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Home My WebLink AboutOC1970-0428 - ESTATE OF SAMPSON·:-- QIommouwra1t4 of 'puunyluauia.t lIan4iuglon aIounly.~!is: KNOW ALL MEN BY THESE PRESENTS: on the 21st.day of April Whereas,at Washi,ngton,in the County aforesaid 70A.D.19 ,before me, Russell Marino ,Register for the Probate of Wills and Granting Letters of Administration in and for the County of Washington,in the Commonwealth of Pennsylvania, the last Will and Testament of LOIS I.SAMPSON late of Monongahela in the County aforesaid,deceased, (a true copy whereof is to these presents annexed),was duly admitted to probate;and Lois Virginia Healey rixtheExecut«r in said Will and Testament named,having appeared before me and taken and subscribed Russell Marino the oath of office prescribed by law; NOW,THEREFORE,I, grant these LETTERS TESTAMENTARY,unto the said Lois Virginia Healey ,Register as aforesaid,do - committing unto her the administration of all and singular the goods and chattels,rights and credits,which were of said deceased,and requiring her to exhibit a true and perfect inventory thereof into the Register's Office,at Washington,within ninety days from the date hereof,and to render a just and true account of said administration at the expiration of six months from the date hereof,and to regard and comply with the provisions of the laws of this Commonwealth relating to inheritance taxes. IN TESTIMONY WHEREOF,I have hereunto set my hand and the seal of said Office at Washington,this 21st. day of April ~n the year of our Lord one thousand nine hundred and Seventy .~~:~,.. ,Register =~~......:::tl.t zaIt.0«S 0 CI)N......IiJ A..t'.:S1 ...::a:~~~S III CI) IiJ i::•H tl.t CI)............H~0~..:l j OF· LOIS (SAMPSON ('LOIS I:~SAMPSON;'of the .City of Monongahela,Washi~gton County,Pennsylvania,do declare this to be my Last Will and Testament, hereby revoking and making void any and all Wills by me at anytime hereto- fore. ITEM I.I direct that all my just'debts and funeral expenses be paid as soon as convenient after my decease.As source of funds for payment I suggest my Savings Account No.'22250 in the Western Pennsylvania National Bank,Monongahela Office. ITEM II.I hereby devise and bequeath all my property,real, personal'and mixed to my niece,Lois Virginia Healey..of Monongahela:, Pennsylvania. ITEM III.Should my niece,Lois Virginia Healey,predecease .me..it is then my will and des~re that all my property go to the children 6f .Lois Virginia Healey,viz:VirginIa Ruth Healey..Rebecca Ann Healey,Sally K•.Healey and Kenneth C.Healey,'in like and equal shares or to the survivor or survivors of them. ITEM IV.I hereby nominate and appoint my niece..Lois Virginia Healey..as Executrix of this my Last Will and Testament.If for any reason she is unable to serve..it ismy will and desire that Kennethe.Heales..Sr... be appointed as Executor of this my Last Will and Testament.I direct that neither.of the above named persons shall be required to post bond or other security in any jurisdiction. ! { ..j ?f"!iIhavehereuntosetmyhand.this 1_(.;'IN WITNESS WHEREOF, oqk~k/,A.D.1967.day .~--rA y~~/~ / This instrument,consisting of one (1)typewritten page (bearing the signature of the above named Lois 1.Sampson)was by her on the date hereof signed.published and declared by her to be her Last Will and Testament, in our presence,who at her request and in her p ,esence anclin the presence of each other.we be~ieving her to be of ~ound a d \~isPosinf.\')~mind and memory, have hereunto subscnbed our names as.Wl!nesses I "",~:!j)~., . .....",A.l·I~t/~y,~j )«(/()I 'l,.'..\:)....'...1 //,,:.--./()--f~-,'--./-:-;.,../..,----"/ ;/ /'''>,t.,,,'---:/{.-,.---...////c<',(.:::"'-:::'<,'/·c.V',,~··.('/{..·l _ /_".~~.,,'.....- -/"~--"r Mary Jane Smith,Notary Public Wasbington,Washington County,Pa. My Commission Expires FenCllary 28 1973 .. l\ffi~a-utt (@f fXfrutnr QDr i\bmtut5trutnr itntt of 'ruuaylunttin } mouutg of IIna4ingtou as: Personally before me,the undersigned authority,a N.R1ax:y..PJ.l.Qli.c._in and for said County and State,appeared J:,.Q~.§..:vJr.g:!.n!.9.:..a~g.l~y ·..···t -who,being duly..execu rlXswornaccordingtolaw,deposes and says that she IS the ~~00f ~1{~mi::~i:Pt1itlOr of the es- tate of .J·-!Ql~.)!~.AM~§.QN deceased,that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of .LQ1S.J!...SA.M.PSO-N..., 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 .Executrix Sworn and subscribed before me this 2.9th }J2 ·0~'.),/~~'f"J~''~7 ~f~IY0 ..J.!0 ..,.,~~&-~xist:ootollx Ex utrlx ..-•..;,.'•-..._.-,-'f...... ADDITIONAL INSTRUCTIONS 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 $50,000,in- cluding Copy of Will and copy of Federal Estate Tax Return. REFERENCE FOR ADDITIONAL COpy Act of 1947 P.L.513 Sec.5.2,72 P.S.4844.2 aJuurutnry nUll l\pprnisrutrut .of the goods and chattels,rights and credits which were of .~q.:i..$..J,s.~mps.o.n.,.late of ..City..of..Monongahela . Washington County,Pa.,taken and made in conformity with the above affidavit. j REALTY:NONE DOLLARS CENTS, PERSONALTY: (a)Checking Account -Western Pennsylvania National Bank "Monongahela Office 18,622 49 (b)Savings Account '-Western Pennsylvania National Bank Monongahela Office 16,070 49 (c)Miscellaneo:us personal items and household furnishings 500 00 (d)10 shares of Studebaker and Worthington Common Stock 459 ..40 (e)20 shares of American Telephone and Telegraph Common Stock 1,503 75 (f)84 shares of International Telephone and Telegrapt!"4,315 _5Q ,, L TOTAL 41,471 63 l0 cI -jit Ii l 1mr 0L f {"J''''''j "j t >..! '-:,;i_l / ,. ,.::1;.".('-v'j' "r1;:;. ~ ....~;::......<::~'"z ;::.... ~~0"'l~ t11 ;,.~;::~t11 ~,<:::><n >0"'>"'"l ,>~"'"l ~t11 ;,.~;;;. 0 ~ac"r1 '";::........\C) '. .Affi~nutt (@f 1£xrrutnr (@r .A~mtut!itrntnr ~ttttt nf 'tuunyhtttttitt } Qtnuuty nf lIan4iugtnu nn: Personally before me,the undersigned authority,a _NQta.r.y__P:u.blic..__in and for said County and State,appeared LQ.t:;l__.YJ.r.gin.ig.__H~_al~Y-. .C~--who,being duly sworn according to law,deposes and says that s he is the ~~~~~~of the es- tate of ~QJ~_J~~A.M~§.Q~...deceased,that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of LQIS__I.SAMPS.QN , 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 apprais~ment of each item made by the above named ~xxx~~~ecutrix Sworn and subscribed before me this JOth }/-0'1£'.liP /A "~YOfJ~l..1~.... ..~:.V~r..:-:-:¥fi.../'")XE~3D1mi~Execu IX ..... ADDITIONAL INSTRUCTIONS 1.An inventory must be filed within three months after appointment of personalllepresentative. 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 Oopies and 2 RCRI-33, Over $10,000,including Copy of Will;1 Original and 3 Copies and 2 RCRI-33,Over $50,000,in- cluding Copy of Will and copy of Federal Estate Tax Return. .REFERENCE FOR ADDITIONAL COpyMa~y Jane Smith,Notary Public A t f 1947 P L 513 S 52 72 P S 4844 2Waslungton,Washington County Pa.co..ec.., . . .My~ommission EXfes ' i 8Ilfitiii'HtSi 19£3 I-3JuUtutnry aub !\pprttintmeut .of the goods and chattels,rights and credits which were 0/L.Q~$...l.~s.q..mp.~.Qn late of City..oi..M.ono.ngahela .. Washington County,Pa.,taken and made in conformity with the above affidavit. DOLLARS CENTS SUPPLEMENTAL INVENTORY U.S.Savings Bonds Series E IIssueDate Denomination January 1951 $25.00 35 62 May 1951 $25.00 34 82 May 1950 $25.00 36 10 March 1954 $25.00 31 92 May 1955 $50.00 61 84 NOTE: On original Inventory only 20 shares of American Telephone and Telegraph Stock was shown.This should be corrected to read 30 shares.The total value as givmis correct as $1503.75. j TOTAL 200 30 'V'd "00 N01:JNIHSV'!1I SlllA\.::i0 H31.SI~3U aNIH VH TLF;sn/j L5 Z ~,Id 0i 'mr 0L c03'-II.:i t~ ~~o ....;:t"H ....~~~Cf)~'Il;:t:H ....)0 ~c I"l :Cf)~ ~~t!:l ~"-.J;:t~~t!:l l:l...C)~:tU ...,~I~"'::l-:Cf)~:0 ...,~t!:l ~":z '"~~'Il ~;:t.... Mary Jane Smith,Notary Public Washington,Washington County,Pa. My Commission Expires F bCIIA'}on,ID:r3 AMENDED INVENTORY i\ffi~autt (@f iExrrutnr {@r i\~mtut!itratnr ~tatr of 'ruunyluattia { Q!ounty of ltan4ington Snn: P 11 b f th d · d th 't Notary Public 'd f 'dersonay e ore me,e un erslgne au orl y,a _..__.In an or sal ~~~~~ya::~d~~:t:~~~~:a:::o~:-~~~~~::t~:~..~:~:t~Y~~--~~~'~~j~~;~~b~n~h:~:- tate of .J-:'QJ.$.J..__.~..AM;e§.QN __.........deceased,that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of __~Q~~_J~_..~AM:p~QN __, 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~~tmxx~.ffit~Executrix ,/~S d b -b d b'f .th'23rd /..y'.worn.an ~su scn e e are me ts }'7"\[I .d~Octo~9~70..~;X~J/A:.q~.a a ,:.:.,:..,.:..,,."''''~''''''/.:.;.J ~~xxE ecutrix .......-.. ADDITIONAL INSTRUCTIONS 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 $50,000,in- cluding Copy of Will and copy of Federal Estate Tax Return. REFERENCE FOR ADDITIONAL COpy Act of 1947 P.L.513 Sec.5.2,72 P.S.4844.2 31uurutory aUll l\.pprainrwrut .of the goods and chattels,rights and credits which were of ~9.~.~..~~$~mp.~9.p., ,..,late of .G~ty..qr.M.9:'}9.P.g9:h~~~,..,:-..,.., Washington County,Pa"taken and made in conformity with the above affidavit. I AMENDED INVENTORY AND CORRECTIONS Add: U.S.Savings Bonds Series E. DOLLARS CENTS Issue Date January 10,1950 Deduct: Denomination $25.00 37 00 The original inventory as filed listed under Item (b) Savings Account,Western Pennsylvania National Bank, Monongahela Office,as having $16,070.49 when it should have read $1670.49 or a difference of 14,400 00 NOTE:The total personalty therefore should be corrected to reflect thi~error or deduction of (14,363 00) E~II ~4 V c:2 1]0 O'L ~a~:l "~l I .:~..... \C l~• COURT OF COMMON PLEAS OF WASHINGTON COUNTY ORPHANS'COURT DIVISION FIRST AND FINAL ACCOUNT OF LOIS VIRGINIA HEALEY, EXECUTRIX OF THE ESTATE OF LOIS 1.SAMPSON No.t:1-Z()-!/~f SUMMARY SCHEDULE A PRINCIPAL -PERSONALTY RECEIPTS Receipts,Page 2 $27,882.93 <!::./" Disbursements,Pages 2 and 3 7,816.17 C-/ Balance -Principal -Personalty $20,066.16 ~ SCHEDULE A PERSONALTY -INCOME RECEIPTS Receipts,Page 3 Disbursements,Page 4 Balance -Personalty -Income BALANCE 88.14 None 88.14 L $20,154.90 C- Balance consists of stock,cash and household furnishings. ,,·i...,. First and Final Account of Lois Virginia Healey,Executrix of the Estate of Lois I.Sampson SCHEDULE A PRINCIPAL -PERSONALTY RECEIPTS Original inventory and appraisement Supplemental Inventory and Appraisement TOTAL Corrections ta'amended Inventory as filed Deduct Adjusted Inventory and Appraisement Bankers Life Insurance Company -Premium refund Pennsylvania Teachers Retirement check {final Lump sum Social Security TOTAL RECEIPTS SCHEDULE A PRINCIPAL -PERSONALTY DISBURSEMENTS Administrative expens es : Russell Marino,Register -Grant of Letters Testamentary and Six Short Certificates Washington County Reports -Advertisement of Grant of Letters The Daily Republican -Advertisement of Grant of Letters Russell Marino,Register -Filing Inventory and Appraisement and RCC-33 Russell Marino,Register-Filing Supplement Inventory and Appraisement Russell Marino,Register -Corrected Inventory and Appraise- ment Peacock,Keller,Yohe &Day -Attorneys fee Russell Marino,Register -Filing this account Mary Jane Smith -Notary fee Total Administrative Expenses ~$41,471.63 200.63 $41,671.63 <:.- .$14,363.00 I' $27,308.93~. ~Q~ 56.00 263.00 255.00 $27,882.93 i'- 24.50 14.00 12.50 3.00 3.00 3.00 1250.00 17.00 5.00 1332.00 "- ,,l ~..~-. Preferred Debts: Bebout and Yohe Funeral Home -Funeral Bill National Ambulance Service Quinet Monument Company -Grave marker Memorial Hospital -Final bill Total preferred Debts' Inheritance Tax Payment on account of inheritance tax Miscellaneous Debts: George's Market Equitable Gas Company West Penn Power Company Alex Rue -Hauling James Weddell -Final rent Monongahela Water Company Sewage Authority Locust Grove Dairy Rocco Flowers West Penn Power Company Total Miscellaneous Debts 1692.34 25.00 380.00 24.00 2121.34 4200.00 24.14 38.86 6.46 10.00 40.57 17.59 8.03 1.70 12.72 2.76 162.83 39.00 44.14 5.00 88.14 None SCHEDULE A PERSONALTY -INCOME DISBURSEMENTS .,, None THE D~~~rG.!~A~LlCAN ,,'-- PROOF OF PUBLICATION In compliance with the Newspaper Advertising Act of May 16,1929 P.L.1784,Sec.3. paragraphs (3)and (25)' County of Washington Iss: State of Pennsylvania ( Personally aSPeared before me,a Notary Public in and for said county and state, .MI'~L~r p..~?p:~.~~.,who,being duly sworn,deposes and says:thaL.~h.e is the J;l.QQkk~.§l~.r of The Monongahela Publishing Co.,a Pennsylvania corpora- tion,and its agent in this behalf:that the said company is the publisher of The Daily Republican,published daily except Saturday and Sunday,having its place of business at Monongahela,Washington County,Pennsylvania;that the said Daily Republican was established in the year of 1846;that the printed notice or advertisement,attached hereto is a copy of a notice or advertisement,exactly as printed or published,which appeared in the said newspaper in its regular issues on.the following dates: ~p.~~J ?7~~~;'t...4 ~~.~!~9..?~. ..Exec.utrix.t.$..Notic.e.L .Est.ate.of LQi.s..J S.~.mJ2.~.Q~__._. that the affiant or the corporation in behalf of which s.n~L........is acting is not inter- ested in the subject matter of said notice or advertising and that all of the allegations of this affidavit as to t7~m:;L~d.:~~~~m . \Sworn jJ and sUb~o~e me this c.REm lJOUGH~R1Y,Not?ry P;;bHc~f )"'T ..__0 ~,~,o;,:,::~:;~:p:r:~NJ:;:;~,C~9it ./r ry Public ~ __~-::-::::":'~'-QTICE EXECUf vj~$A¥P5QN,ESTA!'E 0 .f .ncmgahela.deceB.•~.¢late,!)tllry upon theUtief"$Il'f.t ~';en gtallted above\..J:a:lrc allVllr~0!JS bav-to the '\h<nr 'bSt,th,,"'estate.a.reing'c1aIDlS al_knO\vn the $ame requested dto ~lgna~d or'his attotneytotheunersl. d bted.tO,·t!1e de-and all persons In e to mak"pllY-cedent are request~d eel without de-ment to the undersIgn ..'.. lay.Lois viriiniaHeal~ 1104 Che5ll Str""lMonongahela.~a.1506 Peacock,Keller,Yohe &:Day I 68-70 East :Beau street ~ .Wasningttm,Pit,1:3°[1 1~OApril27,.MaY"' Washington CountfReports ,aa:::SBl::l'f:I:I:::MA1:N::Sr:RE:Er= WashingtOD,Pennsylvania (PUBLISHED BY WASHINGTON COUNTY BAR ASSOCIATION) Estate Notl. 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 them for settlement to the Executors or Admin- istrators or their Attorneys. •• •• • • • ••••• •• • • • 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 t STATE OF PENNSYLVANIA (SS. SAMPSON.LOIS I .•Dec'd. Late of Monongahela,WashingtonCounty,Penna.E.xecutrix:Lois Virginia Healey,1104'Chess St.,Monongahela,Pa.15063 Attorneys:Peacock,Keller,Yohe &Day,68-70 E.Bean St.,Washington.Pa.15301 . 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,published weekly having its place of business at Washington,Washington County,Pennsylvania,and is act- ing as its agent in this behalf;that the said WASHINq.TON COVNTY 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: .............Ap.:£".il 3.0y H).1.0-. .............M.~y ?.1...J4..I pnQ .. ,--- ---~--• KATHERINE C.NICHOlAS.Nn.-'_.-1 _w.asb.f.n<d~-..- that the affiant or the corporation in behalf of which he is acting is not interested in the subject matter of said notice or advertising and that all of the allegations of this affidavit as to the time,place ~!lracter of the PUb{Qica'are t~e. IU /l'?ik .~(~.(_''t'(..;'..10......""".......----.-.~-_.-' Sworn to and subscribed before ~his J~';.7day of....~~~Y.~---,::19\7;~T?B?~.~---=-- ......I&Lz:t.LLt4.;...L.(A k.~.~ Notary Public .,---- STATE OF PENNSYLVANIA, WASHINGTON COUNT:V,~55: The within named Accountant being duly sworn according to faw,deposes and say sthat the above account as stated is true and correct as..~~.~verily believe, ,"")3~Sworn and subscribed before me this Q5 . day of ._~19..2J2... "~. Mary Jane Smith,Notary Public Washington,Washington County,Pa, My Commission Expires February 28,1973 Wa1shington County,ss: ~.~..)~'~........-~~. 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 and Rule of Court,as evidenced by proofs thereof filed to No.b.3.=7().~.7¥..Q , Witness my hand and official 'Seal this ;;}Q_~... ~..I.A _••A1\11)~OdayafJ~9n~_- .,.Register of Wills ~I~i~! 11 ~i t'itj ~i .~ ,~~ I ...h ,I ....0 'I,...toI,;j....i,0 0I:l \:1 .0 ~;j 00(])<)..<:I ...'--<)....<l1 ,"...0 ~0 I' ....~ ii"'''''...H 't:I (]) (])'""....0(1):I.~u I:l -4.~~::'jD "':,r~..-'\...1."i .(])Q)Q:,rx.cU:ULi ..I hli I '"~L ,~0 Z (])...(1):...0 N !A ....P:1 0 P=:i ....t I....,<l1 ~E-<en.~cUi I:l<l1 P-i cU Filc ~·Fi 1 "'piliO ;j E-<s::'....:f 1i \.,,:(1 0~s:::\1)v'.'"•.•-<)w......<)P:1 '+-l '....:R~."!C --;'r:p (\.:;\'.'ILLS oj~~_\},,:\;1<.l-t I..~-,\'J I I:l \:2'"0 1en.s::.~:\~1 J ("!j \~-)(\-r n ~'l co"PA.:<lPO:~i"\;;;;l,r'......I~',.....cU .~.....ooi ~+>(])en.00 '....:..<:I.....~0:ii:....Q0'....~i 0 ~~~I:l 't:I ~I:l<l1 '".... ,',~.. ,.... r~,._. ..... v ~, ...,l~ -.r"'T •.. ........:.....•.....' '.. <!tuurt uf <nummnu (@rp4uun' ~lt 'ltun uf'ltun4iugtuu OJunrt 111inininu <!tuuuty J In the matter of the Audit of Account in Estate of_.:::.L:....:O:....:I:....:S:-::.I:..-•....:.:S::..::A-=-M::.:.:::....P_S-=-O..::...:;.N-'-----~f TO THE AUDITING JUDGE: 63-70-428No.--=::..:::....----:....:::....-....:::..:::....:::...-- our AccountantEnter---'appearance for_,--,--_ 1 19 70'------~~r_---,-- 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.63-70-428 In re Audit of Account in Esta>te of LOIS 1.SAMPSON AUDIT 'tntript fnt'AppttttnUrt FOR :E.?:l .." -'-~f1 r-'" -r·<;('\~ C-..::p. ~,<.~,7 ' ~~2 ~c.; :;0 _.~-~'"O ..""'*--n .:..,.~ »rn -= (/}0 C ::r:-(I),'r. _._-~..;.....g ~~rv ;'z -0'0J>(f)c:e PEACock,KELLER~'YORE '&"DAY Attorney ~2 ------_._...,....---------_.~-~--_._~--_...---~~~~-----.;; .f PETITION SUR AUDIT IN THE ORPHANS'COURT OF WASHINGTON COUNTY Testate Form j j Estate of ~.?~.~.}.:~.~~P.~.?~_ __..__ Deceased N 63-70-4280 _""""""" Fiduciary_I:-!Qi?..YJrg.tnJ9:..H~gl~y . ~~~~~~ Decedent's death..~p.~~L~.~!....~~~.~~~~-Grant of Letters ~P.!:g..?~!..}.~.?Q _ . This is the EtJ;'.~.t..9:n..9..Ein~L :acc;unt filed in 'this estate If there have been former Qccounts filed in this estate,list file number or number and term ,. None E.lection to take Not applicable Under or Against will.(cross out one) Date Election Place of; Filed Record _ . Name of surviving spouseN9.lJ.~:_ ___._____ . List issue,where material:None Did decedent marry after execution of will?(indicate))(¥~No.Any children born after execution of will?(indicate) ~.No.If answer yes,name them _. Leg.atees Lois Virginia Heal~y Virginia Ruth Healey Rebecca Ann Healey Sally K.Healey Kenneth C.Healey Relationship Niece Great Niece Great Niece Great Niece Great Nephew Interest All Contingent Contingent Contingent Contingent Fiduciary,if deceased or not sui juris Sui juris List,if exceptions to above: None If partial intestacy,give facts: Adeemed: None Revoked:Lapsed:Abated:Give Cause: Notice to interested parties.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 cif the filing of the account and of call of audit?Yes.'.""~. If any exception give cause:...Lois..:v.ir.ginia.H.e.ale.y.'s children were the contingent beneficiaries and notice to each one of them was not deemed necessary. File copy of Notice and date of mailing D~.c.~mb~r..l,£..1.9.7.Q . Is estate subject to the filing of a Eederal Estate Tax Return?~.Q . Actual payment made on Pennsylvania Transfer·Inheritance Tax.Amount $..~~~.9.~.~g g.~~.~..P..~.~9 ,. If the Will makes any portion of estate subject to a life-estbte,give name and birth date of life tenant . No portion subject to life estate .........._-------_---______---_--..-----_..___-___---_.._.._--.--- Give Names and addresses of all unpaid creditors who are legally entitled to notice,tog·ether 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 refere~ce 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 accQunt, Itemize any additional debits not shown by account: Total additional debits (Add) Itemize any additional credits not shown by account: Wa,shington County Personal Property Tax Total additional credits (SubtraCt) Balance for distribution NONE $.._._.._. $?~.~.~. $..~.9A.~~.1=.:.~.9 . $.~Q J~:1'~~. If balance for distribution is not in cash,list each item held in kind;giving appraised Value (or distribution Value)'I Balance consist of cash,miscel1aneous personal items appraised at $500.00;10 shares of Studebaker and Vibrthington stock appraised at $459.40;30 shares of American Telephone and Telegraph stock appraised at $1,503.75;84 shares of International Telephone and Telegraph stock appraised at $4,315.50 and 5 U.S.Savings Bonds Series E having a value of $175.46 and 1 -$50.00 U.S.Savings Bond Series E having a value of $61.84 III.r 7 .._~...~.__.._ If Family Exemption claimed by Petition,give place of Record:N9.. If Family Exemption is claimed at audit,give name,relationship and basis for Claim:N.9 . List any advancement or distribution on account that has been made,and nature and amountof same: None Suggested distribution of balance shown,both as to principal and income,attaching signed and itemized elections to take in kind if balance is not in cosh:residuary shares being stated in proportions: All cash,stock,U.S.Government Bonds,and household furnishings should be awarded to Lois Virginia Heal~Y. COUNTY OF WASHINGTON,55: COMMONWEALTH OF PENNSYLVANIA. The above named Fiduciary or representative thereof, being duly ~_w:QX'IL doth depose and say that the facts set forth in the foregoing petition are true to the best of J::l..~!:_ _knowledge and belief. ......$.~Q!..~-to and subscribed before ~l me this Q day of..../....{t19.2.(1. Signature of Offrc~~ Hie of Officer-----7/)~~._.._ . Office exPires ::JJ.i:.J .:z.g}"...!..c:t..?..~. Mary Jane Smith,Notary Public WaslJington,Washington County,Pa. My Commission Expires February 28,1973 And your petitioner will ever pray,etc. vV -4/'-~~~.~.l/.. .."',~'!'.. No 63..,70-428...-_-.~.~__-__. Estate o1--:.9.t§..I.!__.$_c?'m.p.~.9X1:._..........._I~t i C i J," ill ~.....ri_1 I' Deceased Fiduciary_..~_<?t!?_.Y!r.gjJ!t~__H_~9J.~Y------------- •.____'l:.__ ____--- - _•• PE11TION 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 ra ph 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 WiII. 6.Copy of inventory and appraisement. 7.Proof of advertisement of grant of letters if not filed with account. 8.Certificate of liens in case any of the funds for distribution are from judicial sale of real estate. 9.Signed and itemized elections if any distribution in kind. 10.Copy of Federal Estate Tax return if es- tate is subject thereto. PEACOCK,KELLER,YORE &DAY Attorney ",,"'2 '7 I J~H ?7 Pil Z 18 RU SSE LL ;'\/\1:'\N0 f;EGISTEP,OF WiLLS W/\SHINGTON CO ..PA. ,I \' NO 63 ...70 ..428.-----._-----~------_.-.~-..----"----_..-._------------_.-------_._----- IN THE ORPHANS'COURT OF WASHINGTON COUNTY,PENNSYLVANIA. IN RE: ESTATE OF --LOlS-l__--SAMP.8ON----------------------------------------- of the Estate 0 f .14lis_l..__Samp.aan._ has been filed in the office of the Register of Wills and the Clerk of the Orphans'Court of Wash- ington County,Pennsylvania. It will be listed for audit during the term of Audit Court in the week beginning the __14th.day of __De!:..emher ,19__1.9 at which time you may be present for the purpose·of presenting any claims or demands that you may have in said matter. Date: Attorney for Accountant. December 1 1970-------C-----"-"--"~------L-------"--------_ ... Notice sent to: Lois Virginia Healey 1104 Chess Street Monongahela,Pennsylvania 15063 .. IN THE'COURT OF cO,M,MON PLEAS OF WASHINGTON COUNTY,PENNA ORPHANS'COURT DIVISICN J Cl. e IN RE: ESTATE OF LOIS 1.SAMPSON, ~.Deceased. ~zZIIIDo ," ie BEFORE: CIz%UI; ti APPEARA NCES:~UIQ ..I0(U .gTIME:., :I:~01 ) ) )No.428 of 1970 ) ) ) ) -.HEARING ON AUDIT " THE HONORABLE P.VINCENT MARINO,Judge of the s aid Court. PEACOCK,KELLER,YOHE &DAY,ESQS.,of Washington,Pa.,representing the Accountant. Tuesday,December 15,1970,at 10:00 o'clock A.M'J..EST. "(~ e ai0:.~.THE COURT:Number 428 of 1970,the estate of Lois 1.Sampsop, 0:.'f III· 0:deceased.The Executrix is Lois Virginia Healey and the attorneys I-0:~8 arelPeacoek,Keller,Yohe &Day.Mr.Peacock? .~'..iL.MR.PEACOCK:If it pleas,;re the Court,in this case we have all ofII.•o the necessary papers.There was an error in the amount of the savings account as filed.And there was an overpayment of Inheri- tance Tax and the Petition has been prepared for a refund of that ta il. But it won1t be filed until after we find the amount of the tax.TherE are no outstanding claims. THE COURT:Is there anyone elsein Court interested in this -:':""",-k:ill-_11::::"""-;"'-'"1r-----------'-----------------------1.---'2L-1 decedent's estate? (NO RESPONSE) THE COURT:The audit of this account is ordered clos ed by the -.Court. ( AUDIT CLOSED) J. ..:u:ii:l-UI C .I0( §c;;)., :I:I::COl vi0:III~Tbe foregoJna record of the PrOCeed~i$Qponthe bearing II.III .0:,~Of the above cause 1shtiit'eDy apf1l"Oved t.md direded to be rUed. ;;)oU .J0( Uii:II.o \)• \ -~ In tlJt arumt nf <!tnmmnu Jlru!l nf lfunqing1nu arnunty. Jrnnsyluuuiu.(0rpquun f <!tnurt Biuisinu ESTATE OF Lois 1.Sampson, deceased. No.63-70-428 In the matter of the__F_i_r_st_an_d_F_in_,_a_l__ Account of Lois Virginia Healey Executrix ADJUDICATION AND DECREE And now January £,t ,19~,this matter came on for hearing, audit and distribution at this session and testimony taken;and thereupon,upon due consideration thereof thedoa~~tdor distribution in the hands of the Accountant is determined 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 made a part hereof,unless exceptions hereto be filed sec.reg.or on appeal be taken herefrom sec.leg.. SCHEDULE OF DISTRIBUTION Balance per account _ Additional credit asked at audit 8alonce'_ $20,154.90 Lois Virginia Healey,niece,residue,including cash; miscellaneous personal items valued at $500.00;10 share,I of Studebaker and Worthington stock valued at $459.40; 30 shares of American Telephone and Telegraph stock valu at $1503.75;a4 shares of International Telephone and Telegraph stock valued at $4315.50;5 U S Savings Bonds Series~E valued at $175.46 and 1-$50.00 U S Savings Bond Series E valued at $61.84;held in kind and distributed as such at the value as shown,20112.48 Deduct Clerk's Costs &Receipts'--_ Attomey·--=P~e~a::::c::o~ck~K::;:e::::l==l::er::....:Y:.:o:.::h:.::e:...&;:;...:D:.:a::aly:....__ 35.00 No balance III i .i.~'.J r-- x::a.. r--... 0 .~z...:J>-i 8 -+p::r ty c (1) v-tt a 3 ~tD S-o 0...; _tM "" ~0...... _t g.=(1) := ~~ s~~~~ <r 0.. 'W,I " \I ;.', ~~ ..."~~~ ~;l':~ i}J ~.,. J t , >' -'~._-,,:.:) COURT OF COMMON PLEAS Op. WASHINGTON COUNTY..PA. ORPHANS'COURT DIVISION No.63-70-428 IN RE: ESTATE OF LOIS 1.SAMPSON ELECTION TO TAKE IN KIND LAW OFFICES PEACOCK,KELLER,YOHE e.DAY EAST BEAU BUILDING 68-70 EAST BEAU STREET WASHINGTON,PA.15301 "j '71 JMI"Pt;2 I R RUS:,~.!.'_..liW I1EGISTE::;OF WlL.LS WASH1NGTO;')GO.,PA. .'"I ----=::::=:::::--- COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PA. ORPHANS'COURT DIVISION. IN RE: ESTATE OF LOIS 1.SAMPSON ( ) (No.63-70-428 ) ( ELECTION TO TAKE IN KIND AND NOW,this ~-I4/day of December,1970,I,LOIS VIRGINIA HEALEY,sole legatee under the Will of Lois I.Sampson do hereby elect "~~ke all items held by the estate in kind. Resp.ectf~ul.l'I su.bmitt.e~.sL/,e--f''...~t~-... J-:1 COMMONWEALTH OF PENNSYLVAN IA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS COUNTY OF .WA.S.BJ.NG.T.QN .-. RESIDENT DECEDENT IMPORTANT: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 the Inheritance and Estate Tax Act of 1961.) ::t~:,-~:::~~=:~~-_~~:~~::-_-_-}" ......................~(?.~.~y~~gt.J?:t.~g~.9:.!~.Y.......................··············,c.. Administrator of the estate of the above-named decedent being duly sworn,depose S and say S Executrix .......~ Decedent died ......ApXU..JJ?(M;~.th)....(Day)""19iY~?l'{~::::::t~eaVinga last will,copy of which is hereto attached.} o t he:aam:t:::i:::r::;r:fse:tttao;;::;:}:P~~GQGk...K~l.l~:r...YQh~&.Pg,y................................................ whom all correspondence should be 68 ..:7Q:EClst:e~Cl1J,$t:r~~t.Wa,:::;hj,ngtQIJ,.:p~:rl:rl§ylyClntClJ9.~QJ . mailed. That as such ~~~.s:~!.!.:~.~deponent is familiar with the affairs of said estate and the property con- (.;xccutor·Adminislralor) stituting the assets thereof and their fair market value. That at the time of death there was no safe deposit box registered in decedent's iIidividual name,or jointly with,or as agent or deputy of another,or in decedent's individual name,with right of access by another as agent or deputy,with the exception of the following:~ NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPosiT BOX RENTED RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT W ~lvania National Rank Lois 1.::>ampson and Lois Niece Monone:ahela.Fa.s.Healey 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 hereto and made part hereof sets forth fullv 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.fpropertywheresoversituatedownedbythedecedentatthetimeofdeath;all moneys left by the decedent at the time of death,whether in decedent's immediate possession,standing to decedent's credit in banks of deposit,savings banks,trust companies,or other institutions,whether individually,or in trust for any other person or persons giving also separately the accrued interest thereon,if any,down to the last interest day prior to decedent's death in the case of savings banks,and to the date of decedent's death in all other cases;all bonds,postal savings,treasury certificates or notes and other evidence of in- debtedness of the United States to the decedent;all obligations,whether by statute or agreement they are'designated as tax free,of the United States,or any state,or political subdivision thereof,or of any foreign country,which are owned at the time of death;all weariE~apparel,jewelry,silverware~pic- tures,books,works of art,household furniture,horses,carriages,automobiles,boats,and-any and all other personal ch~ttels of whatsoever kind or nature,left by decedent,together with the fairly estimated market value thereof;all bonds and mortgages held by decedent and of all claims due and owing decedent "'-I'at the time of death,and all promissory notes or other instruments in writing for the payment of money of which decedent died possessed,of whatsoever nature,With interest thereon,if any,giving the face value and estimated fair market value thereof,and if such estimated fair market value be less than the face value,it sets forth briefly the reasons for such depreciation as to each item;all moneys payable to the estate from life insurance polici'es carried by decedent;all annuity and endowment contracts the proceeds of which were payable 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. Subscribed and sworn to before me this . ....•.••..~.!mL•.....T1.y of ·················rfllP&,.19.•1Q.. ~~.~..... ,'" ''I ti!1_,r~, 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 assets and liabilities thereof as of the date of death.The schedule also sets forth the interest of decedent at the time of death in any co-partnership or business,and in support of the value of such interest there is annexed to said schedule,financial statements showing the assets and liabilities of said co-partnership or 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,ahd such other facts pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest therein must be submitted.It should also set forth in itemized form,together witht'he fair market value thereof,any other property owned or bequeathed by the decedent at the time of death. The Schedule C attached hereto and made part her~of sets'forth a'true answer to each inquiry contained therein and in the case of transfers ofproperty,real or personal,within two years of decedent's death,in contemplation of decedent's death,or intended to take effect in possession or enjoyment at or after death,said schedule sets forth the nature and value of such property,to whom transferred,the relationship of the transferees to the decedent,the proportionate share received by each transferee and all other facts of a pertinent nature regarding said transfers.In the case of tr~nsfers intended to take effect in posses,sion or enjoyment 'at or after death;there is also'attached to the schedule a co~y of the deed,trust agreement or.other instrument creating the trust.-Ther.~is also set forth in said schedule a list of all property,real and personal,with its value,which passes at decedent's death by virtue of the exercise by decedent,either individually,or jointly with another,.or any power of appoint- ment vested in decedent,either indiVidually or jointly,by the Will,deed,or other instrument of another, With a copy of the instrument creating such power attached to the schedule. That Schedule D attached hereto and made part hereof sets forth the names and addresses of all persons beneficially interested in this estate at the time of decedent's death,the nature of their res- pective interests,their relationship,if any,to the decedent,together with the ages at the time of decedent's death of all minors,annuitants and beneficiaries for life under decedent's Will.It also contains a statement shOWing which of the beneficiaries named in the decedent's Will,if any,died prior to decede~t,~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 Impaid at time of death;taxes accrued.chargeable for period prior to decedent's death (except those allowed under Section 651 of the Inheritance and Estate Tax Act);together with a statement of collateral pledged for obliga- tions,if any.It is agreed that the fiduciary will present proof of said claimed obligations upon re- quest,that if the amount actually paid in settlement of any fee,commission or debt is less than the estimated amount claiming and allowed,that the same will be reported to the Register of WillS,and that the amount of tax assessed can be reassessed in accordance therewith. That the totals of the appropriate columns in Schedules"A","B", "C","E",and "F"as directed therein, have been carried forward and properly registered in the Summary. 0.'-1'/"'·~......f~~....L-~A__ ~~JAi~iW<I~~lXExecu ix .1.1.Q.4 C.h~s.s S.t.r.e.e.t ~MM.. (Street Number) ........:ty!:~.r.1.~pg~?~!~!.?~.~~..~.Q.~.~.. (City or Town and State) NOTE:Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are filled in with details or the word "None",and in case the assets include rare and unlisted securities, securities of close or family corporations or an interest in any co-partnership or business,that the data and statements required under the paragraph above relating to Schedule "B"are attached.Also make certain that column #1 in the "Summary"has been properly completed as above-directed. •RCC-34 (1.64) COMMONWEALTH OF PENNSYLVANIA~.D~PARTM.fNT'OFREVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT -", SCHEDULE "A" REAL PROPERTY Real property in Pennsylvania,with statement of mortgage encumbrances upon each parcel at death of dece- dent.Where property held as joint tenant or tenancy by entireties,report on Schedule "E".Property held by the decedent 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 Commonwealth of Pennsylvania should be described by lot and block number,street and street number,together wi th a general description of the property,with a reference to the record of the conveyance by which the decedent took title;If a farm state number of a. cres;also statement of mortgage encumbronces upon each parcel at death of decedent.Taxes,assessments,accrued Interest on mortgages,etc.,are to be listed on Schedule "F"and must not be deducted from this schedule. NONE (1) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH (2) ESTIMATED MARKET VALUE (3\ DEPARTMENT VALUATION CAUTION (Do not write In this space) Insert this total opposite "real property",Schedule CIA"in the X X X X X "As Reported"column on the last page of this returo. .RCC-35 .COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT •...t· SCHEDULE "B" 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 otpers must be listed under ~chedule "E".Intangible pe,rsonal Pfoperty,titl~d 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, stQckS,.mortgages,notes,together with accrued interest or diVidends,salaries or wages,insurance .pay- able to the estate or fiduciary in said capacity,partnership interests,interest in any undistributed estate of or income from any property held in trust under the will or agreement of another,even though located outside of the State,at the time of death,should be listed in this schedule. 500.00 ../~S c:>.3_}S DEPARTMENT VALUATION .(Do not write in this space) ESTIMATED MARKEl'VALUE 4,315.50 1,503.75 . t ?~~ I 16,070.49 -UNIT VALUE ITEM List and describe fully Checking Account -Western Pennsylvania National Bank,Monongahela Office Miscellaneous personal items and household furnishings o shares of American Telephone and Telegraph Common Stock .~OtJIi - 84 shares of International Telephone and Telegrap Common Stock @ 6~-/..0 7~- Savings Account -Western Pennsylvania National Bank,Monongahela Office 10 shares of Studebaker and Wor~ngtonp/i)~ Common Stock L.:-- Item No. Insert this total opposite "Personal Property",Schedule "B"in the "As Reported"column on the last page of this return. x X .RCC-35 COMMON~ALTH OF PENNSYLVKNIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" 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".Intarigible personal property,titled in the name of the decedent,but payable at death to another or others,including but not limited to P.O.D.U.S.Savings Bonds and tenta- tive trust accounts,must be listed,despite the fact that they are not of the administered estate. Tangible personal property should be listed first (e.g.jewelry,wearing apparel,household goods,and furnishings,books,paintings,automobiles,boats,etc.) Intangible personal property,such as bonds,treasury certificates,cash on hand and in bank, "stocks,'mortgages,notes,together with accrued interest or dividends,salaries or wages,insurance pay- able to the estate or fiduciary in said capacity,partnership interests,interest in any undistributed estate or or income from any property held in trust under the will or agreement of another,even though located outside of the State,at the time of death,should be listed in this schedule. Item No. ITEM List and describe fully UNIT VALUE ESTIMATED MARKET VALUE DEPARTMENT VALUATION (Do not write in this space) SUPPLEMENTAL INVENTORY U.S.Savings Bonds Series E. Denomination January 1951 $25.00 $35.62 ~.[;<.-2- May 1951 $25.00 $34.82 3.(.f.2 May 1950 $25.00 $36.10 'y~./0 March 1954 $25.00 $31.92 3;.fJ-IMay1955$50.00 $61.84 lR/.f Issue Date NOTE: On original Inventory only 20 shares of American Telephone and Telegraph Stock.~was shown.This should be corrected to read 30 shares.The total value as given is correct as $1503.75. Insert this total opposite "Personal Property",Schedule "B"in the "As Reported"column on the last page of this return. RCC-J6 "..eomr'ON1\K\LTH OF PENNSYLVANIA TIUNSFER INHERITANCE TAX ~~SIDENT DECEDENT SCHEDULE "e" TRANSFERS (1)Did decedent,within two years oYdeath,make any transfer of any material part of his estate,without receiving a valuable and adequate consideration therefor?(Answer yes or no)~Q (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)~Q (3)If the answer to (1)or (2)above is in the affirmative state: (a)Age of decedent at time of transfer _ (b)State of decedent's heal th at time of making the transfer.(Note 1). (c)Cause of decedent's death.(Note 1). (4)Did decedent,in his lifetime,make any transfer of property without receiving a valuable or adequate consideration therefor which was to take effect in possession or enjoyment at or after his death? (Answer yes or no)~Q (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)-:~~Q~__ (b)What was the transferee's age at time of decedent's death?__ (5)Did decedent in 'his lifetime make any transfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves for his life or any period which does not in fact end before his death: (a)The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no)__=-~~Q",,-__ (b)The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?(Answer yes or no)-=~~Q~_ (6)If the answer to (5)(b)above is in the affirmative,state whether the right was reserved in decedent alone or others . (7)Did decedent in his lifetime make a transfer,the consideration for which was transferee's promise to pay income to or for the benefit of care of transferor?(Answer yes or no)~Q (8)Did decedent,at any time,transfer property,the beneficial enjoyment of which was subject to change, because of a reserved power to alter,amend,or revoke,or which could revert to decedent under terms of transfer or by operation of law?(Answer yes or no)~Q (9)If the answer to (8)above is in the affirmative,was the power to alter,amend,or revoke the inter- est of the beneficiary reserved in the decedent alone or the decedent and others? (Answer yes or no)~Q NOTE 1:The answers to these questions should be supported by affidavit by the attending physician as well as a copy of the death certificate. NOTE 2:If answer to any of the above questions is yes,set forth below a description of the property transferred,it's fair market value at date of death,dates of transfers and to whom transferred,with relationship of transferees to 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 ~O~E DESCRIPTION MARKET VALUE (Es timated) DEPT.VALUATION (Dept;Only) Insert this total opposite "Transfers",Schedule "C"in the "As Reported"column on the last page of this return. RC.C-.38' CCMMuNWEALTH OF PENNSYLVANIA 'rHANSITIl TNHElU TANCE TAX RFsrDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY n8TRrC:TIO~S:This schedule must disclose all property,real and personal,owned by the rlecedent 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 tmder Schedule "A",plus the date and place of record of instrument effecting vestiture,but do not include entireties Or'out of state real estate value in estate valuation column.Personal property should be listed as in Schedule "B",111us date of acquisition,and the name,address and relationship (if any)of co-owners to the dpcf'dent.-..~'"~. Date of Acquisition,N~e I unit .- Description of Property,percentage Estate DEPARTMENT VALUATION Adtlress and Relationship of Co-Owners,and Place l Value Share Valuation CAUTION-Do not Write of Record of Instrument,where Real Estate.l In This Space.1-:1('"Value of Value of Entire Decedent's Property Interest I NONE I I ,- , I II I II I I I.I I I I,IIIi ., Insert this total opposite "Jointly Owned Property",Schedule liE" in the "As Reported"column on the last page of this return. RCO.:.3:f,·(12-63),..... COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "0" BENEFICIARIES BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED(If step-children or DATE INTEREST OFStatefullnamesandaddressesofallwhoillegitimatechildrenDECEDENTOFBENEFICIARY ave an interest,vested,contingent or other are involved,set STATE YES IN ESTATE wise,.in estate)forth this fact).OR NO BIRTH-_._--_...~. L ois Vi~Q'inia Healev Niece Yes 1104 Chess Street~ Monongahela~Fa.15063 - irginia Ruth Healev Great Niece Yes Contingent 104 Chess Street onongahelSL~Pa.15063 ebecca Ann Healev Great Niece Yes Contingent 104 Chess Street onongahela~Pa.15063 allv K Healev Great Nece Yes Contingent 104 Chess Street onongahela~Pa.15063 enneth C.Healev Greatnephew Yes Contingent 1104 Chess Street Monongahela Pa.15063 K R 1 M S 1 M V 1 M ( h Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE :\IATTER OF THE APPRAISEMENT (Executor-Administrator must comf'!et~"A5 Reported"column #1.)Will Administration t No,Year ... P.oJ THE OF THE ESTATE OF Deceased r'( ~'"'""""i~§..en t1j '"....So'~ o-j "'d ~....Cll Cllll:l ...e:..=:s '"'"0.....::s '"0Clle:..........0II>"0~Cll....0 ~"0~....'< Late of . County of Commonwealth of Pennsylvania REPORT AND APPRAISAL (" c. r: enc:~:::>~W en en >-<: ?"?-?- q ~~ .Vd ..a0 NO1.:J NIII SVh~ Sllliii .10 't131SlfJ3tJ ONiH',!~Jf -i7]';~;;n!j f 1I1'p f'>I .','.".,",,:l .V'oJ 'I}r~~~ E[.l i:d tOt ':"'1 ......) 1 .f1~,.,; 1 ......1: <" <., (. (, -0~-0-0~-0 ~:>'"\..:~-Cll ..... :<'.'g-....~:~:..~:~:- :><\.~ r-0,*~,*,*-0 ~~.>'"t:l():~:~-C::1',) :~.....-3.~:5'II .,,. :~:c:: .~':c.. RCC-SI (2-64) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION NOTICE OF FILING OF APPRAISEMENT LOIS VIRGINIA HEALEY IN YOUR REPLY PLEA.IE REFER TO 38-66-4 J In Re:Estate of ..,......:L=..:O:..:I::..::S::.......:I=-.:........::S::.:A.:.::.~~JP~S~O~N~---.,;_ ____.-;.\~;.;;.A:.:S:.:lII::.::I::.:::N~G::...::T~O::.::N.;...J County -File No.63-70-428 Dear Mrs.Healey: You are hereby notified that the original appraisement in the estate of Lois·I;,$mUJpSQP. has been filed in the office of the Register Of Wills qf .lvashington County on July 30 .,19m.Said appraisement reflects the following valuations: Re al Est ate _--'-.,..."...---".-..".__...,_- PersonaI Property ...:4..::1;..l.L..:6;:...7:...:1:::...:...•.:::.9~3__ Transfers -...-...,.-=--"""'"""..".....__ Total ---_~4...:..:1~,6l:l....!..71do..A.'....9...J.3_.- As to such tax that is paid ~ithin three months from d~te 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.tn./!rate of six (6%)percent per annum is charged. Any party in interest who is aggrieved by an a~praisement may appeal therefrom as provided by law. Date -=-J..:::u=1"'-y--:::.3.=.0..L.•....;1=..9:::...7..:...0::::....-_Signed Title ~'1.R•CHANEY F APPRAI:r- DATE OF DEATH:April 15,1970 Note:This is not a bill. COMMONWEAL.TH OF..PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG 17127 November 12,1970 Mr.William R.Chaney,Chief Appraiser Inheritance Tax Division Room 244,Washington Trust Bldg. S.E.Cor.East Beau &Main Street Washington,Pennsylvania 15301 Re:Estate of Lois I.Sampson File No.63-70-428 County of Washington Date of Death:4/15/70 Dear Hr.Chaney: On November 5,1970,we received a letter from Davis G.Yohe,Esquire, along lath a copy of a letter from William J.Sichina,Vice President,Manager, Western Pennsylvania National Bank,Monongahela,Office,requesting that we make a correction in the erroneously reported amount for a savings account balance in the appraisement of July 30,1970,in the above estate. In Hr.Sichina's letter of October 29th,he advises that the balance in the decedent's savings account as of the date of death,April 15,1970, was,in fact,$1,670.49,instead of $16,070.49 as originally reported and appraised. Based on the facts submitted,you are hereby authorized to adjust your records and we will appropriately change ours. .. Mr.William R.Chaney,Chief Appraiser November 12,1970 Page 2 The second item on Schedule lIB11 reported as lIS avings Account -\'lestern PeIlllsylvania National Bank,Monongahela OfficeH in the amount of $16,070.49, will reduce to read $1,670.49,thus,the total Personal Property $41,671.93, changes to $27,271.93,with the like amount shown as the total Gross Assets. Very truly yours, Herbert A.Brinkley,Tax Examiner Inheritance Tax Division For:William S.Br~~damore,Director Bureau of Cotmty Collections HAB/lsg cc:Mr.Russell Marino,Register of Wills Davis G.Yohe,Esquire La,.,Offices of Peacock,Keller,Yohe &Day East Beau Bldg. 68-70 East Beau Street Washington,PA 15301 ., p.CC-39 (·i..68I COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SUMMARY Estate of SAMPSON, (Last Name) LOIS (First Name) I. (Initial) DATE OF DEATH 4-15-70 FILE NO.63-70-428 REPORT OF INHERITANCE TAX APPRAISER 7-30-70Dated:------'-----'=-...:::.---=--=------- I,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of 'vashington Pennsylvania,do respectfully report that I have appraised the real and personal property as reported in the foregoing return at the values set forth opposite each item in the last column to the right in Schedules "A","B","C',and "E". REPORT OF THE REGISTER OF WILLS I,the undersigned duly elected Register of Wills in and for County,Pennsylvania,do respect- fully report that I have allowed deductions in the amounts claimed by deponent,except as to those items where a greater or lesser amount is set forth in the last column to the right in Schedule "F",which greater or lesser amount represents the sum allowed as a deduction. Dated:_ REGISTER OF WILLS ;<7 ~7/Y3 ~7 C:<7/7-.3 II f VALUE AS REAPPRAISED J.~/ ~ 41 ~71 Q~ 41.671 9:~ $ 41h71 Q~ 41 671 93 VALUE AS REPORTED VALUE AS APPRAISED $ CLEAR VALUE OF ESTATE 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) Valuation of life estates or COMPUTATION OF TAXFORUSEOFREGISTERONLY Tax on $~- Tax on $---------t-- Tax on $----------+-- 2% 6% 5% I $--------+--- .$--------+--- $--------+--- Tax on $1~$ Tax on $15%~$'-..-As evidenced by CharitableExemptions(*) Total Estate Exemption Certificates issued TOTAL TAX $by the Secretary of Revenue. Less tax previously paid $t=BALANCE $ Less 5%of tax if paid within 3 months after death $ BALANCE OF INHERITANCE TAX DUE $t=Add interest at rate of 6%from to $ AMOUNT OF ESTATE TAX ASSESSED $CEstatetaxpaid$L-BALANCE DUE $ Add interest at rate of 6%from t=to $ TOTAL TAX BALANCE $ PAID $ FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE:Where subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason, same should be noted below,with short explanation. \\.(f-,.,... ----1 Will..{No. Admimstration ~ IN THE year . MATTER OF THE APPRAISEMENT OF THE ESTATE OF '. I"QJ.s J~.SAMl'.sON Deceased Late of . County of MONONGAHELA.. '''ASHINGTON ..Commonwealth of Pennsylvania REPORT AND APPRAISAL Fonn RCC-2 DEPARTMENT OF REVENUE ~~F;A~OF COUNTY COLLECTIONS HARRISBURG.PENNA.17127 COMMONWEALT.H OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE J.~J.Y ~.9.t.~..~.?.9 . CDVNTY Ji.~..~.h..i.ng,t..9..n . FILE NO ?..?...:..?...9..::::.~.~.~. Whereas,19.;t.~+...!$.~.mP.~.9..P:late of M9..!1.9..P:g~.h.~J.:.~. in the County of Jiashin.gt.o.n Commonwealth of Pennsylvania,having died on the 1.5 t.h day of A.p.r..il 19 7.0.,seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore,I,w:.~..R..~G..h.J:H1~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,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 Ufe or for years,the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral rate on any such future interest., Description of Asset fERSONALTY: J,LSee ~()nv of Schedule @B"attached to annraisement Unit Values $ Appraisement Made for Inheritance Tax Purpoles 41.671 93 -------------------------------------+----flf-----+---I / Total 41.671 93 ...................lvASHINGTON.....County ! RESIDENT INHERITANCE TAX APPRAISEMENT Estate of LOIS I.SAHPSON Deceased. Late of MONONGAHEAL Date of Death,APE.t.::1 J:5...L !.~..7.9.. Appraisement Docket Vol 38.J ................••..........•.••..•..••••....•...•.••• Page,6.9..~4.No §..~.~.7.Q:::-.4.~.§. Filed in Register's Ofjice,J..u.ly 3.Q.19 70 Amount of tax due,$. DEPARTMENT OF REVENUE Received, Ex-a.mined and Approved,. Wrote abo.rit Appraisement, Appeal jt-om Appraisement,. Entered and charged,. .... ".....-~.....-''; ~ ESTATE OF LOIS 1.SAMPSON DEDUCTIONS ALLOWED IN J THE SUM OF $?0~~/(.17 ./-~~-71rr::;;;lk ... Reghter of Wllh.Ag..' LATE OF Monongahela STATEMENT OF DEBTS' AND DEDUCTIONSREGISTEROF'WILLS AND AGENT O~THE CO~~ONWEALTH OFFICE 01'THE WASHINGTONor:COUNTY -Form RCe·10·' DATE OF'FILING APPA"'SiMiNT June 29:O_J.1970 DATIi 01'DEATH .....;;A=p.;:.r.;:.il=-=1;..;5~,:-.:1:.;;9;...7:..;0::..-_ OAT!:NO.01'NAME OF PAYEE REMARKS AMOUNTVOUCH.... Russell Marino,Register Grant of Letters Testamentary and Six Short Certificates 24 50 WashinQ'ton County Reports Advertisement of Grant of LetterE 14 00 The Dail v Renublican Advertisement of Grant of LetterE 12 50 I'P 11 QQ011 l\tr':l ,...j ......"'Pocri Qtpr KfJmgamt~~J3jtndAppraise-3 bo "R llQQP 11 l\/f::l rinn "Rpcri~ter K~1jni'SU~lepnt Inventory and 3 borIseen Russell Marino,Register Corrected Inventory and Appraise- ment 3 00 ipo,=,r'''r'V Kollo,..Vnhe &Dav Attornevs fee 1250 00 RllQQoll l\/f::l rinn Recrister Filinp'this account 17 00 IMarv .Tane Smith Notary fee 5 00 Bebout and Yohe Funeral Home Funeral Bill 1692 34 National Ambulance Service 25 00 Guinet Monument Company Grave marker 380 00. 'Mp'rnn1"'i~l TT ,1 Final bill 24 00 GeorQ'e's Market 24 14 I.,.".hlp (jaR romnanv 38 86 West Penn Power Company 6 46 Alex Rue Hauling 10 00 .TameQ Weddell Final rent 40 57 Mononp'ahela Water Company 17 5.9 ISewacre Allthoritv 8 03 Locust Grove Dairv 1 70 Rocco Flowers >12 72 West Penn Power Company 2 76 r..."vi (0 Ii A )h,---G(;;:/-tqA A1A -f--3s'-(L() -~~,€H-6-H: elitD.AS CEDUCTIONIO ~OR ",,---,--,,"r/,,--,~ ----if'...r:~::::::..::._-~~~-----=----(L.11.1 DAV 01'SWORN AND IlUBSCI>/B&O If.FORE Mit THIS 23rd OC~()...ZLc:.en:a A 17 -=R_>44CYU#' COMMONWEALTH OF PENNSYLVANIA 1 COUNTY OF WASHINGTON'S.:. I,Davis G.Yohe,ttorney for the MY KNOWL~OGE AND SELIEF.THE FOREGOING IS A.JUST AND TRUIl:STATE", ADIoItr·iIUTRATION 6U6MITTEO TO THE ESTATE 0'"-=~O::..iI~S~I.s-...::S::.::A=M~P=-::S:".:O~MI-_+-_~-I-_1- INioIERITANCi:TAX PURPOSES. Mary Jane Smith,Notary Public Washington,Washington County,Pa. My Commission Expires February 28,1973 ?~I~~CJ~~1:~~~::6:'OR~I~:~~I~~~~~A~~\~~-r:~~p;~::~:~::1~~D~NDER $10.000.UNDER SECTION 701 OF ACT OF JUNE 16.1961.JCOFF~W,--;-----. Lois Virginia ,He~~~;tyof flV~"..,i.·i04·Ch~~'s'Street,Monongahela,Pa.15063.................................................of . (Name)(Addre88) being duly !?.w_m:n .according to law,deposes and says thatShe is the ~~~~_lltr_t~_ .(Exec..Adm.•Legattt.EIC,) of the estate oLLQiS_l,__.8amp.s_Qn ..whose last residence was J?_~_LrhQ.mg_$__~.tr~_<?_t,,_ .(No.)(Slreel) ____~_?_~~~z..~~~~~.deceased,and that the'whole of the estate of said decedent,who died~.P.!.H_J.Q...__J~_7.Q_. (CiIY.Borough or Township)(Dale) -onsisted of: REAL PROPERTY REAL PROPERTY IN PENNSYLVANIA,WITH STATEMENT OF MORTGAGE ENCUMBRANCES 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 Estate Estimated Value NONE . : . Personal Property Add: u.s.Savinf!'s Bonds Series E./'"' Lssue Date:Janua;ry 10,1950 Denomination 11)25.00 $37.00 - .. '." 'v_.~ ) 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,accountnumber and the exact name or names in which the account is registered. Jointly Held Pl:operty Estimated Vaw'. -". NONE - - ,~ , - Transfers within TWO YEARS Prior to Death , NONE That at the time of death there was no safe deposit box registered ih decedent's individual name,or jointly wit~,or as agent or deputy of another,or in decedent's individual name,with right of access by another as agent or deputy,with the exception of the following:- NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT Western Pennsylvania National Bank Lois I.Sampson and Lois Niece Monongahela,Pa.S.Healey - 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 Lois S.Healey Niece Entire - ..~.-._~...~,,~.-..._-_.....~.~~~~~~--~~~--~----~----~-------.......-------...........-------..., ~TE:"'List first five items in the spaces so provided observe notations thereon and instructions RESWI,NT DECEDENT .•DEBTS AND DEDUCTIONS CLAIMED.~. ,, DEBT OR CLAIM NATURE 'OF SAME AMOUNT THIS COLUMN KEGISTER ONLY Funeral expenses paid $$ Family exemption (will not be allowed unless decedent died residing with a spouse or children.) Administration Expenses * Counsel fees *I Fiduciary commission * OTHER DEBTS AND CLAIMS (*)See Note below I '.,, 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.J .() Sub",n••d and ,wmn to bef".m,<hi,......................~1;1;~t;~:i.d~;~i~·· ........?P9.'Aay of ~eremb;.r ,197.0. ~::::t::~~. Washington,Washington County,Pa." )~.Q~..q4~.Ei~..$tr.e~.t . (Street Number) .1W9.r;J.9.r;J.g.::~.he~9-".P~.r;J.p.Eiy.Lva.nia}5.06.3 ..... (City or Town and State) 111,COillililssioll Expll es February 28,1973Havingbeendulyswornaccording to law,do hereby certify that the above appraisement is made in conformity with law on this ..................................day of ,19 . Appraiser 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'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 -C" ,~~.} ." .~ Form No.RCC-62 (7-69) Will 1'<'1")0".Administration SNo..f~.O....Year .70. AMENDED RETURN IN THE MATTER OF THE APPRAISEMENT OF THE ESTATE OF LOIS 1.SAMPSON Deceased Late of ..J.YI.~I?-<;>~g:~f:1~~a................................... County of ..:Vashington...................................................... Commonwealth Jb R.:!'!n..£,Sylvalli"i -r:(j)'I _ _.G~C:~ -L..-(J)c::.i--Z (;~(/;tX:::.~--;'.-.-,. REPOR~4,N;D:APPRAIS~L7 -v ._'"a '<:0 D-rl~-0 '" (")~..".'-o "l!::_.,.--..:;:=:::::::: <:7 2»r-o•(f) c::l t...n 'j 1- )• 1 • I l'l ) ,,) ~ .J) ~)Q) ... I rII _______ RCc-al (2-64) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION ~OTICE OF FILING OF APPRAISEMENT Lois Virginia Healey (Executor ~'{Y~· IN YOUR REPLY PLEA8E REFER TO 38-66-4 J In Re:Estate 0 f_--.,;;L;;..o;.;;i::.:s:.-:I::..;·.:.-:S:.;,:.am=p.;;.:s:..:°:::n.:...-_ _____\\l_a_sh_~_·ng_=_t_o_n County -File No.63-70-428 De ar ~ll's.Healey, You are hereby notified that th~supplemental appraisement in the estate of Lois I.~ampson . has been filed in the office of the Register of Wills qf Washington County on November 10 ,19~.Said appraisement reflects the following valuations: Re al Est ate _--'---=-=-~----- Personal Property ~37~.0;;..0~_ Transfers ----------;::;c=-~~-,---- Total -~3::::..7.!.,.;.:..:0::.;0::...---- 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 __N_o_v_e_m_b_e_r_l=.O--,,~1::..;9:...:7....:0----_ DATE OF DEATH:April 15,1970 Note:This is not a bill. Signed Ti tle ~.J~48<'~I t Alfred Tosi,Appraiser I ·~ SUMMARY '\"c":;;'-CC-39 (5-68) COMMONWEALTH OF'PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT---============================================ i:state of Sampson (Last Name) I.ojs (First Name) T (Initial) DATE OF DEATH 4-15-70 FILE NO.63-70-428 REPORT OF INHERITANCE TAX APPRAISER I,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of__vJi_a_s_h_ing-:::::-t_o_n _ Pennsylvania,do respectfully report that I have appraised the real and personal property as reported in the foregoing return at the values set forth opposite each item in the last column to the right in Schedules "A","B", "C",and "E". Dated:11-10-70 REPORT OF THE REGISTER OF WILLS I,the undersigned duly elected Register of Wills in and for County,Pennsylvania,do respect- fully report that I have allowed deductions in the amounts claimed by deponent,except as to those items where a greater or lesser amount is set forth in the last column to the right in Schedule "F",which greater or lesser amount represents the sum allowed as a deduction. Dated:_ Supplemental REGISTER OF WILLS VALUE AS REAPPRAISED $-------+17 00 17 00 $ 17 00 17 00 VALUE AS REPORTED VALUE AS APPRAISED $ INVENTORY Real Property (Schedule A) Personal Property (Schedule B) Transfers (Schedule C) Joint -Held Property (Schedule E) TOTAL GROSS ASSETS Less Debts and Deductions (SCHEDULE F) CLEAR VALUE OF ESTATE Valuation of life estates or annuities.• • • • • • • • • • • • • • • • • •$r- ESTATE TAX ASSESSMENTS $-----C FOR USE OF REGISTER ONLY Tax on $-----------4--2% Tax on $----------1--6% Tax on $-----------4--5% Tax on $-----------4--~ Taxon $~ Ex.emptions * Total Estate----------l--- TOTAL TAX COMPUTATION OF TAX $--------+--- $--------+-- $------~- $--------+-- $--------1-- $__---_---1.__ (*)As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenue. Less tax previously paid BALANCE Less 5%of tax if paid within 3 months after death ::::::::~~~t=='= BALANCE OF INHERITANCE TAX DUE $l= Add interest at rate of 6%from_____to $-----J AMOUNT OF ESTATE TAX ASSESSED $----~L- Estate tax paid $---IL- BALANCE DUE $------__~~ Add interest at rate of 6%from ------I.to----$-------~t=TOTAL TAX BALANCE $-----~,PAID $--J FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE:Where subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason, same should be noted below,with short explanation. Will Administration !No Year . IN THE \ """'~I~;o MATTER OF THE APPRAISEMENT OF THE ESTATE OF LOIS SAJ:·IPSON Deceased Late of . County of NONONGAHELA.-__--.-. ..Wf$HINGTON .. Commonwealth of Pennsylvania REPORT AND APPRAISAL , ~ Fonn RCC-2 , DEPARTMDlT oil'llEVENUE ...< BUREAU OF COUNTY COLLECTIONS HARRISBURG.PENNA.17 127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE :t:J.Qy..~p.~.~:l:9..~~?.?..q . COUNTY ~~9.:.~.!I.~.~.~~. FILE NO...?2::::..7.9.:4..??.. Whereas,:~9..~~~?.~P~2P:late of !\~~.r:~.r:~~~~.~~. .th C t f VIashl'ngton Co lth"'·'·y"·n I . h .d'dm e oun y 0 ~..................mmonwea 0 cennsy vama,avmg Ie on the :l.:5.t.h day of Ap.~~.J.:19.79.,seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore,I,~~r~~.~~.?~.~,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 Ufe 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 AppraisementDescriptionofAssetValuesMadeforInheritance ZSUpprnmNTAL Tax Purpoaes $I I I PEF..SONAL PROPERTY:I 37 00 iSeecopyattachedtoappraisernntI ! , TOTAL 17 00 I ..'.".., .' .. ,.'..' ... ".. .: /' .' (Number and Street) .....W~······i·p;;;;t···Oiii~i·········,Penna. ,, ....11JASHINGTON ....County , RESIDENT INHERITANCE TAX APPRAISEMENT .Estate of ...LOIS .I..SAJ1PSON........... Deceased. Late of MONO'NGAHELA .. Date of Death,Apr..iL.15.,..197.0 .. Appraisement Docket Vol.,??. Page,§.?:::.~No ??.':::7.9.::4?.?... Filed in Register's Office,~.?y.~?:?19.?.<?.. Amount of tax due,$,.. DEPARTMENT OF REVENUE Received, Examined and Approved,. Wrote abo.ut Appra.isement, Appeal f,.om Appraisement,. Entered and charged,. '- ~ ;. IN RE: 88T..OF LOIS 1.SAMPSON "".sMhttOR CountyLo18VrginlaHealey.Exeoutrix Docket No.1-13,636. J PETITION FOR REFUND of Transfer Inheritance Tax. AND NOW TO WIT April 26th ,A.D.1911 ,I certify that the following is the action of the Board of Finance and Revenue of the Commonwealth of Pennsylvania in this matter: !IAnd now to wit Apr11 23,.4 ,A.D.1971 ~:;~:>fn :tl U?,,-,C::c -(r,_.U)(f'l Z--r; Refund is hereby granted in the amount of $828.7Z..~~'~ o c.z .,...:~ :;J _---o .......::~ :F ~"'Pro l>"..., BY ORDER OF THE BOARD OF FINANCE AND REVENUE GRACE M.SLOAN,State Treasurer and Chairman J.SHANE CREAMER,Attorney General C.DeLORES TUCKER,Secretary of the Commonwealth ROBERT P.CASEY,Auditor General .-e;'.... ROBERT P.KANE,Secretary of Revenue If;}!;~ AT TEST:••P'tf(ff.ti.:.~...~. Secretary,Board 0 Finance and Revenue Copy mailed to:_Ill i~....·1'Y ""..D on..-eeeoc...Q;e ...err..-.o••ea --ay Attorneya at Law Baet Boac Building 68..70 Boat Beau Stl'eat Vash1PgtoD,Penna.15301. Bya p~~~s G,.~!>}l~..~$,sulre~ April.26tb,1911.