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Home My WebLink AboutOC1968-0904 - ESTATE OF PETTIBON.. . PETITION SU R AU DIT IN THE ORPHANS'COURT OF WASHINGTON COUNTY Testate'Form / Estate of S.~.~P.~.'r.~J.~QN ~.Ik/~_ : .__ SARA C.PETTIBON Deceased No ~.Q~..gt.J·.~~.~_ . Fiduciary.._~.!~.:~J:.!?~!!l.!: _ . Administrator CTA Dat.e of _'._'..'. .J';[)ate of Decedent's dea·th J.J;l.l.Y.~.1.4.,.l.~.9.7.:~:~..Grant of lLetters ~~J.Y.?§.I J~§.7.. •-:-)';'-'l -'.1 .1,~....•.~.'. 'Th',hot-Firsb and·Final . -f.J.L.'.f"d ,.'h'.,.IS IS l'e : : ·':account I e In l'IS estate.-.:.!..l _~.-.J ....J .:,...~.~. If there have been former accounts filed 'in this estate,list file number or nUmber and term ~~.I?:~. I.....'""~)...\....\....<._ Election to take Under or Against will.(cross out one)None Date Election Place of; Filed _...Record ..,_.._.__.; ( Name of.surviving spouse ~~~~.___.___:.~..•J ••:••__•._.............•••••••••••__._._. List issue,where material:None.- .......-,. -".!-'. Did dec'edenf marry after execution of will?(indicate)~No.Any childre,n born after execution of will?(indicate) ~No,If answer yes,name them __. .........___-..--.-__--_',;._--.-_.". Leg.atees LAURA·L.PETTIBON Relationship SISTER Interest ENTIRE Fiduciary,if deceased or not sui juris List,if exceptions to above: None If partial intestacy,give facts: None Adeemed:Revoked:Lapsed:Abated:'Give Cause: Notice to interested parties.Have c,1I 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.~. If ..Noneanyexceptiongivecause:. File copy of Notice •and date of mailing ;.. Is estate subject to the filing of a Federal Estate Tax Return?NQ . Actual payment made on Pennsylvania Transfer Inheritance Tax.Amount $..9-.,.Q.9.Q.!.9.9 . If the Will makes any portion oh~state subject to a life-estate,give name and birth date of life tenant N.9.ng . ..............___--___--_--_- -__. Give Names and addresses of all unpaid creditors who are legally entitled tci notice,together with the amounts of such claims;state whether they are admitted to be correct;and whether the claim is denied. None 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: None Total additional debits (Add) Itemize any additional credits not shown by account: Delete one-half interest in real estate* LO.SS..on sa~e of ~~~e~'jl Electric stock ~~~-J;Total additional cr~~" Balance for distribution $. $2,500.00 $391.35 i/:k:g ~99 7 ali$J.".. $~~.!.~.~.~.~}~. $..~.4.!(?~.. If balance for distribution is not in cash,list each item held in kind,giving appmised Value (or distribution Value); U.S.Government Bonds $6,691.50 *property located in the Borough of Midway was determined to be Joing·Tenancy.with Right of Survivorship as in Deed Book 610,page.102.The same,therefore, part of this Estate and is deleted herein. , • •••~I. .'....., \,i'" •......=.~ of record is not a , .' If Family Exemption claim.ed by Petition,give place of Record:N.9.,. 'I '.• If Family Exemption is claimed at audit,give name,relationship and basis for ~Iaim:~~. 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: LA~L.PETTIBON ---,ENTIRE ESTATE \"... COUNTY OF WASHINGTON,55: COMMONWEALTH OF PENNSYLVANIA. The above named Fiduciary or representative thereof, being duly J~W.9.~.I1 doth depose and say that the facts set forth in the foregoing petition are true to the best of his.knowledge and belief. ..............~to and subscribed before me th;s d3>day af..~..1,9.__~J.. S;gnatu,~af off;cer ~__I~. Title of Officer ,~...r~. Office exPires .l..~~:§.'.~.J...t:..1 . And your petitioner will ever pray,etc. .> .~.. j ':No......~9.~..9.f !~.~~. :- "- .~," '. Estate of..·§~~J?~TI!.l?9~~lJsI.~. I- SARA C.PETTIBON•••••••••_•••••••••_._- ---_o.__. Deceased Fiduciary ~..•S~.!?J9.C?~.(. Administrator CTA PETITION SUR AUDIT FROM WHERE DECEDENT LEFT A WILL Counsel of Fiduciary will submit herewith the following,in confo rm ity with Court Rules adopted effective December 3,1951,being rule No.9:pa rag raph b-c;and divisions thereof:shown on.pages 23-24. 1.Written praecipes of all Counsel in the case. 2.Copy of order appointing Guardian ad litem,if pertinent. 3.Copy of Order appointing Trustee ad litem,if pertinent. 4.Proof of service of above. 5.Letters Testamentary or Administration C.T.A.or an attest'copy of Will. 6.Copy of inventory and appraisement. 7.Proof of advertisement of grant of letters if not filed with acco12n.t::'\.")"'""/"'.'f'l'-'"·".H t··j":I ••p 8.Certificate of liens irC\::b'dlsej amYS:9.Tjthe funds for distribution are from judicial saIe of rea I estate..'...',_. 9 S·d d't L.•J '1,:1.,..,'f '....~"T.Igne an 1 emlze e ectlons I',any~__ distribution in kind. 10.Copy of Federal Estat;-oTax r,eturn if es- tate is subject thereto.J.-~I'!\.~'v :1 !.' j2.~..A..~.c:.u~u~~. ~2 ..''';' r lIus4iugtntt <!lnuttty f SS: I,~?~.~!?.~~~~~~.~::~.~.~~.._Register for the Pr~bate of Wills and granting'Letters of Admir.istration,in and for the County of l'Vaslzington and Commonwealth of Pm11,sylvania: To "'~.~!~'CPJi..Q.!I?~.Q9.~_- Administratorof all and singular,the goods and chattels,rights and credits remainiuQ unad'Yl1inistered which were ilf---------------...._"'"J ,-.. ,, s_~!.~...9....~~.~.~~.~~.~...~.~.~...~~.~.~...~~~.~.!p.~.~..._late of the said County, deceased,with a copy of deceased's will annexed,GREETING: vVhereas,the said ~.~.~~.~_..!~.~.:.~.~E.~.~~~~~.~.~~!~.~~.~E.~.~_ o her lOf .......d her 1-t WOll .d T t .t 0 Of11L.•..___t erzme,11'ta e.._I.us 1 an es amen tn Wrt tng, ! . which 'Was duly proved on the ~.~.~~__..day of-:J.-p.JX.;A.Do,I9.f?7.having,'l.CJhilst._~.'t!~.. lived,and at the time of-E:~.r:decease,di'uers goods and ~hattels,rights alld credits,within the said County,by 1'neans 'lCJhereof the full disposition and power of gnnting letters of ldministration thereof,is manifestly kn07c.:n to belong to 1'Ile;Therefor~desiring that the goods and chattel:;,rights and credits which were of the said deceased,and which remai1'!,'unad'ministered,may be well anc.truly administered,converted and disposed of according to the tenor und effect of the s::tid deceased's will and according to law,I do hereby grant unto you the said J~.~.~~J._.g.!.._.~1_.~.~~..___ ___ ................__ ____ - _____o.__..__ ____ _______••_. .--- - -------(in whose fidelity in th£-s behalf 1 very much confide,)full power by the tenor of these presents,to ad1'ninister the goods,chlLttels,rights and credits remaining u1utdministered,which were of the said deceased,within the said Cov,nty,as also to ask,collect levy,re- cover and receive the credits whatsoever of the said deceased,which at the time of..-.h.~r.death were owing, or did in any way belong to···h-ep..and to pa-j'the debts in which the.said deceased stood obliged,so far forth as the said goods and chattelsJ rights and credits will extend,according to their rate and order of law,0 especia.lly of well and truly administering the goods and chattels,rights and credits remaining unadminister- 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 cppraisernent thereof,and exhibiting the same into the Register's Office,at Washington,on or before the-_.day of-_ . next,ensuing,and also a true and iust account,calculation,and recl?!Jning of Jour administration,upon Y01.tr solel1m __Qath ~to render at the expiration of six Ywnths,or when legally thereunto re- quired;and I do by these presents ordain,constitute and depute you,.the said _ _ _. Israel C.Bloom............._. administratOr CTA of all and singular the goods a:ld chattels,rights and credits,which remain unadministered and which were of the said deceased,with a ctJpy of said deceased's Will annexed, 'within the limits afore·said;sa7Jing harmless .and forever indemnifying.me and all other officers against all persons by reason of )Iour administration aforesaid,and saving a:l others their rights,&c. 31n Wtstimnny ·1IlII4trtnf.I ha've hereunto set my hand and affixed the seal of said office ~t Washington,the ?~_~~_day of.-.:.:!."9:~:!._-_:in the year of our Lord •o..Sixty-seven01"'housa"d "lite ,,,...dud alld :----:--------------------~/~f'. /J -~--------.J.2.l:----------~;:------- 1/· . I October 2,1941~" The will 0f Sara C.Pettibone I,Sara C.Pettibon do hereby will and bequeath all my earthly belongings.(all-everything)to my beloved sister- Laura L.Pettibone 1 Made this October Second 1941. Sara C.Pettibon Witnesses John M.Scott Bessie D.Truax ..~......... II (___.............-__~___,""~ - "cc•."---_J :' ,) I LETTERS OF ADMINISTRATION ~~.C.T.A. ESTATE OF SARA C.o PETTIBON ~._.~...-.--_._...-_..---------------------------..----_.-------_.._- aka SARA PETTIBON. ~.....;....~1>,:.\'.,6.....'..'.:...:.. ----------- t • I " ...~ --_._----- ~ -_:__---------<1 " COpy OF INVENTORY .....--..-.. RotarJ Public I.C.8100II sara Pettlbon 'a/k/a Sara C.PettlboD october 67 sara Pettlbon a/kIa Sara C.PettiboD 1Junrutnrg aub 1\,p,praisrwrut of the goods and chattels,rights and credits which were of a~Lnl~~~.(~~~.~."late of.,."~~.~~.~..~:, . Washington County,Pa.,taken and made in conformity with the abOiJe affidavit. DOLLARS CENTS PERSOlULTY: \ \ Bent collections -dae at death Mellon .at'l Bank Burgettstown Office SavinS8 Aco.Ho.16332,Sara C.llettibon Mellon .at'l Bank,Burgettstown Office Checking Acct.Ho.190-9275 Sara C.Pettibon ~b.!lat'l Bank,IIcDonald Office sayiqs Aoct,Sara C.Pettibon 30 Shares of General Eleotric COIIpan)'Stock '97•25 per share u.S.Gov't BGDd '1,000.00 Ko.266792 $89.22 per '100.00 u.S.Gov't Bond '1,000.00 Ko.235478 $89.22 pel'$100.00 U.8.Gov't Bond '1~OOO100 Ko.266804»tS9.22·per $100.00 U.s.Gov't Bond $1,000.00 . Ifo.4S716P 'S9.22 per $100.00 U.S.Gov't Bond $1,000.00 Ko.70068J 'S9.22 per $100.00,. u.8.Gov't Bond '1,000.00 110.700691:'89.22 per $100.00 u.S.Gov't Bond '500.00 110.76236P $89.22 Pel''100.00 U.8.Gov't Bond '500.00 Ro.304828 $89.2a Del'1100.00 . 40 00 10,704 08 3,097 05 9,158 75 2,917 50 892 20 892 20 892 20 892 20 892 20 892 20 446 10 446 10 / •.p ".; COpy OF INVENTORY 1I0t.,PQblic a.a Pett,lbOll aIkI,.Sua C.Pettiboo Sara Pettlbou ahJa Sara C.'Pettlbou 67 " •j, IIIr,. ~}.~r • lhturutnrg Club..~~rCl!8r~rut .of the goods,and chattels,rights and credits which were of.!~'.nlUr~~~~,~late of..~~.~~~.:, . Washington County,Pa.,taken and made in conformity with the aboiJe affidavit. DOLLARS CENTS PlBSONALTY'coat'd: v.8.Gov't DoDd $800.00 Jo.16968J $89.22 'OJ''100.00 C(glOnealth of Penu,lvaala".ohel".Retina_" CUb RBALTY: I at,fl'.dwel1i08 Cburcb street Burpttll......waabllllton Couot)',PeDDa. Bricll bou..II1d."PeDDa.l/a iaten8t ..-6 10 216 67 12 50 '1,500 00 2,500 00 '~1,838 0& I,, i / \ '.'.- First and Final Account of ISRAEL C.BLOOM,Administrator C.T..A. of the Estate of SARA PETTIBON a/k/a SARA C.PETTIBON, deceased. --------------------------------------------------------------- The Accountant is charged with the following: AS PER INVENTORY AND APP~ISEMENT -----------------39,838.05 Total Assets of Estate -------------------------- Total credits claimed by Accountant -------------- BALANCE FOR DISTRIBUTION ------------------------- 39,838.05 7,219.71 32,618.34 The Accountant claims credit for the following: ---------------------------------------------------------------- Register of wills Register of Wills Ruby Mastic Ruby Mastic Washington County Reports Burgettstown Enterprise James R.Hughey,M.D. Wm.H.Kittrell,M.D. Robert D.Vance Mellon Nat'l Bank Bessie Truax O.E.Turner,M.D. Mill Mutual Agency William R.Sausser Mercy Hospital Edwin G.Wilson J.M.Douglas Russell Marino Bloom,Bloom,Rosenberg &Bloom Israel C.Bloom The Gaydos Monument Co. Internal Revenue Service Malcolm Morgan,Co.Treas. Ltrs ..Test &3 s.c. 1 Short Certi=icate 1967 School Tax 1967 Boro Tax Advertising Advertising Doctor Bill Doctor Bill Bond Box Rental witness Fee Professional Services Premium Charge Appraisal Fees Funeral Bill Inventory Final Account Attorneys'Fees Administrator's Fees Monument 1967 Tax ~1968 Tax TOTAL 22.50 :".00 112.76 36.65 12.50 8.00 36.00 1=.00 8E.00 4.00 10.00 300.00 29.00 20.00 18.89 1446.75 4 ..00 16.00 2000.00 2000.00 1000.00 23.00 15.66 7219.71 ------------------------- .> PRbOF OF PUBLICATION ---40>---- ..........._--3 consecutive weeks.commencing on the .2.nd _ . vertisem.ent ..'P.~.:tJ;1Q.Q.n ...§§.t.~:t.B....._........was published in said newspaper for Notary Public EDWARD F.lOUNDER,NOTARY PU3LlC My commission expires Bur9~!~!~~..~~!!~9.~:_~~~.~!~.Q!~~..~~~!!....19 __-'MYCOMMISSION fXPIRES fEBRUARY 1,1969 ss. ............£-~. State of Pennsylvania County of Washington I,~.~B..,Y..Q.§.g.1lrg£J.r..A _publisher of THE BURGETTSTOWN ENTERPRISE,a weekly newspaper published in the Borough of Burgettstown. County of Washington.State of Pennsylvani'a,hereby certify that the annexed ad- day of ..August _19 6.7.and concluding on the ..1.6.th.._day of .._ _ ..AUgllst _:..•19.6.7....0.).......&/i~~:.Pub",h" Taken,sworn to and subscribed before me this .b day of .-!~::t:J..gY:§..t._ 19.•.9.7..._•.. IAdministrator C.T.A•. .NOnCE Estate of Sara Pettibon ja/lc/a Sara C.Pettibon / deceased.late 'of Midway· Letters Adm1nistratio~ C.T.A.upon the above es- tate having been granted to the understgned.all per- sons haVing claims against the estate are requested to make known the same to theun~ersigned orbisattorney an aU persons indebted tothedecedentarerequested to make.payment to the un- dersigned Without delay. Israel C.Bloom 200 Washington TrustBldg., Washington Penna IBloom81.•., d'B •.~oo~.l\osenbel'il'fanloom..-Ill' Attorney ) I '~ iW-~ Washington,Pennsylvania (PUBL.ISHEO BY WA'SHINGTON COUNTY BAR ASSOCIATION) PROOF OF PUBLICATION In compliance witl:.the Newspaper Advertising Act of May 16,1929,P.L. 1784 Sec.3,paragraphs (J)ani (25). COUNTY OF WASHINGTON)ss STATE OF PENNSYLVANIA i . Personally appeared before me,a Notary Pub:ic in and for ~aid 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 busine,s at Washingtcn,Washington County,Pennsylvania,and is act- ing as its agent in t'hie beh;(lf;that the said WASHINGTON COVNTY REPORTS wag;established on March 31,1920,and was designated as the official legal publication for Washingtoo County,Pennsylvania,by order of the several courts of said County,dated Ncvember 11,1920;thet the printed notice or adver- tisement attached hereto ie a copy of a notice or advertisement,enctly as printed or published,which appeared in the said legal periodical in its regular issues on the following dates: August 3 10 17 1967......•............•..••.•..•.•..1....•......1 J _. that the affiant O)r the corporation in behalf of which he is acting is not interested in the subject matter of sad noti::e or advertising and that all of the ,lIegations of this affidavit aSPJ;~he'me,plac;:and ch(Qra of ty~c.ation a~.~~~.e.~//rfr:/:I!.':,../.~/Ltt1 H /~~. .~·.Editor Sworn to and s·scribed beiore ILe this ,~ .}.?~.da:of.~~~====~,196 7... ..../~.({_~..v"'"otary Public KATHE-RINE C.YARD,NotarV/bllC Washington,Washington ,C ,Fa. My Comlrission Exp·rils November 1,196! 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. ...e ••••o •••••••o. PETTIBON,SARA.a/k/a'SARA C..PETTIBON,Dec'd..... Late of Midway,Washington Coun-ty,Penna. Administrator C.T.A.:Israel d._Bloom._200_Washlngton Trust Bldg.,Washington,Pa,". Attorneys:Bloom.Bloom Rosenberg&Bloom,200 Washington Trust BldgWaShington,Pa.., r·. STATE OF PENNSYLVANIA, WASHINGTON COUNTY, The within named Accountant being duly sworn according to law,depose and say that the above account as stated is true and c~rrect as k verily believe. ..6819. .'ROWENE EBELING NOTARY FUBLI MY COMMISSION EXPIRES FEB.8.969 WASHINGTON,WASHINGTON COUNTY Washington County,55:I do certify that I have given legal notice to all persons concerned of the filing of the within account in the manner prescribed by Statute 9nd Rule of C~rt,as evidence by proofs thereof filed to No..J,,!.J.-::..?.1.~/3.a.:. Witness my hand ond official seal thiSJ..c...tI'-!.. dQYOf...•~-..---..........•......-.--------19lt ..~.~. Register of Will; o o Ai~o:>: il"il:'t:lI'lell 1-0Q)+-'rn 'b1JQ)~ ~! ~i~,! ~ ~I ~; ~!" oz •• .0. '';.I 4]'...,...~..~I i_:f•• / .~ ~..t ....--.-...,. '. >,---....------------.."....-T.....,..----........-....':'"-'ii~~.':"~-......----------,....4.......""'-j.....---::::......-_-_-."-3---.J.*,~------1' ","",-_.~ t....J'~_•• (~..,- ,~-.'/;' ..4 .-::~:. _:\10'J: .'j , """\. l"~-:' c ,.:-." I" <'- -, ft'\ 'v '.. The Court is respectfully requested to determine proper distribution in this estate, ,$'m-n &-../k.~ Counsel for Accountant 'I,.,.. LAW OFFICES BLOOM,BLOOM,RoSENBERG &BLOOM I.C.BLOOM GEORGE I.BLOOM MILTON D.ROSENBERG SIGMUND L.BLOOM THOMAS D.GLADDEN GEORGE R.SEWAK 200-210 WASHINGTON TRUST BUILDING WASHINGTON,PENNSYLVANIA IS301 October 29,1968 TELEPHONE BALDWIN 5-410:::> John Hana,Audit Clerk Orphans'Court Washington County Courthouse Washington,Pennsylvania Re:Estate of Sara C.Pettibon 904 of 1968 Dear Mr.Hana: In preparing to distribute the assets of the above entitled estate,it has come to my attention that the $4,000 previously paid by the Administrator as a part payment on the Inheritance Tax was not taken into consideration when the amount for distribution was arrived at.It will,therefore,be necessary to amend the scheduled distribution to show a $4,000·'part·pay- ment.The part payment was not noted in the account which was filed but was indicated on the audit petition. We appreciate again your kind attention to this matter. Sincerely yours, TDG/bjs Enclosures 'C5Z THOMAS D. - GLADDEN IN THE ORPHANS'COURT OF WASHINGTON COUNTY,PENNSYLVANIA ESTATE OF ) (NO.904 of 1968 SARA C.PETTIBON,a/k/a ) SARA PETTIBON,( )_,_~=c'-'_---_- Deceased.( I,h~URA L.PETTIBON,do hereby acknowledge to have received the sum of $24,745.64 that is due me;being U.S. Government Bon"ds in the amount of $6,§91.50 and the balance,..... being in cash in the sum of $18,054.14~being the amount awarded to me in the audit of the Estate of Sara C.Pettibon, alk/a Sara Pettibon,at No.904 of 1968,and do hereby release Israel C.Bloom,the Administrator CTA,from all liability whatsoever on account of the settlement of the said estate. IN WITNESS WHEREOF,I have hereuntb set my hand and seal this ~day of Novernbe~1968. WITNESS: • ,: \ \I. 1 ~ '. ~ IN THE ORPHANS'COURT OF WASHINGTON COUNTY,PENNA. No.904 of 1968 ESTATE OF SARA C.PETTIBON,a/k/a SARA PETTIBON, Deceased. AUDIT RF:r.F.TPrpS LAW OFFICES BLOOM,BLOOM,ROSENBERG &BLOOM WASHINGTON TRUST BUILDING WASHINGTON,PENNSYLVANIA /- v ,. I I - -----~------------ ... 3Jn t~r (@rpQunn·mourt of lIun~tn!lfnu Ctrnuuty In the matter of the Audit of Account in Estate of SARA PETTIBON alk/a SARA C.PETTIBON TO THE AUDITING JUDGE: No.90 4,__~II---'19_fo _g ,A.A. our I.C.BLOOM,ADMINISTRATOR,CTAEnter~,appearance for·__::....:._-.::.-=----=----_ .it:>day ,19 ~! N.B.-Counsel ·shall,by separate paper,present a concise state:nent of each claim,with supporting calculation of any interest claimed.Objections to an account as filed,shall be concisely stated in a separate paper. Council suggesting proper distribution shall file a separate concise state- ment in that regard. << ~1 'Cot ~~\of...:::v ~0 ~ '"Q) ~ ....,:... oj ~~ ~ ....,enr.1 ~ .S ~::+ ....,'"~,l-::+.J=~::l -0 0 -!""r' 0 ~ p:: N, 0 0 ~:J ~ o-r , =r;z;, c. ...0 '{«...... ~.~:g ~~ ~s:+ Q)'''- ~...\of "l ~-~r~Cot ,0 ~ ~$.t J0~~ Z !:~: .j In the matter of the..ft.r~t~.Ug..E.tn.~.l... Account of }~E?:~Lg.~.J?~?.2~-'. Administrator C.T.A. 11"tl1r @rp4anl1'(!lourt Df mU114ittgtnn Clluttttty 904 68NoOf19 ,~ESTATE OF ..§.~~~..g..·..P~~.t~.t?~~.~..~/tl.~__ ..e.~~~..~~~t~~~.r!.~. Deceased. /SCHEDULE OF DISTRIBUTION e.895.35 Balance -..-.-.---. Additional credit asked at audit Balance per account _-.-.. ADJUDICATION AND DECREE And now ~~~?~.~.:.::iQ ,19.?~,this matter came on for hearing, audit and distribution at this session and testimony taken;and thereupon,upon due consideration th~5of7!hr ~~Iance for distribution in ;the hands ~f the Ac.countant.is d~term.i~ed to be $_._.,__'"and the account IS accordingly confirmed,and It IS ordered, adjudged and decreed that the said balance be paid out by the Accountant in accordance with the schedule of distribution hereto attached and mode a part hereof,unless exceptions hereto be filed sec.reg.or an appeal De taken herefrom sec.leg. Deduct Clerk's Costs &Receipts . Attorney ;!?.1~Qx:P:J_..:J?.19.Q!IJ:,..B.Q~~J1R~r.g.&..:s.l.O'Qm . 42.00 $25,680.99 Russell Marino,Agent,transfer inheritance tax, including tax due on jointly held property,$933.20 Interest from 10-14-68 to 10-28-68 2.15 935.35 $24,745.64 Laura L.Petibone,sister,residue,includingU.S• .Government Bonds,held in kind and distributed as such at the appraised value,24745.64 No balance .3 ,0 0 Z-t..n ::J m n -+!J -...,~III 0 :::r~c (l) :3 .6 ..3 0 "'t'~3~(l) 0 ~.0 0 0=-t.."'t'....,-t.."'t' ~ (l)....,....0 0 en ....-....or=<£.o~_" -t..-t.. ,f ~"'1" ·-....-.to+:::r t"c ~:L:~>....(l) ·..c e."=•>~,'0- ;,'hoe....."=_!~~ I\l "'.,--'.',.~~ '~'~•~J =.,~'.,~ 0r..::":SCC -f":--"'"tl)....;> ," tot ;>tl) ~ II I J Il~.•'. Form RCC-33 RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS COUNTX OF ··..·····Wasblng·to·n··································. C.T.A. .~.~~.~...~;;.;,~;.~;t..;..;;.;;~~~~....~~.~.~.~..~.....~p=OF (State full name or d'(~ent). ,Washington ADM~NISTRATORLateofCounty. PennsylvaniaStateof :.} Washington ss:County or :. I~WORTANT:This return must be completed in detail and filed in.duplicate,with will attached,with the' Register of Wills of the County where decedent resided;Return is due within one year after date of death,unless an extension is granted by the Secretary of Revenue.(Section 703 of tte Inq~rit!ince_.!in~.E.~tate .'.fax i\ct of 1991.) .......l.,c...,J.;lM)QM...................................................................................................~ Administrator C.t .aI.the estate of the above-named decedent being duly sworn,depose S and say S ....,19 9..7J testate leaving a last will,copy of which i.hereto attached.} (Y""r)L=~cm=(lIay) BLOOM,BLOOM,ROOENBERG Be BLOOM....,,.,..-....,_. Decedent died J..~.~.y ~,. (Month I ..200 Was hingtonTrust ..Bu1.lding .. Washington,Pennsylvania That as such ...Adm........~.....t..•.a...._.....deponent is familiar with the affairs of said estate and the property con- n:x"cutor·Arlmini.lraLorl .'.., !'tituting 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 ir~decedent's individual name,with right of access by another as agent or deputy,with the exception of the following:- '}Name and address of attorney or other authorized representative to .. whom all correspondence should be mailed. 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.DEC~DENT That the contents of said safe deposit box or boxes are itemized under Schedules of this return,with the exception of the following,for the reasons hereinafter set forth: That Schedule A attached h,ereto and made part hereof sets forth full v 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 ,J •interest day prior to decedent's death in the case of savings banks,and ~o the date of decedent'~death in all other cases;all bonds,postal saVings,treasury certificates or notes and other.'evidence of in- debtedness of the United States to the decedent;all obligations,whether by statute or agreement they llre deslgnaterl as tax free,of the United States,or any state,or political SUbdivision~the;~of,or of nny rorei~country,which are owned at t~e time of death;all wearing apparel,jewelry,sJlverware,pic- .~./'Jtures,lJooks,works of art,household furniture,horses,carriages,automobiles,boats,and .any and all other personal chattels of whatsoever kind or nature,left bydecedent,together with the fatrly estimated market vallie thereof;all bonds and mortga~es held by decedent and of all claims due and owing decedent dt the time of death,and all promissory notes or other instruments in writing for the payment of money of wld.cll rlecedent rlied possessed,of wha~soever nature,wi th interest thereon,if any,giving the face value Clwl estimaterl fair market value thereof,and if such estimated fair Ilarket 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 policl'es carried by decedent;all annuity and endowment contracts the proceeds of which were payabl~upon the death of the decedent;and all the corporate stocks and dividends due thereon and unpaid as of the date of death,bonds and accrued interest thereon to the date of dece- dent's death and other investment securities owned by the decedent at the time of death,With the market value thereof at such time. "-. In the case of securities of close or family corporations,the values reported.are as far as possible substantIated by financial statements of the corporations,showing the asiets 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 business. A copy of the co-partnership agreement,(if oral,a statement setting forth the nature of the agreement) together with a statement setting forth the character of the business,its location,and such other facts pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest therein must be submitted.·It should also set forth in itemized form,t.ogetryer.with \the lair mar~et val~e 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 ofproperty,real or personal,within;two .years oJ decedent's death,in contemplation of decedent's death,or intended to take effect in possession or enjoyment at or after death,said schedule sets forth the nature and value of such property,to whom transferred,the relationship of the transferees to the dece~ent,the proportionate share received by.each transfe~ee and all other·facts of a pertinent nature regarding said transfers.In the case of transf~rs ~ntended to take effect in possession or enjoyment at or after death,there is also attached to the ?c.~ed~le a co~y of the deed,trust agreement or other instrument creating the trust.Therl~is also set forth .in said schedule a list of all property,real and per~~~~l,~JtW its value,which pa~ses at-decedent's death by virtue of the exercise by decedent,either indiv"iduarly,or ,jointly with another,or any power of appoint- ment vested in decedent,either individually'or ,jointly,by:the will,t deed,.or other instrUment of another, with a copy of the.instrument creating such power attached to the schedule. . .~..1 That Schedule D attached hereto and made part.~ereQf(sets .forth;~he names and addresses of all persons beneficially interested in t~is estate at the time of decedent's death,the nature of their res-.. pective interests,.their relationship,if any,to the decedent,together with the ages at the time of decedent's death of all minors,annuitants and beneficiaries for life under decedent's .Will.I:t 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 vestiture 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 fudiciary'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 (If ~.death;taxes accrued chargeable for period prior to decedent's death .(except.those.allowed under Section 651 of the Inheritance and Estate Tax Act);together with a statement of collateral pledged for obliga- tions,if any.It is agreed that the fiduciary will present proof of said claimed obligations upon re- quest,that if the amount actually paid in settlement of any fee,commission or debt is less than the estimated amount claiming and allowed,that the same will be reported to the Register of Wills,and that the amount of tax assessed can be reassessed in accordance therewith. That the totals of the appropriate columns in Schedules "A","B","en,"E",and "F"as directed therein,· have been carried forward and properly registered in the Summary. (Street Number) (City 0'1'Town and State) ...........................................................,, ,. ._. 'ESTHER EWAUGH,NOTARY PUBLIC My Commission Expires March 23,197') W h't f'Wasnintrtnn'COUIl'yNOTE:B~¥o~&O~f~ing arrraavit'make sure all blank spaces in the arfidavit and schedules annexed are filled in with details or the word "None",and in case the assets include rare and unlisted securities, securities of close or family corporations or an interest in any co-partnership or business,that the data and statements required under the paragraph above relating to Schedule "B"are attached.Also make certain that column #1 in the "Summary"has been properly completed as above-directed. Subscribed and sworn to before me this l/..rrz/;,.,....... ................,:"E ,.:day of ~,19 G.7G~1 dt·..Ir-......_:~~. ,.-- RCC-34 (1-64) Co...I,4MONW};AL 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 u).on each parcel at death of dece- dent.Where property heid as joint tenant or tenancy by entireties,report on Schedule "E".Property held by the .de.cedent·as tenant in common with another or others,should .be identified as to quantum of interest and the estimated value should be that of the decedent's interest only. The real property located in the Commo!"wealth of Pennsylvania should be described by lot and block number,street and street number,together with a general description of the property,with a reference to the record of the conveyance by which the decedent taok title;If a farm state number of a· cres;also statement of mortgage encumbrances upon each parcel at death of decedent.Taxes,assessments,acc;,ued Interest on mortgages,etc.,are to be listed on Schedule "Fit and must not be deducted from this schedule. 2 sty fr dwelling Church Street Burgettstown.Washington Caunty,Penna. /~~.?-~/.fu&e...~~fb~P..,a.)p_ .~--/i~-ol~~~~ a.,-r::I-'/1 :..J s"/.<?~~.-4!!~"",tJ(.7.,"~-e.dfl~ v V~H.J6-C- (1)(2)(3)/ DEPARTMENT ASSESSED VALUE I VALUATION FOR YEAR OF ESTIMATED I'- CAUTIONDECEDENT'S MARKET VALUE (Do not wr Ite DEATH In.this space) 4;,500.00 I P7rei''n1'rn I /' Insert this total opposite Clreal property",Schedule ClA"in the X X X X X ..As Reported"column on the last page of this return. 4',,500.00 RCC-35 ~OMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "n" PERSONAL PROPERTY 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".Inta~gible 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 anyundis tributed 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. Stock I . Item No. ITEM List and describe fully Rent collections -due at death Mellon Nat'1 Bank,Burgettstown Savings Acct.No.16332,Sara C.Pettibon Pgh.Nat'l Bank,McDonald sa.;;Zi Acct,Sara C.Pettibon 30 sharls of General Electric Co. $97.25 per share - Mellon Nat'l Bank,Burgettstown Checking Acct No.190-9275 Sara C.Pettibon U.s.Gov't Bond $1,000.00 No.266792 $98.22 per $100.00 Nov.11,1945 U.S.Gov't Bond $1,000.00 No.23547H $89.22 per $100 •.00,Dec.15/66 U.S.Gov't Bond $1,000.00 No.266804D $89.22 per $100.00 Dec.15,1966 U.S.Gov I tJ"Bond $1,QOOiOD No.48716F $89.22 per $100.00 Mar.15,1967 U.S.Gov'ti Bond $1,000.00 No.70068J $89.22 per $100.00 Dec.15,1966 U.S.Gov't Bond $1,000.00 No.70069K $89.22 per $100.00 Dec.15,1966 U.S.Gov't Bond $500.00 No.76236F $89.22 per $100.00 Mar.15,1967 UNIT ESTIMATED VALUE MARKEr VALUE 2,917.50 3,097.05 .... 892.20 892.20 892.20 892.20 892.20 892.20 446.10 DEPARTMENT VALUATION (Do not write in this space) U.s.Gov't Bond $500.00 No.30482B $89.22 per $100.00 Dec.15,1966 U.S.Gov't Bond $500.00 No.16968J $89.22 per $100.00 Mar.15,196TJj Commonwealth of Pa.-Teacher's Retrmt. .\.i Il16.D.Insert this total opposite "Personal Property",Schedule "B"in the "As Rt!p,qrted,"culumn ofl..the last pag"e Qf t.Qj:s return.U.~.~av1ngs ~ond No.~1~4bI592E-7-42 Ser1es E issued to Miss Sara C.Pettibon U.S.Savings Bond No.Cl1467593E-7-42 446.10 446.10 l 216.67' X X 12.50' ~J2,~~~.u~ 100.00 100.00 $33038.05 RCC-36 I....••• ('0\!'10\'li7 \1,TII OF PF~N~YL\i ..1.NIA T\L\NSFFll INHERITANCE TAX nE~InEXT DECEDENT SCHEDULE "e" TllAS SFEnS (1)Did decedent,within two years of death,make any transfer of any material part of his estate,withOl:.t receiving a valuable and adequate consideration therefor?(Answer yes or no)no (2)Did decedent,within two years of death,transfer property from himself to himself and another or others (including a spouse)in joint ownership?(Answer yes or no)DO (3)If the answer to (1).or (2)above is in the affirmative state: (a)Age ·of decedent at time of transfer _ (b)State of decedent's heal th at time of making the transfer.(Note 1). (c)Cause of decedent's death.(Note 1). (4)Did decedent,in his lifetime,make any transfer of property without receiving a valuable or adequat~ consideration therefor which was to take effect i.n possession or enjoyment at or after his death? (Answer yes or no)~n~O~_ (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)~D~O~·_ (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 e:~ressly 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)DO (b)The right to designate the persons who shall possess or enjoy the property transferred o~ income therefrom?(Answer yes or no)DO (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 t·) 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 enjo~~ent of which was subject to chang~, because of a reserved power to alter,amend,or revoke,or which could revert to decedent under terms of transfer or by operation of law?(Answer yes or no)~D~O=-__ (9)If the answer to (8)above is in r-he ~ffirmative,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)DO NOTE 1:The answers to these questions should be supported by affidavit by the atten<ung physician as well as a copy of the death certifica~e. NOTE 2:If answer to any of the above questions is yes,set forth below a description of the prcpertl 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 iiIIi I DESCRIPTION MARlmT VALUE (Estimated)DEPT.VALUATION (Dellt.·Only) Insert this tnt".]opp{)slte "Transfers",Schedule "C"in the "As Reporter!"column on the last page of this return. •• COMMONWEALTH OF PENNSYLVANIA THI\NSFTH.INHEIUTANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY I NSTRrCTIONS:This schedule must disclose all property,real and personal,owned by the decedent jointly wi th 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 under Schedule "A",plus the date and place of record of instrument effecting vestiture,but do not include entireties or out of state real·estate value in estate valuation column.Personal property should be listed as in Schedule "B",plus date of acquisition,and the name,address and relationship (if any)of co-owners to the decedent. Description of Property,Date of Acquisition,Name I Unit Address and Relationship of Co-Owners,and Place Value of Record of Instrl~ent,where Real Estate.I percentage Estate Share Valuation DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's property Interest Brick House Midway,Penna.1/2 interest u.S.Savings Bond No. Series E Issued to Miss Sara C.Pettibon or Miss Laura L.Pettibon 2500.00~11~ 100.00 I.j'.l,oo Ot____________••_.--.L..__--L.---U~~=~~-----_+----- Insert this total opposite "Jointly Owned Property",Schedule "E"' in the "As Reported"column on the last page of this return. ; . .... RCC-37 (12-63) Ctnnllr,\WEAI.TII OF I'E:'\:'\SYYL\NIA TRANSFER 1:'\IIEHITA!\'l'E TAX RESIDENT DEL'EDENT SCHEDULE "D" BENEFICIARIES ;.: BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED(If step-children or DATE INTEREST OFStatefullnamesandaddressesofallwhoillegitimatechildrenDECEDENTOFBENEFICIARYaveaninterest,vested,contingent or other-are involved,set STATE YES IN ESTATE wise,in estate)forth this fact.)OR NO BIRTH Laura L.Pettibon .I •£3 ....,\I.'j,sister ves entire .... ... -- ,. ..~-, ~,,,f- r r ,'-.-",. : \ h Deponent further says that all the above-named beneficiaries are liVing ~t this time except below: NAME DATE OF DEATH RESIDENCE -'- ~IATTER OF THE APPRAISEMENT Will Administration t No Year . . Dol THE OF THE ESTATE OF .\,' , ..J~ -'1 .(Executor-Administrator must complete "As Reported"column #1.) 0 ~~'"0 ::0..,:"rJ ct>ct>0 ..,e:..Vl :,::l Vl Vl :Vl 0 ~~.~::l '"0:ct>e:..:.~.., I»~:(\-0x''"dI»...~"'tl ct>0-..,.., (b 0 ~'t:l tr:1 ct>... Vl ..........'<I».....ct> .. (~ \ t •1 ~~en.()() 1-.:?":r :~.~....:...r5K--.,; SARA PETTIBON a/k/a SARA C.PETrIBON Deceased Late of Wasb1Qgt.Q.n . Count\"of ..WashingtoD...-. Commonwealth of Pennsylvania REPORT AND APPRAISAL :, enc: ~~>~ en 0-<: ()?" -> lo ~..: ~-E19 ~-EI9'0 .~:~~~:w:J\.:00 ::\,,: •:.Of'.:0:)~:(11::~ :~::Q': L , "_.'!l. '- .y)'-E19 ,~,~.:,: :,",,: :~: :6.:~: -00 .y) ~.: :~::~::~: :C\: ~: -EI9 -EI9 :(.1):,:G!J ~J:0:>":w:Vl :00:~:.:.(t)::::0:-g~:(11:::;. .~C!:!~2 :~ ~a «'-E19:~:---1'\\j\'?" :~:~ti:(1o:C4C!:~:~:~2"l-:J:..:""1-:.:30.,:C\-.:c.;.,:C\~::c....~ ~. ii, !. ACC·O I (a·U) COMMONWEAL.TH OF PENNSYL.VANIA DEPARTMENT OF REVENUE BUReAU OF COUNTY COLLeCTIONS INHERITANCE TAX DIVISION NOTICE OF FILING OF APPRAISEMENT ISRAEL C.BLOOM (~AdministratorlCTA IN YOUR RI'~Y '~.A'I RI'."TO 37-36-4 j In Re:Estate 0 f __--'S~A~RA~.....CUL.--Il...P~ET..T....I!MoB~QtoIolNL.....(;I,a>l_!kQ.I_J/a.......-.....;...-- ___...:.:\'l.:..::AS~H~I::.:N:.:::::.GT.:..:Q~N:..---..:..._County -File No.9441-163 Dear Mr.Bloom: You are hereby notified that the original appraisement in the estate of Sara C.Pettibon a/k/a has been filed in the cffice of the Register .of Wills qf Washington County on December 18 ,19-27.Said appraisement reflects the following valuations: Real Estate 4.:.5.0.Q;",0.0 Personal Property 33Jj;-918~O~~~5 ___ Transfers 2.600.00 Total 40,138.05 As to such ~ax that is paid within three death,a five (5%)percent discount is allowable. remains unpaid after one year from date of deat~, of six (6%)percent per annum is charged. months from date of As to any tax that interest at the rate Any party in interest who is aggrieved by an appraisement may appeal therefrom as provided by law. Date __~D::..::e::..::c~e~mb=e.:!:..r--,1~8~,,-,,l!o...9~6u7 _Signed _ DATE OF DEATH:July 14,1967 TitIe W.R.CHANEY,CHIEF APPRAISER Note:This is not a bill. .COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RCC:39 {6-67l RESIDENT DECEDENT .-·PETTIBON,SARA C.,a/k/a PET'!'IBON,SARA FILE #9441-163 July 14,1967 SUMMARY I~the unclersigned #63 Washington FILE #9441-163 the real and personal opposite each item in r~EPonT OF INHElUTANCE TAX APPRAISER cluly appointed Inheritance Tax Appraiser in and for the County of ,Pennsylvania,do respectfully report that I have appraised property as reported in the foregoing return at the values set forth the last column to the right in Schedules "A","B","C"and "E". Da ted:12/18/67 07/14/67 z;,~~If?..L....a.\o~~,--e~~c:?/~~NHER'~TAX APPR~~~ 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,except 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: REGISTER OF WILLS VALUE AS REPORTED VALUE AS .'\.PPMI SED V~A=L=UE:::.:'"--"A=Se-.:.:RE,,,",',=!\P""""P,-"RA=I,-",S=E.:::.D 3;41500.00_$41500.00._*_ 33,038.05._33,038.05._ INVENTORY Real Property (Rchedule A) Personal Property (Schedule B) Transfers (Schedule C) J oint-Held Property (~chedul~E) TOTAL GROSS ASSETS LESS Debts and Deductions (SCHEDULE F) CLE~~VALUE OF ESTATE 2,600.0Q_ 40,138.05._ ======.= 2,600.00._ 40,13.8W._ =====.-======:= Valuation of life estates or annuities.. . • . . . .*__ ESTATE T,~X ASSESS~ffiNTS $_ CO~WUTATION OF TAXFORUSEOFREGISTERONLY Tax on $•__f5% Tax on $.__10% Tax on ~r.,df Tax on $:~ Exemptions :=(::,) Total Estate __ TOTAL TAX Less tax preViously paid BALANCE Less 5%of tax if paid within 3 months after death '"';,------~------- $------~------ $-----'".~======~=$------ *=====1= (,::)As evidenced by Charitable Exemption Certificates issued by the Secretary of Reyenue. BALANCE OF INHERITANCE TAX DUE ~--------- Add interest at rate of fl%from to $----------AMOUNT OF ESTATE TAX ASSESSED $_ Estate tax paid $_ BALANCE DUE !t._ Add interest at rate of 6%from to *_ TOTAL TAX BALANCE $_ PAID $ FOR USE OF REGISTER ONLY ADJUST~ffiNTS 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.I I I ,,-"~'\ Will ~T Administration \No.," I~THE ,Year ~~. ~IATTER OF THE APPRAISEMENT OF THE EST:\.TE OF ,~J\M ,9,~,,P.~.,.:r:r.B.ON"~j~/~", Deceased Late of "","",.MJPWAY"" County of "WAS,H1NGTON,,,,,,,."""",,,,,,,,,,, L. Commonwealth of Pennsylvania REPORT AND APP~AISAL p ......!- MPARTME'NT 'OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG.PENNA.17 127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT D.\TE De.cemb.e.r 18.,.19.6?.. COUNTY Y.l.~.~.~.~.9..~_ . FILE NO 944.~::J.6.J.. Whereas,$..~.r.~G..,P..~tt.i.b..Qn.late of M.~4~y.. \'1 h't.Co lth f Pl"dintheCountyof...............................................)~,!?....~..Qn........................................................mmonwea 0 ennsy vama,haVing ied on the .................................~4....~.~.............................................day of .......................~~y..........................................19...6.7...,seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;. Therefore,I,....................,:...........W..!.R.!.....Qb.~n~y..............................................................,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,iherebyfilethefollowingappraisement:!! In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after I 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 Unit Appraisement j of Asset Made for InheritanceValuesTaxPurpoles I I $I, IREALTY:I I IAsnerS~hed111p."A"l....'i00 OD I PERSONALTY : As ner Schedule "Btl '3'3.018 05 I.. TRANSFERS: '. NONE NONE JT.HELD: As ner Schedule "E"2.600 00 .,. ',. Total ..40,1}8 0.5,,., ,. '~l.", .. '.,. .'. ;'0' II fonn:~fhb~~::~~sw~aLt~I~~:~:;o~e~e:?J~":~e~~..7~;~~..I~~?- .Appraiser /'.~............................,................................................................................................................... ~"~_...._"~\..........................................................................................................................,Penna.','(Poet Office) .....................v.JA$.HX.NGT.QN ::......County RESIDENT INHERITANCE TAX APPRAlSEMEN'l' Estate of ..............,SARA C.•....PETTIBON a/k/a . Deceased. Late of .........................................MIDWAY.. Date of Death,J.uly 14 196.7 . Appraisemel!t Docket Vol.,.3.7.. Page,..3.~4 No 9441",.l6J.············ Filed in Register's OfJice,De.c.•....18,.19 67 . Amount of tax due,$. DEPARIMENT OF REVENUE,. ....~:;'r'"j•...•.••....~...........•..••.••.•..•..•,•.,•.•. -0.!"""'-:-,.-.,Received, '..... Examined and~~prr~ve:d~~'t ;t"•.~:~::~.••••••••••••••••••••••••••••• Wrote abo.ut ~:&fi!]1.tse'r,~J,;~~,L..L.,;. ........--~. l.~ Appeal f"om Appraise»dfrt,. Entered and charged,. ~" i !".G ~,_A, / .....s ...~~~THE SUM OF ;j'-.!J/-?/DATE APPROVED .,.., dvud1 JJz~~ ~9'!o gr DEDUCTIONS 'ALLOWED.'.-~....J STATEMENT OF DEBTS AND DEDUCTIONS OFFICE OF TME REGISTER OF WIL.L.S Form RC C ·10 washingtonOF COUNTY AND AGENT OF THE COMMONWEALTH ~~~7)/~~/(3 /j'"~Z' Sara Pettibon a/k/a Sara C.PettibonESTATEOFL.ATE OF ~W..;.;a:::.s::;.h=i;.:.n:..ogL..t:;:..o:;:..n~,__=P:_e:..:n:..:;.n.:.:._a_.__ DATE OF FILING APPRAISEMENT __:::.../__-.c.;Z~~:::...----=.t....;·P;..."DATS OF DEATH __J_U_l.;:y_l_4-:..,_1_9_6_7 _ DATE NO.OF NAMi OF PAYEE REMARKS AMOU:>ITVOUCHI;IIl 7/26 67 Register of Wills Ltrs Test &3 S.C.22 50 8/1 67 Register of Wills 1 Short Certificate 1 00 8/2 67 Rubv Mastic 1967 School Tax -lT2-'7'6..... 8/2 I 67 Ruby Mastic 1967 Boro Tax ~36 .65-· 8/3 67 Washinqton County Reports Advertising 12 .50 8/3 67 Burqettstown Enterprise Advertising 8 00 8/14 67 James R.-Hughey,M.D.Docb r Bill 36 00 8/15 67 Wm.H.Kittrell,M.D.Doctor Bill 15 00 8/18 67 Robert D.Vance Bond 88 00 8/29 67 Mellon Nat'l Bank Box Rental 4 00 I 8/29 67 Bessie Truax witness Fee 10 00 I I 9/11 I 67 O.E.Turner,M.D.Professional Services 300 00 I 10/4 67 Mill l\1utual Agency .__+Premium Charge 29 00...1 I 10/17 67 William R.Sausser 'Appraisal 20 00 I 10/17 67 Mercy Hospital Fees 18 89 10/19 67 Edwin G.Wilson Funeral Bill 1446 75 12/12 67 J.M.Doucrlas Inventory 4 00 Russell Marino Final Account 16 00 6/8 .68 Bloom,Bloom,Rosenberg &B.Attorneys'Fees 2000 00 6/8 68 Israel C.Bloom ~Administrators Fees 2000 00-_. 11/20 I ,I67TheGavdosMonument, Co.Monument.______,lonn nn \I - 4/10 68 Internal Revenue Service 1967 'fIav -p.~-f)()'- 6/-h 1::0 ~..,..~.l,..,al::o.LV.LV.LyClU',--....Xa-x ...:::Lr-r.:.r.:. .~f},../J.~I-~~....JL .;.t'C ~ 1-:'{/../ ?2S7J 05 I 7:&L'/L q A tLJ {1£\ COMMONWEALTH OF PENNSYLVANIA COUNTY OF Washington I,Israel C.BJoom MY COMMISSION EXPIRES FEB.8.1969 WASHINGTON,WASHINGTON COII:'lT\' ',.~••1'" ,...', 1/:0 :2 :'f! r r ..>-,,'-'. \.:. r(',. ,', f", -' 'i ~ ......,.....:- ,J J,-' .'.. 1"', '.-(' .~.'.