HomeMy WebLinkAboutOC1968-0185 - ESTATE OF CAMPSEY---------------------------------------------------.------~~,~~----~~--.. ----~~
Testate Form
PETITION-SUR AUDIT .. ~. .. . "~
IN THE ORPHANS' COURT OF WASHINGTON COUNTY
Estate of .... EJ:~ .... 9..'! ... Qf:.~J.:>-~~--~~~~~---~JmX ___ Q_!I_ .... __ No. -~;,3::-.G8.~1B.5 ....... ______ .: ______________ .............. .
QAM.:P.SEY., ... JRJl ... !.;/ltjf:A __ lli\RRY .. O .•... CAMP.SEY ........ . Fiduciary ... Emma .. Bll.r.na .. C.amps.e.y., .. .A.drnr.x..
.c ... t ... a, .................................................................. .
Deceased
Date of "'·• ._,s,,. "~'-"''-''··•"' :\-~.-,'.: · ~t~:t'~Ddt~ o1fr.n ~<:-
Decedent's death ... J.I~J1J.l.~X'.Y-... lQt.h~---~-9.6.8. ................. Grant of L~ttets ... .Januar.F---2~-th;----196-S-------------------
This is the ... .E'=:r-~t ... §.nd .. F.inal ....... ; ............. : ............. account fi le'd in this estate
If there have been former accounts filed in this estate, list file nu"mber or number and term ... Nane._. ____________________ _
-~~Rn~-·-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Election to take Date Election Place of;
Under or Against will. (cross out one) Filed ______________ ........ _______ . __ __ Record· .. _____ _. __ ....... _____ .... __ ..
Name of su rvi vi ng spouse ______________ ... .E:rom~ ... E:u:rns_ .. C.amp.s .e.y ___________ ... _ ... ____ .: ___________ . ___ . __ . _____________ . __ .... _______ .. _____ .. __ .
List issue, where material: Not material •
.. n~<~·· p ··~"t.l J-!>00-.f·
Did decedent marry after execution of will? (indicate) ~-No. Any children born after execution of will? (indicate)
~ No. If answer yes, name them. _____________ --------____ -------------------____________________ . _______________ ..... _______________ .. _________ . ___ . ___________ .
• --------------------------------------------------------------------------------------------·------·--------------------------------------------------------------------------------------
Legatees Relationship Interest Fiduciary, if deceased or not sui juris
ElVIMA. BURNS CAMPSEY Widow All Sui Juris
Cist, if exceptions to above:-· Adeemed: .,_.,-Revoked:··--Lapsed: --Abated: Give Cause:
No exceptions~
If partial. intestacy,· give facts: None •'
Notice to inte~ested p~rties. Have all parties, having either vested or contingent interests and all crediors entitled
to noticE;!_ (Court Rule No. 9 paragraph C: Section 6: Subdivision c) received written notice of the filing of the account
and of call of audit? Yes. xb!l.vt
If · · · · None any except1on g1ve cause: .... ----------•----------·--------------------
File copy of Notice
an_d date of mailing ......... ~.t-~.a.chad.h.e.r..e.to ... b.aaving .. .da;t.e .. No.v.embe.r. .. 27.:th,~ .. l.9.6a.: ....................... .
Is estate subject to the filing of a Federal Estate Tax Return? ........... ,N.O.a ..... ~ .................... _. .. .:> ...................................... .
Actual payment made on Pennsylvania Transfer Inheritance Tax. Amount $ ...... N.on.e. •..................... : ................... . .
If the Will makes any portion of estate subject to a life-estate, give name and birth date of life tenant ..................... .
...... H.9. ... :J.,;i..f~ ... t~.:u~n9..Y-·-·····-··-············-··········-·-·····-·········-·······-···-··-·-··-···········-···-·············································-········
Give Names and addresses of all unpaid creditors who are legally entitled to notice, together with the amounts
of such claims; state whether they are admitted to be correct; and whether the claim is denied.
All creditors or whose claims the accountant received notice have been
paid in rull.
Give reference to such parts of the will as require interpretation by the Court; a reference to all questions re-
quiring adjudication, and a statement of any other facts deemed necessary for the preparation of the adjudication:
None.
Balance for distribution per account,
Itemize any additional debits not shown by account:
Total additional debits (Add)
Itemize any~ additional credits not shown by account:
Affidavit to this petition
John J. Hughes, advance for
certified mail
Total additional credits (Subtract)
Balance for distribution
$1.00
1.45
$ .. .3.,. ... 6ll.D.O ........... .
$ .... None •....................
$ ............. 2 • .4.5 ____________ _
$.~ .. .s.os. •. R_Q. ______________ _
If balan:e for distribution is not in cash, list each item held in kind, giving appraised Value (or distribution Value);
1964 Rambler Classic Six $500.00 (Family Examption}
Real Estate: Two (2) lots or parcels or ground situate in the Borough
of Claysville~ Washington County, Pennsylvania, Known and designatea as 122-wayne Street. Having·ere6ted
thereon a two story rrame dwelling.
[-.:· !'
.... -..
llu11qiugtnn OJnunty. 1111:
I, ........ R.ua.ae~l.J4.arino ....................................... Register for the Probate
of Wills and granting Letters of Administration, in and for the County of
T·V ashington and C onunonwealth of Pennsylvania:
To ....... ~A~~-~-~---~!~1?-~-~~---···························································
Administra to:~t~f all and singular, the goods and chattels, rights and credits
remaining unadministered, which were of_ .... J:t~ ... 9.! ... 9~~.P-~~-'1.1_~j~J!L
· Barr,-0. Campse J --~~r.l ... Q.! .... Q~-~P.-~.~Y. ...... !r.! ... Aft/! ................ late of the said County,
deceased, with a copy of deceased's will annexed, GREETING:
vV here as, the said .. ~! ... ~.! .... ~~-~P.-~-~-1.'-t~~---ii:~-;---g.~---·gi:~·~Z;~
0
• His lof 0 d Hi 8 l W oll · d T · . 't. uz.. ................ J. etune, ma e ...................... ast 1 an estament zn wn tng1
which 'was duly proved on the .. 2.~.tb~ ..... day of. .. J.a..n.~:ry. ............... A. D.,l~-~~--having, zvhilst ....... 'J!:.! ..
lived, and at the time of.~.!~decease, divers goods and chattels, rights and credits, within the said County, by
means rc,!zereof the full disposition and pmc.•er of gr.mting letters of administration thereof, is manifestly
known to belong to tne; Therefore desiring that the goods and chattels, rights and credits which were of
the said deceased, and which remain unadministered, ntay be well and truly administered, converted and
disposed of according to the tenor and effect of the nid deceased's rCJill and according to law, I do hereby
grant unto you the said ........ J.imn& .. ~~-m, ___ Q_"mP.~~-"1. .................................................................................. .
-·---·------------------------------------·-------------------------------------·-----------·--·-------------------------------------------------------------------------------------·
............................................................................ (in whose fidelity in this behalf I very much confide,) full
power bj' the tenor of these presents, to adtninister the goods, chattels, rights and credits remaining
unadministered, which were of the said deceased, within the said County, as also to ask, collect levy, re-
cover and receive theocredits whatsoever of the said deceased, which at the time of.~t~ .... death were owing,
or did in any way belong to ... Him..and to pay the debts in which the said deceased stood obliged, so far
forth as the said goods and chattels, rights and credits will extend, according to their rate and order of law;
especially of well and truly administering the goods and chattels, rights and credits remainingunadminister-
ed, which were of the said deceased, according to the tenor and effect of said deceased's will, and according
to law; and making a true and perfect inventory and conscionable appraisentent thereof, and exhibiting
the same into the Register's Office, at Washington, on or before the .................... day of ............................... .
ne.'t:t, ensuing, and also a true and just account, calculation, and reckoning of your administration, upon
l . . Oath d • h . 0 0
• f 0 h h l · your so emn .................................... to ren er at t e expzratzon o szx mont s, or w en egally thereunto re-
quired; and I do by these presents ordain, constitute and depute you, the said ............................................... .
Emma Burns Campsey ·--------·-----·--------------·-----------·-------·-----·-----------------------·---------.·-----------------------·---------------·------.. ------------------·----------------·-------·
administrat ~i.K C • T • A of all and singular the goods and chattels, rights and credits, which
remain unadministered and which were of the said deceased, ·u.:ith a copy of said deceased's Will annexed,
within the limits aforesaid; sa11ing harmless and forever indemnifying me and all other officers against
all persons by reason of )'Our administration aforesaid, and saving all others their rights, &c.
Ju Wr.stimnuy lf4rrrnf. I ha-ve hereunto set my hand and affixed the seal of said office at
Washington, the ____ g_~-~h~ ....... day of ........ ~~--~-~l ................................................ in the year of our Lord
one thousand nine hundred and .... ~.!~~-l ... ~-~6-~~---·······-···-··············
···········-~.&~---·· Register.
Jr.
• -t.·r--·· .•.
i=x: ~ ~
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p • tTJ 0 :e (') UJ ....,
: ID t-3 bS > > il t-3 0 '=' tTJ 5!1:
0 ~ -~~ z "''j ?> -~ ~ ~ ~ ~ r -= :z:
63·~68-185 63-68-185 /
i\ffi~nuit ®f 1£xrrutnr ®r A~ministrntnr
jltatt nf Jrnnayluauta, ( !i!l: <!tnunty nf Baa~tngtnn
Personally before me, the undersigned authority, a ..... ~.9..~.~.?::Y.: ... ~~~.!.~.£ ................................ in and for said
.~~~&~/~p:~~~~:~if~~~·;;;;;;;;;·~~-;;~g;toftt':~.!~~
a?kt.a ... HARRY .... O.~ .... C~SE.~., .... J.R.. ..................................... ..deceased, that '\'!' \'jre~~~~~ fi\!9'lf"'tli.RRX 0
complete mventory and appraisement of the real and personal estate ofCW.SEY..]tZ~l.a .... l:IARRX~.J:>..~ ~~SEY ,
deceased, except real estate outside the Commonwealth of Pennsylvania; that the figures opposite each item •
of real and personal estate in the foregoing schedules are determined and stated by the undersigned to
be the fair value of said items as of the date of the decedent's death, based upon a just appraisement of each
item made by the above named ~ Administrator. c • t • a •
· Swo nd subscribed befor£e this .. /l. .... :..... l .(' A:) ~
. day .E ... ·~t .......... : .... ~·~:!L x..~~ .. AJ. .. ~d;r:i~~t./~~,.t~ .. ~--~;·~·~~:lr.a~f~fl(l,•u n. ""1r!fn ..• ~a...._ ~,;::···~:····;·-;;;;·rc:< .... ~~~;~~;;:~~-·INSTRUCT!ONS ~ ~
\
1. An inventory must be filed within three months after appointment of personal representative.
2. A supplemental inventory must be filed within thirty days of discovery of additional assets. .
3. 1 Original and 2 Copies and 2 RCRI-34, Under $10,000; 1 Original and 2 Copies and 2 RCRI-33
Over $10,000, including Copy of Will; 1 Original and 3 Copies and 2 RCRI-33 Over $50 000 in~
eluding Copy of Will and copy of Federal Estate Tax Return. ' ' '
REFERENCE FOR ADDITIONAL COPY
Act of 1947 P. L. 513 Sec. 5.2, 72 P. S. 4844.2
H .Jl.ttUCA.W_l,r~fU~.,f-~'8~ of the goods and chattels, rights and credits which
were of ..... §i~~it .... g.~~.!?. .... ~.X .... Q .. , ................. late of .~.9..~.9.~B.~ .... 9..~ .... ~.!~.Y..~.Y.~ .. !.~.~ ........................ .
Washington County, Pa., taken and made in conformity with the above affidavit.
DOLLARS
\ PERSONAL PROPERTY:
\ . '\ 1964 Rambler Class1c
;REAL ESTATE:
Six
ALL those two certain lots or parcels of ground situatE
in the Borough of Claysville, Washington County,
Pennsylvania, bounded and described as follows:
PARCEL I: FRONTING 102 feet, more or less, along the
Eastern side of Wayne Street in the Borough of ClaysvilJ,e
aforesaid and extending back therefrom of equal width II
200 feet, more or less, to the Western side of East All,~.
BOUNDED on the North by lot of Andrew and Burneda Jackson;
on the East by East Alley; on the South by lot of Margarl1et
M. Gordon an~ Parcel II and on the West by Wayne StreetJ
Upon the above described premises is erected a two-stor~
frame dwelling.
PARCEL II: FRONTING 69 feet, more or less, along the
Western side of East Alley and extending back 31 feet,
500
CENTS
00
1 more or less, to line of Margaret M. Gordon lot.
BOUNDED on the North by Parcel I, on the East by East
Alley, on the South by lot of PriceR. and Irene
McCullough and on the West by lot of Margaret M. Gordon,
being the 31 feet of the rear portion of the Margaret MJ
Gordon lot which adjoins Parcel I on the South. I
BEING the same lot or parcel of ground devised to Harr:11
0. Campsey, Jr., in the Will of Harry 0. Campsey, who
died May 26, 1947, whose will is of record in the
Register's Office of Washington County in Will Book 71,
page 109, wherein the above two parcels of ground are ~
described as follows: "I give and devise to my son, /
Harry o. Campsey, Jr., the house in which he now r~si~s at No. 122 Wayne Street, Claysville, Pennsylvania./ 5,000 00
~~OTAL 5,500 00
63-68-185
\
2:J30
Inventory and Appraisement
IN THE ESTATE OF
H.o. Campsey Jr • ..................................................... ~·············· .. ··~········· .................... .
Filed ............ Mu .... 2.Q ................................ , 19 .. 9JJ. ..
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19-I:LJ
STATE OF PENNSYLVANIA,
WA_SHINGTON COUNTY, ~ SS:
The within named Accountant being duly sworn according to law, depose and soy that the above account
as stated is true and correct OS--------------~-h~----------------------verily believe.
. . /7' 7/{ Sworn and subscnbed be,fore me th1s ..................... .
-----~to."b~:r. ____________________________ 19 ... 6a •..
..... ~--L~~----
~ : tffed. / .f/ /f' t /
Washington County, ss:
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E-t R..ial~ zyj ali < "'~ m ; H: 2;.; G:i • t:-4 .Pi fil ttl H •n m : an Iii ~X~ .,.; 1 a . . ~-~~~ ~: ·g!
; (!) G) rtji ~11.1 r4 <t!i qp.p, l l Jm ~ ~ ~ ::r::o d i i
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I do certify that I hove given legal notice to all persons
concerned of the filing of the within account in th~ manner
prescribed by Stotute o~Rule of Court~~v~ence by proofs
thereof filed to No ......... "C!J:.O.fj .. /7..: ... /.. ... .
tl . -a.
Witness my hand and official seal this ...... /?.:' .............. .
day of ..... &~z~~-~------------------------------------------19 ... 1..f
-------~-'2?/c~-Register of Wills
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The Court is respectfu II y requested to determine
proper distribution · this esta
..
IN THE ORPHANS' COt~T OF WASHINGTON COUNTY, PENNSYLVANIA
Re: Estate of H. O. CAMPSEY a/k/a)
HARRY O. CA1\'IPSEY, JR. a/k/a ) No. _______ of 1968.
HARRY 0. CAMPSEY, Deceased. )
FIRST AND FINAL ACCIDUNT of EIVllVfA BURNS CAMPSEY, Administra-
trix of the estate of H. o. Campsey late of the Borough of
Claysville, Washington County, Pennsylvania.
---- -----------------------
Accountant is charged as follows:
To Inventory & Appraisement filed:
Real Property:
Personalty:
Total:
$5,000.00
500.00
----------------------------
Accountant claims the following credits:
l.Russell Marino, Register Letters of administration c.t.a.
2.R. A. Brownlee Funeral Home Funeral expenses
3.John Gaydos, Canonsburg, Pa. Monument
4.Claysville Cemetery Assn. Opening grave
5.James McCoy, Mechanic Automobile repair
6.John J. Hughes, Attorney, Advances:
Washington Co. Reports, Adv. 12.50
Claysville Recorder, Adv. 10.00
Russell Marino, Reg., Filing
Inventory & Appraisement 3.00
Russell Marino, Reg., Filing
First & Final Account 15.00
7.John J. Hughes, Attorney for Accountant
Total Credits:
- -------.. ----RECAPITULATION ------------------ - - - ----- --
Total Assets:
Total Credits:
Balance for Distribution:
i
$5,500.00
1,889.00
$5,500.00
17.00
1,192.00
350.00
75.00
64.50
40.50
150.00
$1,889.00
$3,611.00.
W ashingion County Reports
~~§!SE@~!Ii:!ii!:!~
Washington, Pennsylvania
(PUBLISHED BY WASHINGTON COUNTY BAR ASSOCIATION)
PROOF OF PUBLICATION
In compliance with the Newspaper Advertising Act of May 16, 1929, P. L.
1784 Sec. 3, paragraphs (3) and (25).
CoUNTY OF WASHINGTON f
STATF. OF PENNSYLVANIA ( ss.
Personally appeared before me, a Notary Public in and for said County and
Commonwealth, CHARLES C. KELLER, who. being duly sworn, deposes and
says: that he is the Editor of the WASHINGTON COUNTY REPORTS, the
official legal periodical for said Washington County, publis'hed weekly having its
place of business at Washington, Washington County, Pennsylvania, and is act-
ing as its agent in this behalf; that the said WASHINGTON COL'NTY
REPORTS was established on March 31, 1920, and was designated as the official
legal publication for Washington County, Pennsylvania, by order of the several
courts of said County, dated November 11, 1920; that the printed notice or adver-
tisement attached hereto is a copy of a notice or advertisement, exactly as printed
or published, which appeared in the said legal periodical in its regular issues on the
following dates:
...... F..eb.ruar.y .... l-5.., .... 22., .... 29., .... 1968 ....... .
'
that the affiant or the coq~oration in behalf of w~h'ch is acting is not interested
in the subject matter of ~ ndce or a_~ertising a t at ~I ~e ga · ns of
this affidavit as to the tille)£.M\ce a11d ~~racter h publi · a t . td .
Sworn to and subscribed 15eefm'l""""lm',-t-hrn,----------
....... 2.~.tl}day of ...... :ehruary: .............. , 196 .. 8. .. .
....... M'l:Li.tU..~ ... e..c······· . ~--tary Public
KATHERINE C. YARD, ~otary Public
Washington, Washington Co., Pa.
My Commission Expires
November 1, 1969
.:::::.~
Estate Notices
The Register of Wills has granted letters,
testamentary or of administration, in the
following estates. Notice is hereby given
to all persons indebted thereto to make
payment without delay and to those hav-
ing claims or demands to present t:hem
for settlement to the Executors or Admin-
istrators or their Attorneys. .................
CAMPSEY, H. 0., a/k/a HARRY 0. CAMPSEY, JR., a/k/a HARRY 0. CAMPSEY, Dec'd.
Late of Borough of Claysville, Wash-ington County, Penna. Administratrix C. T.A.: Emma Burns Campsey, 122 Wayne Street, Clays-ville, Penna. 15323 Attorney: John J. Hughes, Claysville, Penna.
The Claysville Recorder
Claysville, Pennsylvania
PROOF OF PUBLICATION
c. ...
In qompliance with the Newspaper Adverti.;>:ing Act of. May 16, 1929,
P. L. 1784, Paragraph 3, Sub-.para•graph 25.
Comnmnwea~th o Penrusylvania, o nty of Washin.gton, ss: Personally . eared befere ~a N~.PUblic in and ~or said County
and state ~;Jff-___ ~--.. --,r'~ be~g/~n
aocording to law, d~o/~/nd says that he is the~~~----··---
of the C1ay:svil1e R.ecorder, and its agent in thi.s behaJ·f; tha•t the a-bove
named pens·on i.s the publiL<her of The C1a.ysville Recorder, eiSitalblished
June 15, 188·8, weekly ne·w~p.aper of general circulation, printed and pu:b-
li.shed and having its place of bus•ineS\S. at Claysville, Wa1sihington County,
P.ennsyJ.van'ia, where it hws been es:tabli\Sthed and publi\Sihed continuously
for more than six months prior to the publication of the notice hereto
aettached; that tl)e printed notice or advertisement hereto attached i.s a
copy of an official adverti.sement, official notice, legal notice or legal adver-
blls:ement. ex·aotly as pl'inted or pubJilshed in The ClaysV!ille Recorder in its
regula.r issue or issues on the following da•te 'or d:a;tes: --------------------~~---_, __ Z:::_!_~_:ZE-)_~z~cfthat neither the affiiant
nor The C:J.. . ville Recorder is inter~sted in the subject-matter of said
notice or ertisement and that atl/of the allegatio ~f,rthis a davit as to the time, plwce and manner oif4blication ar r W _
:_.:...;· / ~ ~~
sworn and .su\loc.r.tbed be:o:e~--~~s-. ~----.-i da:-~~E £4-~-----.~~-~7#
. ~ (
--~~--~-.. -c.4L --------
Notary P•Jiblic t'.!OT/\~Y ;-•t 1i'· U ':
-• H \ A { ~. , i !. .. ·~ t .. ,, ~·~ -· ·• ~ • l .,,·~W' ClaysvHtC 1 tl'U-·:~·=·:.:_./i· .. nl --~· ··~-.·"'
My Ccrmn.E>~~~he:.; f··/,e:r.3i). 1961
1 ADMiNisiR'AT.R'i5{7s·~t4C>TitE ~~
Estate of:H. 0. CAMPSEY a/k
/a. HARRY 0. CAM:PSEY JR.
a/k/a HdRRY Q. CAMPSEY,
deceased late of Bor:ough of
Claysville, Wash{ngton County, Penna. · ·
Letters of Administration C. 'I. 1.
A. upon the above estate having~ I been granted' to the undersigned'
notice is hereby given to those I indebted thereto to · make im~ 1:
; n1ediate payment, and to those
·having claims to present thein
I. for settlement. .
Emma··Burr:is Campsey,1
Admiriistratrix CTA
122 Wayne Street,
Claysvflle, Pa. 15323
John J. Hughes, Attorney
1
.
Claysville, Pa. 35·3t: · ....
If Family Exemption claimed by Petition, give place of Record: ......... N.ane. .. f'i~e.d •.................... , ........ -------··-------··-
If Family Exemption is claimed at audit, give name, relationship and basis for Claim: ..... ----------··--···----·······--------------·
Surviving spouse is entitled to her exemption for the reason that
she lived with the decedent as a part of his household at the time of his death.
List any advancement or distribution on account that has been made, and nature and amount of same:
None.
Suggested distribution of balance shown, both as to principal and income, attaching signed and itemized elections
to take in kind if balance is not in cosh: residuary shares being stated in proportions:
Einma··Burns · Campsey
1964 Rambler Six
All
$500.00 (Claimed as her family
exemption.)
Real Estate: Two parcels of ground situate in the Borough of
Claysville, Washington County, Pennsylvania,
having erected thereon a two story frame dwell-
ing known and designated as 122 Wayne Street.
COUNTY OF WASHINGTON, SS:
COMMONWEALTH OF PENNSYLVANIA
The above named Fiduciary or representative thereof,
being duly ..... sw..arn ..................... doth depose and say
that the facts set forth in the foregoing petition are true And your petitioner will ever pray, etc.
to the best oL ... he.r.----··-··-----------knowledge and belief.
_____________________ .Sw.o.rn .............. to and subscribed before
:•.this __ k __ , ___ day L _?,: ________ ~-_;;;:;..J ...... l9 .. 68~ ----~~
::>1gnature of Off1cer.... -~-2.. ~-~
:;;:.at .~:~:::,::L3eL_::::I~:~~~::: : ___ : __ :: __ :::_·:_:: ____ :: ___ :::: ___ :_: _____ : __ : __ : __ : ...... :.: ... : ... : ............. : .. :
-I
..
' '·'
'\
No. ______ §;?.~_6_e~_l8.5 __________ ~9.68 .• _________ _
Estate of ..... HARRY ... O ..... CA:MP.SEY,---.J'R...---
a/k/a H. o. Campsey a/k/a
Harry 0. Campsey
Deceased
Fiduciary ..... ~E1 .. B.urns ... Camp.se.y. ........ .
PETITION SUR AUDIT
FROM WHERE DECEDENT LEFT A WILL
I
Counsel of Fiduciary will submit herewith the
following, in conformity with Court Rules
adopted effective December 3, 1951, being
rule No. 9: paragraph b-e; and divisions
thereof: shown on pages 23-24.
1. Written praecipes 9f. all Counsel in the
2.
3.
4.
5.
6.
7.
8 .
9.
10.
case.
Copy of order appointing Guardian ad
litem, if p~rti~ent. d
Copy of .Or~er appointil"!g.' Trustee ad
litem, if p~rtj_nent. ~ _ ~
Proof of ser~ice of ;bove. i ,
_._·. -. ' Letters Testqmentbiy or 'Aaministration ,
C. T. A. or-<gn att~st copy.-.£fjWill.
Copy of i<;;'ventor/a'nd appraisement.
Proof of advertisement of grant of letters
if not filed with atcount.
Certificate of liens' in case any of the
funds for distribution are from judicial
sale of real estate.
Signed and itemized elections' if any
distribution in kind.
Copy of Federal Estate Tax return if es-
tate is subject thereto.
_________ :f.9h~ ___ :f._~ ___ H:t:l:gf?._~-~-~---~-~q_, ________________ _
Attorney ""_..,2
I
\ ,,
3Jn tqr ®rpqnns' arnurt nf llnsqtugtnn arnunty
In the matter of the Audit of Account in
f H. O. CAMPSEY a/k/a HARRY Estate o · No. 63 -. 68-185 of , 19.....6.a..~
JR.
O. CAMPSEY1.a/k/a HARRY 0
Deceased.
TO THE AUDITING JUDGE:
Enter my appearance for Accountant
/'~L A _.--"') A~
~ Q_,7?&./4?V,L_
.. . -l 7 . -----:--~
/ / ' 19__6B_.. (, Glth day 6f{necemberY
N. B.-Counsel shall, by separate paper, present a concise statement of each
claim, with supporting calculation of any interest claimed. Objections
to an account as filed, shall be concisely stated in a separate paper.
Council suggesting proper distribution shall file a separate concise state-
ment in that regard.
,./
No. ___________ , 19 __ , A.A.
In re Audit of Account in Estate of
AUDIT
Jrarrtpr for i\ppraraurr
FOR
Attorney
3Jn t4t ®rpqnns' Qinurt nf llnsqingtnn C!!nunty
ESTATE OF { No .. ~~-~-~~-~ 1;f 5
19------------, A.A.
~~ __ _<?_: __ ~-~~p_~~z~--~::/~/.~---------------------------· \ In the matter of the ___ .f~E~~--9.-_t?-_?: __ :~)9§-_L ______ _
~-~~~_'.!__.Q_: __ ~~-~p_~-~Y.!. .. ~~~.~--------------------· Account of---~-~-JP..§-__ ~~I-~?. __ (]_?:P.?-.P.?.~Y.L _____ _
Harry 0. Campsey, Jr., Deceased. __________________________ _-6-_<?:~t.9.t~-~~§.-~~:0: __ Q_!_T_!_.f?:_. ___ .
ADJUDICATION AND DECREE
"/. ' -And now _____ p_~~~~J:? .. E?.:r.. _________________________ ~~, 19 .. 9.$. __ , this matter came on for heming,
audit and distribU'tion at this session and testimony ,fuk~n; and thereupon, upon due consideration
th3re§Dsh1sgalance for distribution in the hands of the Accountant is determined to be
$----l--------•--------------------------------------------and the account is accordingly confirmed; and it is ordered,
adjudged and decreed that the said balance be paid out by the Accountant in a~cordance wi1th .the
schedule of distribution hereto attached and made a part hereof, unless except1ons hereto be flied
sec. reg. or an appeal be taken herefrom sec. leg.
Balance per account _________________________________________________________________________________ __
Additional credit asked at audit
Balance _______________________________________________________________________________________________________ _
Deduct Clerk's Costs & Receipts----------------------------------------------------------------
Attorney ________________ l?..h!! __ ~_. ___ g~g_l:J:~?. ____________________ ----------------------------------
Russell Marino, Clerk 0. C. , costs in certifying real
estate to Recorder, $4. 50
Costs filing election to take under will 2. 50
John D. Woodward, Recorder, costs recording
certification of real estate,
Emma Burns Campsey, widow, Family Exemption,
including cash and 1964 Rambler Classic automobile,
2.45
17.00
7.00
8.05
held in kind and distributed as such at the appraised value, 1000.00
Russell Marino, Agent, transfer inheritance tax,
Emma Burns Campsey, contribution to maintain assets of
estate in kind,
Emma Burns Campsey, widow, residue, including real
estate as hereinbelow described, held in kind and
distributed as such at the appraised value,
154. 59
2578.09
5000.00
$3,584.55 •.. / /ddf f!! /'Y~Gf'Ul!p f!Lv-
$3,576.50
No balance
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REAL ESTATE TO BE CERTIFIED TO THE RECORDER OF WASHIIJ:.JGTON
COUNTY BY THE CLERK OF THE ORPHANE' COURT
H. 0. Campsey, Jr., a/k/a Harry 0. Campsey, a/k/a Farry 0. C!J.,mpsey, Jr.,
devisor, to Emma Burns Campsey, devisee of all the rigfl.t, title aq:i interest
of the devisor in and to parcel of improved real estate de~cribed as VIZ:
ALL those two certain lots or parcels3c f ground s tuate in the
Borough of Claysville, Washington Cour;.ty, Pennsylvania bounded< nd described
as follows:
PARCEL I: FRONTING 102 feet, more or less, c: long the
Eastern side of Wayne Street in the Borough of ClaysvillE aforesaid and extending
back therefrom of equal width 200 feet, more or less, to the Weste n side of
East Alley. BOUNDED on the North by lot of Andrew anc Burneda cJ ackson; on
the East by East Alley; on the South by lot of Margaret l\!1. Gordon , nd Parcel II
and on the West by Wayne Street. Upon the above descri ed premises is erected
a two-story frame dwelling.
PARCEL II: FRONTING 69 feet, more c r less, ale ng the Western
side of East Alley and extending back 31 feet, more or le~s, to line of Margaret
M. Gordon lot. BOUNDED on the North by Parcel I, on he East b~ East Alley,
on the South by lot of PriceR. and Irene McCullough and pn the WeE. t by lot of
Margaret M. Gordon, being the 31 feet of the rear portio!D of theM rgaret M.
Gordon lot which adjoins Parcel I on the South.
BEING the same lot or parcel of grounc devised tc Harry 0.
Campsey, Jr., in the Will of Harry 0. Campsey, who di~d May 26, 1947, whose
will is of record in the Register's Office of Washington Cpunty in W ll Book 71,
page 109, wherein the above two parcels of ground are d( scribed a~ follows:
"I give and devise to my son, Harry 0. Campsey, Jr., t~e house ir which he now
resides at No. 122 Wayne Street, Claysville, Pennsylvar ·a."
CERTIFIED TO ftECO~D~?c: JrNUA y 2, 1969
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T
IN THE ORPHANS' COURT OF WASHINGTON COUNTY, PENNSYLVANIA.
Re: Estate of
H. O. CAMPSEY a/k/a HARRY O. CAMPSEY,
a/k/a HARRY O. CAMPSEY,
Deceased.
ELECTION TO TAKE UNDER THE WILL
)
)
JR.) No. 63-68-185
)
)
KNOW ALL MEN BY 'r:flESE PRESENTS, That, I, Emma Burns Campsey
of the Borough of Claysville, Washington County, Pennsylvania,
widow of Harry o. Campsey, Jr., deceased, who died January lOth,
1968, leaving a will dated November 8th, 1959, admitted to pro-
bate on January 29t~, 1968, by the Register of Wills of Washing-
ton County do hereby elect to take under the Will of her husband,
the said Harry o. Campsey, Jr., and hereby accept the estates and
interest therein devised and bequeathed to me, and forever relin-
quish my right as surviving spouse to take against said will.
In Witness Whereof, I have hereunto set my hand and seal
this ,£ 4t;:>1 J J day of ad-Q f!n c, p _ao b / ' 1968.
i! ~ 1},_
Emma Burns Campsey -~ ~.. (f'CEAL)
For:\1 :\'t>. R<~-62 (12-66) THIS FORM REQUIRED IN ALL ESTATES WITH GROSS ASSETS UNDER $10,000, UNDER SECTION 701
EFFECTIVE JANUARY 1, 1962. (FILE IN DUPUCATE WITH COPY OF WILL ATTACHED)
;;. OFFICE OF THE REGISTER OF WILLS
County of ... WASRl~OlQN .......... .
EMMA BURNS CAMPSEY .............................. · ................... of .............................................. .
(Name) (AddreBS)
being duly ----~~_Q:fi'J ________________________ .afCO~ding_t9 Jaw,... de.J?oses and sa_ys that he is the------~-~-~-!!!_~~-~~-~-~!_~--~-!-~_!_~_! __ _ H. 0. CAMPSEY at kt a HAKRr 0. CAMP:;EY (Exec., Adm., Legatee, Etc.)
of the estate of _ _g/kl~L~X ___ Q_, ___ Q~S~-X~---~E>se last residence was ___ l_~_2 ___ W.§..Y-D-~ __ S_tX'_~g_t,: _____________________ _
(No.) (Street) g
_____________ Cl9.Y-~Yill~--------------·deceased, and that the whole of the estate of said decedent, who died __ /-::::_l_(?__~--~---(Cicy, Borough or Township) (Date)
consisted of:
REAL PROPERTY
REAL PROPERTY IN PENNSYLVANIA, WITH STATEMENT OF MORTGAGE ENCUMBRANGES UPON EACH PARCEL AT DEATH OF DECEDENT,
WHERE PROPERTY HELD AS JOINT TENANT OR TENANCY BY ENTIRETIES, GIVE NAMES, ADDRESSES AND RELATIONSHIP OF OTHER OWNERS.
Real state ALL those two c?rtainwlot$ or: pacr:cels · fi ot Cla svJ.lle ashJ.n toil ount
bounded and described as follows: ~RCEL I: FRONTING 102 feet mor:e or:
Eastern side of Wayne Street in the Borough of
the
afor:esa d
the Western side of East Alley. BOUNDED on the North byfut of on· on the East b East Alle • on the Sou h
by lot of Mar:gar:et M. Gordon and Parcel II and on the West by Way e
Gordon,
'bed remises is erected a two-stor
•
devise to Har:r:y
who died Ma 26
Estimated
Value
on
Personal Property
$ 5,000.00 ·~
1964 Rambler: Classic Six 500.00
NOTE: You may expedite the processing of this return by filing with it, and as a part of the return,
letters from financial institutions or mortgage holders, certifying to amounts on deposit or owed by the
decedent as of the date of death. Such letters must be signed by a responsible officer of the financial
institution or mortgage holder and indicate clearly amounts of principal and interest in the decedent's
account at the date of death and the type of account, account number and the exact name or names in
which the account is registered.
-,,.
Estimaftd Jointly Held Property Value
N 0 N, E ' --o.oo
-
. '
(
Transfers within TWO YEARS Prior to Death
N 0 N E : o.oo
,,
:
~ .
c '. -· .
'·
That at the time of death there was no safe deposit box regist~red ih decedent's individual name, or jointly with, or as agent or deputy of
another, or in decedent's individ~al 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 THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
c ' '
'
;
-
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED AGE OF LIFE
(If step-children or DECEDENT TENANTS OR INTEREST OF
(State full names of all and their addresses who have illegitimate children STATE YES ANNUITANTS BENEFICIARY
an interest, vested, contingent or otherwise, in estate.) are involved, set OR NO AT DEATH OF IN ESTATE
forth this fact.) DECEDENT
-
RESIDENT DECEDENT DEBTS AND DEDUCTIONS CLAIMED
NOTE· List first five items in-the spa'ces so provided, observe notations thereon, and instructions.
DEBT OR CLAIM NATURE OF SAME AMOUNT THIS COLUMN
f!tEGISTER ONLY
Funeral expenses paid $ $
Family exemption (will not be allowed unless
decedent died residing with a spouse or children.)
Administration Expenses *
Counsel fees *
Fiduciary commission *
I
OTHER DEBTS AND CLAIMS
( *) See Note below
'·
'
=
Total
Note: The estate agrees to advise the Register of Wills if the amount actually paid in settlement of any fee, commission oi· debt is greater
or less than the estimated amount claimed and allowed.
"""<'
Subscribed and sworn to before me this .... ./. 6. ............. . ::3n . .. 0 ....... ···~ day~f / .... a-.y:. ·.·· ........ 19.68
~-,%._···~···············
-4; ~ '¢ · {iLd /f; dlr
(Street Number)
(City or Town and State)
Having been du~y, ,~ording to law, I do h~certify that the above appraisement is ~e in conformity with law on this
j .................... ~.A../. ......................... .
............... d;7:-:-............ dayof ·····················:· :--:--..................... ,~(.~;§~~~·~
~ Appraiser
In the event that any futut·e intet·est in this estate is transfened in possession or enjoyment to collateral heirs of e decedent after the I,
expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer·inheri-'
tance taxes at the lawful collateral rate on any such future interest.
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County, Pennsylvania, do respectfully
report that I have allowed debts and 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 said schedule above, which greater or lesser amount represents the sum allowed as a deduction.
Dated: ..................... · ................... · ··· ..
Register of Wills
..
'
,
Form No. RCC-62 (12-66)
Will Administration lNo. · · ........ Year .. · .. .
IN THE
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
H.O. CAMPSEY a/k/a HARRY 0.
CAMPSEY a/k/a HARRY 0.
CAMPSEY, JR.
Deceased
Late of ... ~9;t:.Ql;lg)1. 9.~. «;:.l.~Y.S.'[~~.~~ ..
Washington County of .......... ,:__;, ................. .
( -.. c-;
Commonweaithpf Pe_~nsylvania
!2~ ~ .. (/),~:.) ~ ~
---1 .:::_> ~
,...,.... J r-' • ~ .... -tll ---
REPORT AND APFRAISAL ~~·_:;; '
.... : J ., :---, ,-:::.:-::,; : I I ' r--.""_-c.n"·-! 3 ..
0 lo
u
JOHN J. HUGHES, ESQUIRE
" '
"· • .•
R C C-81 (2-64)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
NOTICE OF FILING OF APPRAISEMENT
(Executor~
IN YOUR REPLY PLEA8E
REFER TO
In Re: Estate of H. 0. CAMPSBY • aka HA.nRY O. CMiPSBY
WASJJJ:NGTOI County -File No. 63-68·185
You are hereby' notified that the Original
appraisement in the estate of. 8. 0. CAWS&T, iki HARRY 0. CAMPSIY
has been filed in the office of the Register of Wills qf MASffi]'TOfOM
County on . May 24, , 19_68 Said appraisement reflects the
following valuations:
s.ooo.oo Real Estate ____________ ~~-fl~------
Personal Property _______ S_O __ O_._OO ______ __
Transfers ____________ ~~~~~------
Total _______ ..:~SIL!·I!'J-!S~OOI,f;K·..._.oo_·'----
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 one year from date of death, interest at the rate
of six (8%) percent per annum is charged.
Any party in interest who is aggrieved by an appraisement may
appeal therefrom as provided by law.
Date __ l!a_Y_24_· ·_,_· _1_9_6_8 ____ _ Signed
DAfB OF DEATH: Jaauary 10; 1968
Title
Note: This is not a bill.
·'
CAMPSEY, H. 0. aka CAMPSEY, HARRY 0.
...., . ~.
:"Cc-;q" ( 6-64) ,..,,
COVMONWEALTH OF Pl\NN~'Y~;XN!:\'
T)l:\N~FF.H. INHI~RITANC:r<; TAX
FILE # 63-68-185
January 10, 1968
fu~SIDENT DECEDF.NT SUMMARY
FILE # 63-68-185 TlEPOHT OF INHERITAt,iCF. TAX APPRAISER
I, the unrlersigned duly appointed Inheritance Tax ~ppraiser in and for the County of
#63 WASHINGTON , 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", Ji!'{~/ Dated:
I I
01/10/68
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for _________________________ __
County, Pennsylvania, do respectfully report that I have allowed deductions in the amounts
claimed by deponent, ~xcept as to those i terns 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:
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)
CLE~~ VALUE OF ESTATE
Valuation of life estates or
annuities
ESTATE TAX ASSESSMENTS
FOR USE OF REGISTER ONLY
Tax on $ ·--11%
Tax on $ ·?lJO% Tax on $ . "'~
. __ Hi% Tax on $
Exemptions ( ::<) ·--Total Estate
TOTAL TAX
Less tax previously paid
BALANCE
Less 11% of tax if paid within
3 months after death
BALANCE OF INHERITANCE TAX DUE
Add interest at rate of B% from
to
REGISTER OF WILLS
VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REL~PRAISED
$ 5 '000 ·. 00 $ 5, 000. QQ__ $ _____ _
__ __,_5-><.:0Q,.,_._..llil.. 5 00_. QQ_
s ,soo.:ITO s-, 5oo. qo
======·~ =====:__:....___ ======:=
$ ____ _
$ ------
COMPUTATION OF TAX
<I> •;J
~
$
$
$
$
$
$
----------~· ·---
======:· .
======:=
(':') As evidenced by Chari table Exemption
Certificates issued by the Secretary
of Revenue.
$--~----AMOUNT OF ESTATE TAX ASSESSED $ _____ _
Estate tax paid
BALANCE DUE
Add interest at rate of 6% from
to
FOR USE OF REGISTER ONLY
$ ~-----
TOTAL TAX BALANCE
PAID
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.
Will
Administration ! No.
IS THE
Year ........... .
~lATTER OF THE APPRAISE:MENT
OF THE
ESTATE OF
H. 0. CAMPSEY, aka
Iit\.RR¥ 0. .CAHPSEY ....
Deceased
Late of .. CLAYSVILLE
Countv of \vASHINGTON
~ . . . . . .. . .. . .. . ....
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
,..
II
\
iJ
---
Fonn I '• ~ RCC-2· ' .H9.:.Y ...... ?..4.. '-....... .!.Q .. §..~ .... : ................................... .. "' ,t, \ COMMONWEALTH OF PENNSYLVANIA DATE ' ' DEPARTMENT OF BEVEN~ . . RESIDENT INHERITANCE TAX #63 . WASHINGTON COUNTY BUREAU OF COUNTY COLLECTIONS ..................................................................................................
HARRISBURG, PENNA. 1712 7 APPRAISEMENT FILE NO. 63-68-185 ..................................................................................................
Whereas, ..... ?..'~ ...... 2 .. ~ ...... 9.~.~ .. ~~.X ..... ~~~.~ ..... ~.~~X ...... 9. .. ~ ...... 9.A.~.§.~X late CLAYSVILLE of ...............................................................................................................
in the County of ....................................... WA.S.H.l.N.G.T.QN. ...................................................... Commonwealth of Pennsylvania, having died on
the ................................ J.2.~.~ ............................................ day of ......... J.~~~.~E.Y. ..................................... 68 19 ............ , seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, ~r'l. R. CHANEY 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.
Unit Appraisement Description of Asset Values Made for Inheritance
Tax Purpoaes
$
D'Ii"AT'T'Vo
A
As per appraisement fiJID 5,000 00
PERSONALTY:
As per appraisement filed 500 00
TRANSFERS:
NONF. NONF.
' T'T' J..Jli'Tn 1Hi'Q~ .
NONE l NOID
TOTAL 5 500 00
'
'
'
fonn~~·:~h bl:-; !:1fh~w<>r!l ~~J.~~~:: ~:; ~·~~~~ ~~~::;;e~~~~~ i
Appraiser ./ ................. ,-y ........... 1 ...........................................................................................................
1::::-.. .L~ J (M\Im~ ~Strtet) ................................................................ r·Ofti;~·i ......................................... , Penna.
WASHINGTON Cou·nty
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
H. 0. CAMPSEYaka HARRY 0. CAMPSEY ........................ ············ .................................... .
Deceased.
Late of
CLAYSVILLE
Date of Death, .......... ~~~:L.l.<l.EY. .. !9..L ... !.~.~.~-.. ..
Appraiseme1!f Docket Vol., .................. ..3.7 ......................... ..
Page, .... ~ .. 9.J.:::-.J ...... No ...... §.3..:::-9.$..:::-J .. 6..5. .... .
Filed in Register's Office, ~1.a,Y ..... 2.4 .. , .......... 19 ....... 6.8
Amount of tax due, $ ................................................................. ..
DEPARTMENT OF REVENUE
Received,
Exa.mined and Approved,
Wrote abo.ut Appra.isement,
Appeal fMm Appraisement,
Entered and charged, ....
'
•
Form RCC-10 DEDUCTtONS ALLOWED IN ~.3..-__j-6 M
OFFICE OF THE
REGISTER OF WILLS
THE SUM OF------------.2±. ............... :::::::
OF __ 1_fTA_S_H_I_N_G_T_O_N ___ COUNTY
STATEMENT OF DEBTS
AND DEDUCTIONS /~ -11 J -~ y
DATE APPROVED . . . . . . . . . .................................................. . ~/~ill~ I
AND AGENT OF THE COMMONWEALTH
DATE
Register of Wills, 'fft./·
H. o.,.,. CAMPSEY. a/kl..,a I I 11 V
ESTATE oF F.ARR~ O. CAMPSEY, JR •• a k a LATE oF __;t~h.;.;e;;......=B;...;:o;.:;r..;o;..;:u:~::g.;;.;h:.....;;o~f--=-C=l;;;.ay._s=-v.:....:l::;:.;. =e~,'-------
HARRY 0. C.J.\.MPS EY,
DATE OF FILING APPRAISEMENT ----------DATE OF' DEATH ---------------
NO. OF
VOUCH Ell: NAME OF PAYEE
Russell Marino, Reg.
R. A. Brownlee Funeral Home
John Gaydos
r.1 ::Jvsvi lle Ge_met_ery Assn.
James McCoy, Mechanic
John J. Hughes Attorney,
REMARKS
Letters of administration c.t.a.
Funeral expenses
Monument
Cbening grave
Automobile repair
Advances:
l.ll}a.Shlngton ljo., ttep or"Gs, Aav.
12.50· Claysville Recorder
Adv., 10.00; Russell Marino,
'RAO' fi 1 i nO' Tmrent.orv !:1-nrl
Aop~aiseroent, 1,09; Ru~sell M"ar1no . .tteg., f1hng ll'1rst
and Final Account 15.00
John J. Hughes, Attorney for Accountant
AMOUNT
17 00
1,192 po
350 00
75 00
64 50
40 50
150 00
I clv ,.sa '
(/
1,88~ 00
COMMONWEALTH OF PEN":'SYLVANIA }
coUNTY OF WASHINGTON se:
1, EMMA BURNS CA11PSEY EREBY CERTIFY. THAT. TO THE BEaT OF
INHERITANCE TAX PURPOSES.
BWO~ND SUBSCRIBED II~FORE ME THIS 21st DAY OF' . '--(/ , r--/ AJCtober~ / _ ,, 68
\/.. /....---?5 #..L .1---':'P A.A___. ~ot:arv Public . {!J1 commission/ expires: October 18, 1969.
SlT:.\ ;I~}·.:-: l":::I:'~J ~cr:.:~~·~·:. --i~~~J~)~;·~J
l "I
.(I ...... -i ' ' ..
RCC-4 (8-68) CQMMO('IWEALTH OF PENNSYLVA
. _ .. DEPARTMENT OF REVENUE ,,
NO. A 03 30 0 5 OFFICIAL RECEIPl•PENNSYLVANIA INHERITANCE ANJ>
ONE HUNDRED FIFTY-FOUR and 59/100 d 11 RECEIVED o ars --~ --~ --.
representing Pennsylvania Inheritance or
Emma Bums Caapsey t Excr. Estate Tax due from the following estate: From: lll!l
122 Wayne St., Claysville, Pa.
Address----------------1
A tty. J. J.. Hughes
63-68-185 ·1-10·68
File No. Date of De
Date of Payment January 2; 1969
Name of Decedent H. ~~~~SEY ,aka HARRY ,.
County WASHINGTON
Remarks:
2% Tax on $ $ l&:.ll
2,576.50 154.59 6%Taxon $ $ JH
15% Tax on $ _________ _
%Tax on $ _________ _
Estate Tax, Act of
May 7, 1927
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three montis after
I
date of death
Plus interest at the rate of
$ •
$ _______ _
$_. ______ _
154.59 $ _______ _
$ _______ _
__ %from----------to _____________ _ $ _______ _
u oo ~ [p [Ln @ill urn SEA I;
NOTE: This Triplicate Receipt to be retain.ed lor audit purposes.
TOTAL AMOUNT PAID
. f d./ ,.d.{ ;;;f/,£ ·..---.n.-.{/ , Recetved by
NOTE: In accepting the transfer inheritance tax bn future estates, prior to the death of the life i (?ignature)_ -:;/ ~ ' ,/ ./.
tenant or tenant for years, as evidenced by this receipt, it is~ understood that the Commonwealth shall ~~ ..-'"' .tfy.--Z?~ £.// t/ ~,./
not be precluded or prevented from hereafter assessing' additional inheritance tax at the death of the 4' / (JI
life tenant or tenant for years whenever it appears that such additional tax may be legally due -"" > •--', 1
154.59
collectible for onv reason whatsoever.
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