. HOFFMAN
(STATE FULL NAME OF DECEDENTI
} AFFIDAVIT OF
CO-
EXECUTOR S
~
IN THE MATTER OF THE ESTATE OF
Late of Upper Allen Township ,Cumberland County
State of PENNSYLVANIA
County o?lORK
J."
~
EDWARD E. HOFFMAN and BRUCE W. H. FRANCIS
Co-Executors
of the eslale of the above-named de~edent being duly sworn, depose
and say
(MONTH)
Name and address of attorney or }
other authorized representa'ive to whom
all correspondence should be mailed.
(DAY)
, 19~{testate leaving a last will, copy of which is hereto attached. }
( YEA R) ;XllUltJm[
Decedent died
September 20
JAN M. WILEY, ESQUIRE - WILEY, SCHRACK & BENN
19 North Baltimore Street, Dillsburg, PA 17019
That as such Co-Executors deponent is familiar with the affairs of said estate and the property constituting
(~~
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: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A S,-<FE DEPOSIT BOX
Commonwealth National Bank ~
4 South Baltimore Street
Dillsburg, PA 17019
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under Schedules
with the exception,of the following, for the reasons hereinafter set forth:
of this return,
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 possession, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued interest thereon, if any, down to the last interest day priClT 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, horses, 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 interes t thereon to the date of decedent's
death and other investment secuLl,,'S 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
possible substuntiated by financial statements of the corporations, showing the assets and liabilities
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:lUsiness.
A copy of the co-partner'ship agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement settin,g 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 t;ake 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 pa~ses at decedent's death by
virtue of the exercise by decedent, either individually, or jointly wi th 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 D 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 inter'ests, 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, and the 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 vesti ture 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 behalf of this decedent's estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and hldiciary'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 t~on 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 Scherlules "A", "B", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
.
..........................................
~;:t"'{i(fi':/f4'U'l~ (J]~G;:v~
EDWA@....r.;..~...Ji~f..lli.~..................~.R.p..g.~....w.~.B..~.....f..MB.G..l?.
(Executor-Administrator)
336 W. Allen St. Box 31, R.D. #6
.......................................................................................................................-..............
(Street Number)
Mec h.aI.1.~.<7.~?1l..!..~.~.....~.A...................F.~.Y.?~.~.p..l?:r. C?.?.....~.A..............
17055 (City or Town and State) 17268
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
f'illed 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 requil'en unner the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
/.
,
,t. i \. \
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..... day of.,
,'ru' 1979
......r.......... .............,.
\~',
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Subscribed and sworn to before me this
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RC C-34 (4.73)
COb4MONWE,A.LTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE IIA"
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 surviorshrp or tenancy by entireties should be reported on Schedule "E.")
The real property locoted In the Commonwealth of Pennsylvania should be (1) (2) (3)
described by lot and block number, street and street number, together wi th 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 a- FOR YEAR OF ESTIMATED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEATH In this space)
to be listed on Schedule "F" and must not b. deducted from this schedule.
NONE
I
\"J U~
Insert this total opposite "real prope. ;y", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
RCC -35
RESIDENT 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 li8ted 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, and 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 any undistributed
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
No.
ITEM
List and describe fUlly
UNIT
VALUE
ESTIMATED
MARKEl' VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
Commonwealth National Bank (hereinafter referred
to as CNB)
NOTE: SEE ATTACHED LETTER OF CONFIRMATION FOR ABOJE
,,,,..
$ 4,704.69---
$ 2,629.30
$ 247.69
"".,
$ 19,924. 7 a/' ",/
$ 247.69 /'
",/
$ 7,000.00 /
,,'
$ 471. 93
$ 119.00//"/
$ 115.00/'/
...."~
$ 7 1 . OCY"
,,---
$ 1,000.00/
1. CNB checking acct. #222-482657-4
2. CNB regular savings acct. #22-0001001-1
interest to date of death
3. CNB Evergreen Savings acct. #22-0010726-2
interest to date of death
4. CNB Certificate of Deposit #22-3328
interest to date of death
5. Medicare Refund
6. Return of rent security deposit
7. Bricker's Auction House sale proceeds
8. Proceeds from sale of 1970 Volkswagen
TOTAL PERSONAL PROPERTY
$ 36,531.08
.-)
"~::J Co , S::. ~ u c
Insert this total opposite "Personal Property", Schedule "B" in X X
the "As Reported" column on the last page of this return.
Commonwealth J~
National Bank ~
November 9, 1978
Wiley, Schrack & Benn
19 N. Baltimore Street
P.O. Box 288
Di11sburg, Pa. 17019
Re: Estate of Aden E. Hoffman
Dear Mr. Wiley:
In reply to your letter dated October 6, 1978 on the above estate,
the following information listed below is as of D.O.D. September 20, 1978:
Checking Account - #222-482657-4
$4,704.69 Opened - See Attached
Account in his name only.
Regular Savings - #22-0001001-1
$2,629.30 Accrued Interest - $247.69
Opened - 7-23-71 Account in his name only.
Evergreen Savings Account - #22-0010726-2
$19,924.78 Accrued Interest - $247.69
Opened - 4-3-73 Jointly held with Esther Hoffman
Certificate of Deposit -
Princ.
Accrued Interest
#22-3328 $7,000.00
Account in his name only.
$471.93
If you have any questions, please feel free to contact us.
Very truly yours,
~~~~
Daryl S. Myers
Vice President
DSM/cg
The Commonwealth National Bank, 10 South Market Square, Harrisburg, Pa. 17108 (717) 564-9500
RCC.-3b
.cOM;MO~WEALTH OF PE:s'NSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
T R.AN S FEllS
RESIDE~T DECEDENT
(1) Did decedent, within two years of death, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) NO
(2) Did decedent, wi thin two years of death, transfer property 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 transfel' of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enj0yment 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 subject to his power of disposition? (Answer yes or no). 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 under which 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 the 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 could revert to decedent under terms
of trans fer or by operation of I aw? (Answer yes or no) NO
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) NO
NOTE 1: The answers to these questions should be supported by affidavit by the attending 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 d~scription 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 decedent, 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 provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
1'-\
\ '-l <v--"~
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
RCC-37 (.12'-63)
COMl\1.0NWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
(
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED
(If step-children or DATE INTEREST OF
State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY
aye an interest, vested, contingent or other- are involved, set STATE YES IN ESTATE
wise, in estate) forth this fact) OR NO BIRTH
Edward E. Hoffman son yes
336 West Allen Street
Mechanicsburg, PA 17055
Bruce W. H. Francis <=:j-pn-<=:on yes
Box 31, R.D.fl6
Waynesboro, PA 17268
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
....
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...............
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Real Property.............
Personal Property
Transfers ..........,.
SUMMARY
..........(Sch. "A")
....... . (Sch. "B")
..............,......... ."... .......,.. (Sch. "C")
................ ......................
Gross Taxable Estate
(1 )
(As Reported)
$ ., ,NONE:,
$ .).6.,.~.:u.08
$ . NONE:,.
$
$
$ ..:J.6.>.?31 ~q8
(2)
(As Determined;
$
$
$
$
$
$
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S~CC-3~
,c(;)MMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
'*
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
with 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 lmde,r Schedule
"A", plus the date and place of record of instrument effecting vesti ture, 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
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
unit
Value
Estate
Valuation
percentage
Share
NONE
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" column on the last page of this return.
DEPARTMENT VALUATION
CAUTION-Do not Write
In 'rhis Space.
Value of Value of
Entire Decedent's
Property Interest
N{J~
'R C ':-39 (5-68)
COMMONWE.c,L TH OF PENNSYL VANIA
TRANSFER INHERiTANCE TAX
RESIDENT ~ECEOENT
SUMMARY
Estate of HOFFMAN
(Last Name)
ADEN
(Firs t Name)
E.
(Initial)
DATE OF DEATH 9/20/78
FILE NO.
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", "B", "C", and "E".
Dated:
, - C., -~--.
\?\, Q_ ('_',--v--;~~\~~j
t. _~.._.._,/
;. )
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.
BALANCE OF INHERITANCE TAX DUE
Add interest at rate of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED $
Estate tax paid $
BALANCE DUE
Add interest at rate of 6% from
to
Dated:
INVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint - Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
annuities. . . . . . . . . . . . . . . . . . .
EST A TE TAX ASSESSMENTS
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
TOTAL TAX
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 months after death
REGISTER OF WILLS
V ALUE AS APPRAISED
$
VALUE AS REAPPRAISED
$
31,008
21
$
t=
1=
=t
$
COMPUTATION OF TAX
2%
6%
5%
10%
15%
*
$
$
$
$
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
$
$
$
t=
$
$
t=
$
C
L-
$
$
TOTAL TAX BALANCE $
PAID $
l=
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills, for proper reason,
same should be noted below, with short explanation.
REV-457 (8-78)
DEPARTMENT OF REVENUE
BURI!AU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
4-20-79
Cumberland
21-,78-0541
COUNTY
FILE NO.
_''''''_''_'''P>>.__'''''~'''''___''''''''_'.;',.............-
Whereas, Aden E. .Hoffman late of Upper AHEm Twp.
Cumberland
in the County of Commonwealth of Pennsylvania, having died on
the 20th day of September 1 rj7~, seized and possessf~d of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti , an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to asse~s 3.:1.] 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 .,fter the e:<piration
of any estate for life or for years, the Commonwealth hereby expressly reserveS the right to appraise and assess transfer inheritance taxes iL the lawful cclioteral
rate on any such future interest.
UNIT - Appraisem9nt
DESCRIPTION OF ASSET VALUES Made for Inheritance
Tax Purposes
l$ ,
Real Property l\T~_~ I
1 36 ,531 08
Personal Property I -~'-i
'T'...~...~~,.,~,," None
Jointly Held Property None
. ----r
Total Assets 36,531 08
-
.
'.., -
I
I
"-
I
!
Have been duly sworn according to law, I do hereby ce~tify that the above appraisement is made i.n conformity
with the law on this ?11t-h day of ",J i' " April _ 19 ~.
; '-. ',~ '>
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,",
Appraiser
(Number and Street)
Harrisburg,
(Post Office)
, Penna.
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nRCC4(2I77} COMMONWEALTH OF PENNSYLVANIA
n NO. H 063182 DEPARTMENT OF REVENUE
; OFFICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE TAX
JI:
ii RECEIVED
~I
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-.....---------BIGltI:urf HUNDRED SIrrY 8:
49/100--. ...-.,- ----....-....-...-....-
dollars
Jan M. Wile
representing Pennsylvania Inheritance or
Estote Tox due from the following estate:
(Bruce W.B.Francia)
2 '7~ Tax on
$
$-
Box II 288
6% Tax on
$
$-
Dl11aburg.Pa.
17019
I 5 % Tax 0 n
$
$-
Cou nty
Cumberland
TOT AL TAX CREDIT
Less five percentum of tax if
paid within three months after
date of death
Plus interest at the rote of
_ % from
to
$
1,,860.49
I
.~
:!i
;'
I I
File No.
21-18-542
9-20-1978
Dote of Death
'7~ Tax on $
Estate Tax, Act of
May 7, 1927
$
Date of Payment
January 24.1919
$
Name of Decedent
ADAN E. HOPPMAIf
$
rks:
PAID ON ACCOlJltT.
$
\
1.~.49
~~
uOO~(P[L~@illu~
TOTAL AMOUNT PAID J 1;' /, " ',(,
Received by j tgllj / " \ Lk"
NOTE: In accepting the transfer inheritance tax on future estates, prior to the death of the life Richard ~naAitl.r.On
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 additional inheritance tax at the death of the Regiater ot W111.
life tenant or tenant for years whenever it appears that such additional tax may be legally due and (Title)
collectible for any reason whatsoever.
SEA L
NOTE: This Triplicate Receipt to be retained for audit purposes.
11
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