HomeMy WebLinkAbout1-17-79
~/-11'-(J~S-
~
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
*
",. fo-: "' -'
- .'\
RC C-33 (4-73)
tl
RESIDENT DECEDENT
COUNTY OF CUntbeL la.nd
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 Reuenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
Cumberland
Pennsylvania
CO."" }
EXECUTOR
JANET S. DAVIS
EXECUTRIX
IN THE MATTER OF THE EST A TE OF
AFFIDA VIT OF
ROBERT S. WHEELER
(STATE FULL NAME OF DECEDENT)
ADMINISTRA TOR
County of
Cllm}JeTl;~nC1
}.,
State of
Admini stra tor
JANET So DAVIS
of the estote of theobove-named decedent being duly sworn, deposeS and say S
~E'pt-pmhE'r 17, 1 Q7S ' 19_{testate leaving a last will, copy of which is hereto attached. }
(MONTH) (DAY] (YEAR) Intestate
Nome and address 01 attorney or} ~'7illiam J. I~erpan
other authorized representative to whom
all corresjlondenceshould be moiled. 122 N. "Rnola nrivp, Rnoli'1, "ppnni'l.
Executor
Decedent died
That as such TIxes;utrix deponent is familiar with the affairs of said estate and the property constituting
(EXECU OR-ADMINISTRATOR)
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 fullowing: -
NAME AND ADDRESS OF BANK OR OTrlER INSTI TUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A S,.FE DEPOSIT BOX IN NAME OR NAMES 0 F HOLDERS TO DECEDENT
NONE :NONE NONE
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 8 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 sian, s tanding to decedent's credit in banks of deposit, 3avings
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 prior 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 Stales to tile 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 cf 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 hriefly 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 or tk ..i"I,: of death, bonds and accrued interest thereon to the date of decedent's
death and other investrm'., ",.J 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 f'amily corporations, the values reported are as far as
possible substantiated by f'inancial statements of the corporations, showing the assets and liabilit.ies
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 f,cht'dule, financial statements showing the assets and liabilities of said co-part.nership or l:lUsiness.
A pOT') r the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
togeU,er wi th a statement setting forth the character of the business, its location, and such other facts
1','rt1~.;1Cf' to the husiness as may be pertinent to a fair and just appraisal of the decedent's interest
therei.l: Ji:nst be submitted. It should also set forth in itemized form, together with the fair market value
ther",:f, any "ther property owned or bequeathed by the decedent at the time of death.
The ~chedule C attached hereto and made part hereof sets forth a tnle answer to each inquiry
containecl ther-ein 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 t1lke effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transferred, the
relatl.onsJdp of' the transferees to the decedent, the proportionate share received by each transf'eree 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 attaeherl to the schedule a cony
of' the deed, trust agreement or other instrument creating the trust. Ther,~ is also set f'orth in said
schedule u list of' all property, real and personal, with its value, which paEses at decedent's death hy
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 D attached hereto and made part hereof' sets forth the nllmes anrl addresses of all
persons !wneficially interested in this estate at the time of decedent's rleath, 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 H statement showing which of the benef'iciaries named in the decedent's will, if' any, died prior
to dr>:cdent, 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 instnunents eff'ecting the ,estiture of
real estate and the date of acquisition of personalty, plus the name, arlrlress and relationship, if Ciny,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all rlebts
and derluctions 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 furJiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkel's, and reli-
gious services, in consequence of the death of' the decedent; debts and claims owing and unpai<l at time of
death; taxes accrued chargeable f'or period prior to decedent's rleath (except those allowed under SecUon
651 of the Inheritance and Estate Tax Act); together with a statement of' collateral pledgerl 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' Wi] Is, and that
the amount of tax assessed can be reassessed in accordance therewi tho
That the totals of the appropriate columns in Schedules "A", "B", "C", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed Ilnd sworn to before me this
C/..
... ..,...""..,.,,"....,,....' ., . . 9." day of .
\; '. '.,., , ----.....",
~ ., ':"\ . .......
",... ~........_~..
~._"... " "". "<. '\
.........> ~;2ff~sO":.-'.,~_...
..........RaVr!t;:::f~~~%g.'r,tment..",lO{)G,......
. ....67,lO.."Dorches,ter..."Road..
(City or Town and State) .
Cnarleston SDHrh Caro11na
NOTE: Before signing aff'idavi t make sure all blank spaces iu the a'tf'1{T"avrt an(r~cheifu es annexea are
filled in with details or the word "None", and in case the assets include rare ami unlisted securities,
securities of' close or family corporations or an interest in allY co-partnership or business, that the
data and stll.tements requirerl under the pllra.r;raph above relatinp; to Scherlule "B" are attacherl. '\1so make
certain that column #1 in the "Surrnnary" has been properly completed as above-Ilirecten.
.......~...
"'" 19,.~t,',
..,bL
,1..\',i!-:S M..riAk"~Q
r,.~,i:1, r.:'" ."~':,,'C:{... -; ~~',r.
; , ) V ""~""'\ I'~,L' ~.:.' /
" ,,'
RC C.34 (4-73).
COM~ONWEA~ TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
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 ClE.")
The real property located In the Commonwealth 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 a. FOR YEAR OF ESTIMATED 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 DEATH In this space)
to be listed on Schedule "F" and must not b. deducted from this schedule.
NONE NONE NONE N~
N~
Insert this total opposite "real property" I 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 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, 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 ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No. List and describe fully VALUE MARKET VALUE (Do not write in
this space)
Da.uphin Deposit Ba.nk & Trust Co. I
I V
checking account no. 90007646 ./ \ C\ $17,237.96
./
"V
"\ ~ /'
./ "J- I
\.... '-J'
"' ../ /".
( 0 .-,/'
-.J (~ )
fl,\'2-~,.q~
Insert this total opposite "Personal Property" , Schedule "B" in X X
the "As Reported" column on the last page of this return.
.'
.RCC-3.S
rU\IMO\W1::A l.TH ()Ii l'E'\\fSYLL\\' J: 1\
THA\~FFl{ I\TFll[T,\\l'F TAX
S C !!EDf]U': !I C "
T It\'1<..:FI.:rLS
l"
~~~ &
v. ":~'~'~.,
L!"~~:::I '~):j
/j't(1!(~~ t\
, /, \..~o~~,~(<~ I
~.(:~;,~:.s:;~
nESIlW\T OFCfnF\T
(1) Did dc>cedent, within two years of death, make any transfer of any material part of his ""talp, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) _~_
(2) Did decedent, within two years of death, transfer property from himself to himself' and another OJ'
,,~hel's (including a spouse) in joint ownership? (Answ'~r yes or no) no
(3) l..~ the answer to (1) or (2) above is in the affirmative state:
(a) Ag;e of decedent at time of transfer n fa
(b) State of decedent's heal th at time of making the transf'er. (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
consideration 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 subject to his power of disposition? (Answer yes or no) no
(b) What was the transferee's age at time of decedent's death? ri/a
(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
(11) 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 1.n decedent
alone or others n/a
(7) Did decedent in h1.s l1.fetime make a transfer, the considerat1.on 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 t1.me, transfer property, the benef1.cial enjoyment of Which was subject to change,
because of a reserved power to alter, amend, or revoke, or which cOllld revert to, decedent under terms
of transfer or by operation of law? (Answer yes or no) no
(9) If the answer to (8) above is in the affirmative, was the power to alter, ameT"I, or revoke the 1.nter-
est of the beneficiary reserved 1.n the decedent alone or the decedent and others?
(Answer yes or no) no
NOTE 1: The answers to these questions should be supportert by affidav1. t by the attendi ng 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 descT'ipt1.on 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 detaile<i statement of facts on which sai.d claim 1.s based.
NOTE 3: L1.st applicable property below .in manner in which prov1.dect in Schedules A, B, or E.
ITEM
DESCRIPTION
MAlUillT VALUl:<~
(Es Uma ted)
DEPT. VAI~UATION
(Dept. Only)
NONE
NONE
~~
Insert this tatrd opposite "Transf'ers", Sche,lule "e" in the
"As Reported" column on the last. p'lge of this return.
Ree-57 (12-6])
l'-o\glO~\n~~LTE OF rEX;'\!'Y'-L\:-';[A
TRANSFEI, iNiiEHITA:\CE TAX
RESIBENT DE('EDENT
SCHEDULE "11"
."~
~-:;'~- ;~
" r'.,~..-~,,\:~
it',"-:;~>~i .~
IJf'."'-'--"~~
~:_j. ~}.)~~~>~ ";::, ~f<:~. - I),
BE:'\J I:::F1 C1 A H 1 ES
BENEFICIARIES AND ADDRFS'ES r. RELATIONSIE:" -r-;:I-~R-\rIVED I __n_m-r--_--- ----- -----------
. ... -~. S (If step-clH'dren or I .,) I DI\TE', IN'f'FRES'!, OF
State full names and addresses of rdl who illpgitlmatl:!' chJrlren II DEl:~:~>EN! OF I~E~~ErH'jARY
l:n-e an ] nt p~est ~ i::~t~~. 2~~~;~ 7gent or 01)1Pr-! rr~~rthn~~lt~e~i~c~'\t ST(;}{ I :\,~E~ lsI HTJ], 1"; f'ST\ TF
--------------1-------- I ----~----------I-----------
I !: '
\ I I I
I I I i
JANET S. DAVIS I I ~
Ravenwood Apt. 100 G I ~
6710 Dorchester Road I C ~ -- - _._____
Charleston, South caroli~a .~~IN I yes i ~ntire Estate
+ ,---t---t-
l_-IIl-
L --l I
+ I
~--
I ~
I -+- I I
t- -1 I I
-+-- I L 1-
-r-------j- I -+-
I I I -+-
-L I I I
-J ! I .
~ -1 I I
l I I I
I -1---
I
-
J
t
I
~-=1
I
I
~
I
I
Deponent further says that all the above-named heneficiaries are Uving at this time except below:
---"-------- .
NAME DATE OF DEATH RESIDENCE
NONE NONE NONE
I
..
.s ~
. ~l:t
:~ ~ ~
5-'0
"o.u
~ ~,
5 \-)~,
-............
::3 :n ~
u ::l ::>
<lJ E 0..
r~ u
e 0::
SUMtl.IAIW
(Sch, "A")
. (Sch. "B")
(Sch. "C")
Heal Property
Personal Property
Transfers
Gross Taxable Estate
( 1 )
(As Reported)
$ NONE
$17,237.96
$ . NONE
$
$
$17,237.96
( 2)
(As D/'lI'rll1ilwd)
.$ NONE
$ 17,237.96
.$ NONE
.$
$
$ 17,237.96
f- '0
Z Q.I
.... W Ul
o:l '" ...l
Q; - ~ Q.I
>< "'" u ~
W rit Q.I
Cl [I'J
(JJ ~ -
- ~
~ ~ ,~ c:c
~ rit
p... ~ ::c c Cl..
0 b1 "" =-
p... ::: '0 2:
w ~ w H s:: ~
:t J:: W :.-.
"" W ,... f- ::1 ItS :: Q
~ ..,.. "" ~ (J} ,.Q rl Z.
C - 0 f- (/) k S
Z f- (JJ 8 :>to Q) p... ~
~ W ~ Q) ~ ...... I-
rit ...-I c
0 c:c
c (::Q ~ .... 0
c ~ 0 U Q.,
'Z W ~ 0 ~ ;...;
o:l f- ::: ...... ~ Cl::
.t: -'
f- 0 I
.~ ~ ...... :.-.
0 .....
~ E ...... Q; g
'- - ~
::;;~ .....J (5 (3
R C C-38
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This schedule must disclose all property, real am!. personal, owned by the decedent jointly
wi th another or others, including intangibles, standing in the name of the decedent and others. List
reel! estate first, as entireties" or joint tenants, giving brief' description, as indicated tmder Schedule
".-\", plus the date and place of' record of' instrument ef'f'ecting vestiture, but do not include entireties
or out of stctte 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 Recorct of Instrument, where Real Estate.
^
unit
Value
pe reen tage
Share
Estate
Valuation
,-'"
/'
NONE
NONE
NONE
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 This Space.
Value of Value of
Entire Decedent's
Property Interest
N~
*'
R E V-SI8 (8-78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
RE FER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
Janet S. Davis
Ravenwood Apt. 100 G, 6710 Dorchester Road
Charleston. South Carolina
(Executor or Adm ini strator)
In Re: Estate of
Robert S. Wheeler
Cumberlanctounty - Fi Ie No.
21-78-0525
Dear Ms. Davis:
You are hereby notified that the Original
appraisement in the estate of Robert S. Wheeler
has been filed in the office of the Register of Wills of Cumberland
County on ~"'cl1 '9 , 19--$, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
17.237.96
None
None
S17,237.96
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. ~T3. ""_.
Date
March 19, 1979
Signed
Title Administrative Officer
Note: This is not a bill.
REV-457 (8-78)
DEP'ARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DAl I::
March 19, 1979
COUNTY
FILENO.
(!"mh~'r1t:llnn
;>1-78-01)25
Whereas, Rnhert S. Wheeler late of Wormleysbur~
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 17th _ day of September 19 78, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, LP-n Fnl iini ti , an appraiser duly appointed according to law,
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 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.
DESCRIPTION OF ASSET UNIT Appraisement
VALUES Made for Inheritano
Tax Purposes
"Rp~l - $
None
Personal Pronertv 17,237 b6
Transfers None
.Tnint.-Hp-l d Prnpp-rty Nnn...
'YV\lT'I A T A <" C'Vm co 'It,,, ":)"2,'7 at;
I
Have been duly sworn according to law, I do hereby certify that the above appraisen;>.ent is made in conformity
with the law on this , 9+h day of ' ("\ ,....-, (\ M~rch" . J 19 -29-.
Appraiser
Harrisburg
(Number and Street)
, Penna.
(Post Office)
';>,
.....
C
::I
o
\.)
t.f)
~
~
)
00 -0:
c- ~~
\ ~:
...... ~:
0):
~. ~'
, '" 3\
0:
~
uJ
~
tJ)
4-
0::
c..
~
'><
<!
t-
uJ
U
Z
<!
t-
~
uJ
:r.
z
t-
Z
uJ
o
(j)
uJ
0::
: '"0
: ~
: m
: t)
\ 0
~\
~ ,\
o
. '
e 01:
ro
;;\ \\
~:
LIl. <:0: .,g
""" ~ ......
k l: 0
~ ';::i: '.>
~ ,:
O't
i
0:.
~
~
o
<l>
.....
ro
....:\
C@.:
\!'\:
~:
0:
,;.\:
(\1:
.....
<l>
..1:1:
t)
o <:0:
(:4 <:0:
..... ~:
C
<l>
8
<l>
00
-e ci"
0.. en
~ ~
.c
.....
ro
<l>
(:4
4-4
o
<l)
.....
ro
(:4
0"
c--:
0-
.......
<;:\;
,.q;
i\
<l)
t)
S
o
00
~~
<l)
.....
00
'0,
~
.S
'"0
<l)
......
G:.
~
m
-;:l
'"0
X
ro
.....
4-4
o
.....
c
-;:l
o
~
uJ
::>
~
~
cc.
u..
o
'Z
uJ
~
~
c:(
0-
uJ
o
..
~
c
8
<l)
00
'li:\
a
P..
~
'"0
<l>
>
'(0
t)
<l)
IX..
'"0
<l)
>
o
a
P..
~
'"0
C
ro
'"0
<l)
C
"s
ro
G1
.....
-;:l
o
..0
ro
<l)
.....
o
1-0
~
...s
c
<l)
~
00
'(;
a
P..
~
8
o
<b
.....
ro
<l)
P..
~
'"0
<l)
en
~
.s::
t)
'"0
C
ro
'"0
<l)
~
<l>
.....
C
t.x:\
r----- ,
~.
1..........--__... =......;..... -...-.- =- ~ ~
.. RCC 4 (2/77)
H COMMONWEALTH OF PENNSYLVANIA
i~No.H 063751 DEPARTMENT OF REVENUE
:' OFFICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE TAX
H
,Ii;
; RECEIVED
11
,t;
~
.--
~ Fr
-'
II
II A e
II
.
.
u
i File N
~. Dote 0
lI%:I:l&..
:.=.IL ____ :JI!::lIiO."~.,~ __~ ~ -= ~ ~~'
.......~:II!:l3IiL..
-----------SIXTEEN HUNDRED
S~-FOUR & 98/100------------------
dollar
representing Pennsylvania Inheritance or
Estote Tax due from the following estate:
Nome
--- ----
William J. Iter-pan, EsQ. . 20/, Tax on $
ss 122 N. Enola Drive 6 % Tax on $
Enola.ft. 17025 15% Tax on $
o. 21-78-525 Dote of Death 9-17-1978 % Tax On $
Estate Tax, Ac
1 Payment January 9.1979 May 7, 192
01 Decedent RO'RF.R'l' So. VRDT.1r.'R TOTAL TAX CREDIT
Less five percentu
Cumberland paid within three
dote of death
ks: Plus interest at the
_ % Irom
PAID ON ACCOUNT. to
D D TOTAL AMOUNT P
$
$
$
$----
t of
7
$-----
$____~664. gee
County
m of tax if
months alter
$
r a,
I 'iT 00 ~ [p [!,~ @ ill 'iT~ SE A l AID, \Ui6!l.<l8
! NOTE. Th', Trip'.... R~'".. bo ....,,,...., '0"" po....... \. .10 (I (J' .
~ Received by __L Lf" 1- A A A[J..-L \ ~__
NOTE: In accepting the transfer Inheritance tax an future estates, prior to the death of the l'f~lciiircr l~nlO'r.r80n _n
. i tenant or tenant for years, os evidenced by this receipt, It IS understood thot the Commonweolth sholl
illl not be precluded or prevented from hereafter assessing additional inherltonce tax at the deoth of the nR.g1ater ()f_J[~:1.J.~___
fl, life tenant or tenant for years whenever It appears that such odditional tax may be legally due ond (Title)
~L :!.ctlblefo~ny reoso::~.atsoe\fer~~ ___'" ___.._.--..-. ~-.-- ."'lII!:C:II: ..~ '7.IIiiI( ~~___~___~_~
role of
$