HomeMy WebLinkAboutOC1970-0545 - ESTATE OF COLEMAN~ -3-7 {/ __ __s-.y .s-
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Qtnuuty nf 1ltllaa4iugtnu sa:
Personally before me, the undersigned authority, a ... N.o.ta.r.y...J~ub.Li.c _______ in and for said
County and State, appeared __ Gl\.RR.E..T.L . .E..~ .... C.O.LE.MAN.~----------·-··-----------·············· .. who, being duly
sworn according to law, deposes and says that he is the ~~w.xwxadministrator of the es-
tate of ---~-8J~.L.A.~ ____ C_Q_I,__~_M_8lt.t ................... deceased, that the foregoing schedules constitute a
complete inventory and appraisement of the real and personal estate of .... J.a.n.e. .. J.\. •.... Co.l.e.m.an,
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 :&b®llXOOJt Administrator. •·~ .. ~~~.·~um:;;•~~~·~·.·.~·~···}··A~ ................ .
.. otary Pu i lDDITIONAL INSTRUCTIONS
An inventory must be filed within three months after appointment of personal representative.
A supplemental inventory must be filed within thirty days of discovery of additional assets.
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
Juu.rutnry attb .Appraia.rm.rut of the goods and chattels, rights and credits which
were of ...... J.A.N.E ... A. ...... C.OLE.M.AN., .............................. late of ........ Mo.n.o.n.g.~.h.~.l.Q. ......................................... .
Washington County, Pa., taken and made in conformity with the above affidavit.
PERSONALTY: To amount received from Hormell, Tempest
Simmons, Bigi & Melenyzer, Attorneys at Law:
Settlement of negligence case
Travelers Ins. Co. Check No. 0~468259
Aetna Ins. Co. Check No. M35968372
Expenses
Attorneys• fees
$359.00
833.00
Check No. 3546 dated January 20, 1973
REALTY: None
Personalty
Realty
Total assets
$1308.00
0.00
$1308.00
$1750.00
750.00
2500.00
1192.00
DOLLARS CENTS
1308 00
0 00
J
FORM 67
REV. 1-50
REG. WILLS
i\ppliratinu fnr 14ttttr.a nf i\~mini.atratinn nu tqt
Estate of ........... !~~ .... ~.~ ..... ~9.~~-~.!. ....................................................................................................................................................... .
late of .......... ~9.~.9.~.9:.?.:h.~J.~.t. ..... P..~.n~.l§.Y..J:Y.~nJ.~.t. ...................................... , Deceased.
Before the Register of Wills of Washington County
personally a ppe ared ........................ 9.~E5.~.!:~ .... ~ ..... ~.?..~~-~-~~ .. ~ ................................................................................................... ..
who, being duly sworn deposes and says that. ............. ~!..~~~-... ~.~ ..... ~.9..~.~-~~.~.r. ................................................................... .
age .... ?..Z ... Y.ffiaving ... h.§.r. .... last family or principal residence at ..... ~.Q .. ?. .... ?..h.~.!'.f.9:~n .... §.t:!'.§§.:t..!. ............. .
(Street and Number)
..... ~~-~¥. .... ?..~ .... ~?..~.?.~.~-~~-~-~-~ ...................................................... , Washington County, Pennsylvania, died intestate
(City, Borough, Township)
at...~~~-... ~.~9.:~.~-!. .... g~ .. ~ .. !. ............ , .......................... , on the~ .. ~.:'::h!ay of ................ ~P.~~.J:.t ............................................... .
A. D., 19 ... ?..9. ......... , art ............ } .. ; .. ~.9. ......................... .?..~ .. M., possessed of personal estate to the estimated value
$ .... ~?..~.~ ................. , and of !'eal estate in the Commonwealth of Pennsylvania to the estimated value of
$ ....... D.9..~~ .............. , sit u.at e i n ............. J~.~.!.!.~E.~ ..... !.~~~-~ .... ~.~.~ ..... ~~E .... ~.9.~~-~-~-~.!-:!'.9:.t:~.9.~ ........................... .
purposes).
The names and addresses of the decedent's surviving spouse (if any) and other heirs (including
heirs by adoption) are as follows.
UESIDENCE
Garrett E. Coleman Son 608 Sheridan Street ......................................................................................................................................... ·······································································································
............................................................................................................................................ ~.?.~.?.~~-~?.~.~~ .. ~ ..... ~.~.~ ...... ~.~·-~-~-~ .................... .
······································································································· ·········································································································································
................................................................................................................................................................................................................................................
········································································································································· ·······································································································
................................................................................................................................................................................................................................................
.......................................................................................................................................... ...................................................................................................... .
....................................................................................................... .................................. ...................................................................................................... .
That deponent is over 21 years of age, resides at... .... ~ .. ~-~ .... §.~~E-~9.-.~!2 .... ~!:~.~~.:'::.!. ................................... .
Monongahela, Pa. 15063 ..................................................................................................................................................................................................................................................
is a citizen of the United St~tes and a resident of Pennsylvania, and respectfully applies for Letters of
Administration upon the Estate of said decedent, no letters having been previously issued thereon.
Swom and subscribed before me this ...... !..L~ ... ,_.-~~ .. ~ .... ~ .... .
e tember, 70 day of ...................................................... ;.:J A. D., ~9 ................ ..
REGISTER
COMMONWEALTH OF PENNSYLVANIA } SS·
WASHINGTON COUNTY, .
And now ....... ?..~P..!-.~~.§.r. ......... /~ ...... , 19 .... 7..Q .. , come s ......... G.~.~.r.§.t.t ..... ~.~ ...... QQJgm.g,n .. , ......................... .
who being duly sworn doth depose and say that ....... J}.!?. ................ will well and truly administer the goods and
chattels, rights and credits of ......... q.~!2~ .... ~.: ..... ~.9..~~~-~?. ....................................................................................... , deceased,
to the best of...~.~-~ ..... skill and judgment in strict compliance with the laws of this Commonwealth, mind-
ful of the laws relating to inheritance taxes.
-?¥
Sworn and subscribed before me this ...... ~~ ...... ..
day of... ... ~~-~-~~E.!..: ...... .:;;·-:d_-D., 19 ... ?..9. ........ .
.................. f...~--~~
... ~~.C. .... ~ .....
REGISTER
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APPLICA. TibN FOR
Letters of Administration
ESTATE OF I
...... -!.~~ .... ?:\~ ..... ~9.~~~-f. ....................................... .
Deceased
R $ ............................. .
Letters .......................... ,........................... 4 (J) U
p $ .... -;;r: ................... .
Extra Alias .......... ' ..... $ ........................... ...
Certificates . /.A..~-... $ ...... : ... l.. .... q .... 9
Renunci6tions ............ $ ............................. . .. ~,;
······················""'··········· .. ··············--······a· $::.:::..:.::.:·················--·· tl ?:' . ~rn?J (A ~-··········•·· ... ············us:··~···~··············~·T-'1·······; ........................... .
btal ............... ~···~--r~ ........ f.'~······-~----·~l .... 9.!.. .... ~ t7
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0 c ---o Z -"ri ;!oo-::::t: ,....., . :r:-'--::E. :;:0 -
Joa§IShr:L.:;!ioffmcnn
Attorneyca.t L::rw:::>
942 ;w;-'Iaaia Stre'iii'
I:loaougahela, Pa. · ~50 63
Attorney
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~t¥, ¥?-3SI
,-
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C!Inmmnnwrnltq nf Jrnnagluania, { ss.
Dlhts~ingtnu Qlnuutg. \
I, 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,
to Garrett E. Coleman
administrator of all and singular the goods and chattels, rights, and
credits, which were of Jane A. Goleman
WHEREAS, the said Jane A. Goleman .
.Monongahela
(
L
late of Washington County, deceased,
GREETING:
late of
in the county aforesaid, lately died intestate
(as is affirmed), possessed of divers goods and chattels, rights and credits, within the said County,
Russell .Marino
by reason whereof the power of granting administration thereof doth belong to me; I therefore, confiding
in your fidelity, do by these presents grant unto you these LETTERS OF ADMINISTRATION, here-
by committing unto you full power to administer the goods and chattels, rights and credits, which were
of said deceased within this Commonwealth, you having taken and subscribed the oath of office pre-
scribed by law; requiring you to well and truly administer the goods and chattels, rights and credits,
which were of said deceased, and to exhibit a true and perfect inventory thereof into the Register's
office, at Washington, within ninety days, and to render a just and true account of your administration
.at the expiration of six months from the date hereof, and to regard and comply with the provisions of
the laws relating to inheritance taxes.
IN TESTIMONY WHEREOF, I have hereunto set my hand and
caused the seal of said Office to be affixed this 15th •
day of September in the year of our Lord one thousand
nine hundred and Seventy
_, .............. ~ ... ?.2?.~
RUSSELL MARINO, Register.
•
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1Knnm ~11 :!len iy W~tst Jrrsrnts
JANE A. COLEMAN, }
Estate of.............................................................................................................................. No ..................................... of
19
··················
Monongahela, Pa. late of.. .......................................................................................................... , Deceased
KNOW ALL MEN BY THESE PRESENTS,
. I
That we, ... 9..~.:..:.~.::.~ ..... ~ .. : ...... ~.?. .. ~~~~?..L ..... ~.~ ...... E!::.~.~.9.~.P.~.~ .. ~ ....... ~.~.?. ............. ~~.~.~.~.9: ..... ~~ .. ~.~.~ .. ~ ...... ~.~.9:~J.~.~Y .... ~nd
..................................... ~.~.~.~~.~.~.!. .... ?..?. .. ~ ...... ~ .. ~.~ .. ~~?.!..~ .. ~ ...... ~~.~ ...... ~~.~.~ .. ~.l ...................................................................................................................... .
all of Washington County, Pennsylvania, are held and firmly bound unto the Commonwealth of Pennsylvania, for the
use of those interested in the estate, in the sum of ............... f..i.Y.~ ...... Hundr.e.d .... Dollar..s. ............................................................................... .
Dollars, to be paid to the said Commonwealth, to which payment, well and truly :to be made, we do bind ourselves,
jointly and severally, for and in the whole, our heirs, executors, administrators, successors and assigns, and each and
every of them, firmly by these presents. Sealed with our seals and dated the J.1:.~.h.! .............. day of .......... J?.~P .. t..~.m'Q .. ~.r. .. .
A. D., one thousand nine hundred and .......... ;?,~ . .Y.~ . .D:t.Y. ................... .
THE CONDITION OF THIS OBLIGATION IS, That if the above bounden ............................................................................................... .
........................................................................ G:ar.r.e..t.t ...... B. .•...... C.ol.e.man ......................................................................................................................................................... .
Administrator .......................................................................................................... ..
cording to law, this obligation shall be void as to those
main in force.
Sealed and delivered in the presence of:
or any of them, ·shall. well and truly administer the estate ac·
who shall so administer the estate; but otherwise, it shall re-und.~ .. ~~GUiii-"~~~
~~J.:t~ID.Qr..~ .. ,. .. ............ $ ... r..~ .. t.y. ........................... .. SEA )
~tatrmrut nf ~urrty
I, .............................................................................................................................................................. , surety in the sum of $ ................................................ on the
administration bond in the estate of.. ...................................................................................................................................................................... , say that I reside at
............................................................................................................ , Washington County, Pennsylvania; that I am the owner of real estate, the
title to which is in my own name and duly recorded, situated in .......................................................................................................................................... ,
Washington County, Pennsylvania, worth above all encumbrances $ .................................................................. ; and that I am worth the
amount expressed in said bond, over and above my just debts and liabilities .
............ s't~~·~;: ...................................................................................................... :P: .. O": .......... ..
t;tatrmrut nf ~urdtt
I, ............................................ : ............ : ........................................ :.:: ........................................................ , surety in the sum of $ ................................................ on the
administration bond in the estate of... ..................................................................................................................................................................... , say that I reside at
-............................................................................................................ , Washington County, Pennsylvania; that I am the owner of real estate, the
title to which is in my own name and duly recorded, situated in .......................................................................................................................................... ,
Washington County, Pennsylvania, worth above all encumbrances $ .................................................................. ; and that I am worth the
amount expressed in said bond, over and above my just debts and liabilities .
............ s't~~~;: ...................................................................................................... :P: .. o: ........... .
COMMONWEALTH OF PENNSYLVANIA, }
SS:
WASHINGTON COUNTYY,
And now ................................................ 19 ............ , comes .................................................................................................................................................................................... .
who being duly sworn, says that he is acquainted with the financial standing of the securities to the within bond; that the .
said obligors have each executed the said bond and that the sureties thereto are the owners of real estate in their own
right of value more than the penal sum of said bond over and above all incumbrances and exemptions.
Sworn and subscribed before me this ............................................... .
day of.. .................................................................................................... A. D. 19 ........... .
Co,
No ...... l6.ao ................ .
A~mtutstrattnu 11Jnu~
IN THE ESTATE OF
........ ~~.~ .... ~.~ ..... ~.9.~.~~-.,.. ...................................... .
And now .... S.epte.m.be.r. .. ,.l.,S., ......... , 19."].0 ....
Bond approved and Letters issued to
............ G.ar.r.~.~ ....... QQ.~~ ................. ..
~fl"';:t;l cn G) c:: U") r~ ~ ;:.-U" ~
............ :w.h.Q .... ~~g;q.~1.. ... 9.~~!.~~~~.~ ........
;0 rn r ~-n
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R ~rc·'M .... · .. u.sso.J,; -r.nurino~ ····························~-;···--··:··~:-·················-·--·-·························· .. ······ ~ ~; ::;...: Register
. I--or-e; :t> en c:;:)
c:::>
Bond Book. ...... ~ .. :s.!..................... Page.J..Z ..
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IN THE COURT OF COMMOM ~LEAS
Of WASHINGTON COUNT~, ~ENN~
SY'LVAN::CJ.\ ORPRANS ~· COURT
DIVISION NO~ OF 1970
ESTATE
0F
JANE W. COLEMAN, also known
as .TANE A. COLEMAN,
Deceased
PETITION UNDER SEC. 202 OF
THE FIDUCIARIES ACT OF 1949
FOR SETTLEMENT OF ESTATE
---~~.
J3/D ~~:=_'"7) c:_; t I
1 _,r-~ ::.: ;·· -"'--_ :. ::: (..') ,'-') 3;; ;--,.. .. ~ . A) ~--· ---• .. ~()-' r; ~ _: .~:-' J-;-. • :·,
9: . ~-.. I • ·• 0 ~,... !. ..... ., • 'l-' l. -; . q;d. p --·---
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~~SEPH L. HOFFMANN ~~ ATTORNEY AT LA'W' ~ :::l 242 WEST MAIN STREET ~'I~ MoNONG.AHELA3ENNSYLVANIA
15063 r ./
J.A3-0~ lf
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IN THE
COURT OF COMMON PLEAS OF WASHINGTON COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE
OF
JANE W. COLEMAN, also NO. OF 1970
known as JANE A. COLEMAN,
Deceased
PETITION UNDER SECTION 202 OF THE FIDUCIARIES
ACT OF 1949 FOR SETTLEMENT OF ESTATE
To the Honorable P. v. Marino~ President Judge of said Court:
The petition of Garrett E. Coleman respectfully
:r;-epresents;
1 ~ That Jane W. Coleman, also known as J·ane A •.
Coleman, a widow, aged fifty~seven years, here~n called decedent,
died. at New Eagle, Washington County~ Pennsylvania, on April 16,
1970, being at that time a citizen of the Commonwealth of Penn-
sylvania and the United States of America, and domiciled at No.
608 Sheridan Street, Monongahela, Washington County, Pennsylvania.
2. That decedent died intestate and no Letters of
Administration have been granted in her estate.
3. That your petitioner is a son of the decedent and
the only person entitled under the intestate laws of the Common-
wealth of Pennsylvania to receive the decedent's estate.
assets:
4. The decedent's estate consisted of the following
Cash on person
United States Treasury -Income Tax
Refund
Mon-River Towing Company -wages
$100.00
187.75
57.00
1960 Chevrolet Sedan
Manufacturer's No. 016193113196 '
Total
1.50.00
$494.75
In addition thereto the decedent or her estate may be
entitled to a refund of a nominal amount upon payments of the
income tax for the year of 1970~
5. The debts of the decedent or her estate, all of
which have been paid by your petitioner from his own funds are
as follows:
L. M. Frye ~ Funeral expenses $1430.00
J• •. P~ Hughes, M.D. -Professional services 45.00
C~ F. Melenyzer ~ Account vs. decedent 25.00
Kay Mart -Account vs. decedent 174.61
Ferrara '·s Shoe Store -Account vs. decedent 16.65
Mern,orial Hospital ':"'.Account vs. decedent 228 .. ~6
Dr~ McGee ~ Profe~sional services 15.00
J'ewel Tea Company-Account vs. decedent 4.2.76
Signorini Garage ~ Account vs. decedent 1.32 ~ 78
Robert Bolger TV~ Account vs~ decedent 4.50
Underwood Cleaning Service -Account vs,
decedent
Vilette Wright ""' Account vs. decedent
Mon Valley Cern,etery ~ Grave marker
George a. Giles, D.D. "Honorarium
Administration costs
Total
4._00
120.00
265.00
10.00
53.00
$2567.26
6. That your petitioner is sui juris and the only
person interested in the estate of the decedent.
7. WHEREFORE, your petitioner requests your Honorable
Court, pursuant to Section 202 of The Fiduciaries Act of 1949,
P.L. 512, as amended, 20 P.S., Sec. 320.202, to award distribution
of the estate of the decedent in the amount of $494.75 to him in
partial reimbursement of the funds advanced by him for payment
of the debts of the decedent or her estate~
~CaLAA-c
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF WASHINGTON
Garrett E. Coleman
Before me 1 the undersigned officer, perso~ally
appeared Garett E. Coleman, to me personally known( who, being
duly sworn according to law, deposes and says that the facts set
forth in the foregoing petition are true and correct as he
verily believes.
o Garrett~ Col,em.an ·
Sworn to and subscribed before me this 2.2 /fO, daY'
of May, A~ D. 1970.
My Commissio~ Expires:
BttTY t WENZEl, Nbbry Publlt
Monongahela, Washington ~ounty, ?a.
My Commission Exp1re:i.
May 91 1972 _...-"
IN THE
COURT OF COMMON PLEAS OF WASHINGTON COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE
OF
JANE W~ COLEMAN, also NO. OF 1970
known as JANE A. COLEMAN,
deceased
ORD~R AND DECREE
AND NOW,
consideration of the petition does hereby Order,
Adjudge and Decree that the assets of the Estate of Jane w.
Coleman, also known as Jane A. Coleman, deceased, in the amount
of $494.75, be distributed to Garrett E. Coleman, the son and
sole heir of the said dece~ent; and that certified copies of this
Order shall constitute petitioner's authority to endorse and cash
the check of the United States Treasury in the amount of $185.75
and the check of the Mon....,Ri ver Towing Company in the amoun.t of
$57~00. A certified copy of this Order shall likewise constitute
authority on the part of the said Garrett E. Coleman to execute,
acknowledge and deliver an assignment of the title of a 1960
Chevrolet Sedan, Manufacturer's No. 016193113196, to himself or
any other person; and furthermore, the said Garrett E. Coleman is
further authorized to execute on behalf of the decedent the Income
Tax Return for the year of 1970, and to receive as sole heir of
the decedent any excess tax paid.
This Order and Decree is made pursuant to the provisions
of the Fiduciaries Act of 1949, P.L. 512, Section 202, as amended,
20 P.S. 320.202.
STATE OF PENNSYLVANIA,
WASHINGTON COUNTY, ~ SS:
The within named Accountant being duly sworn according to law, deposes and says that the above. account
as stated is true and correct as ........... D.~---························verily believe .
Sworn and subscribed before me this ... ;< .. /.~-.d~c:~ ...
day of ......... A~_D_!-!_q._r..Y..L. _____________________ 19 __ }_~-----Administrator of the Estate
of Jane A. Coleman, dec'd
............. :&~l~~~·······
BETTY E. WENZEL. NOTARY PUBliC MO~ONGAHELA, WASHINGTON COUNTY
MY t;OMMIS:SIUN EJ\1-'IHI::S MAY 9 Membe p . , 1976 r, ennsylvamaAssociation of Notaries
Warshington County, ss:
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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 Sta·tute and Rule of Court, as evidenced by proofs
thereof filed to No ..... G .. .J=--2-~~/ __________ _
Witness my hand and official •seal this---~------------------
day of _____________ /1._4f ___ c__dz ________________________________ 19-7-Y.
F ll ED,
------------------~-~
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Register of Wills //7 ~
J74 JAN 'q !,. ,, !2
RUscrl' .,,~. ' v L .. _ L lru.\j (/ N 0
REGISTEH OF WILLS
W.A.SHINGTON CO .• PA .
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·a~D,lSa S!4-l U! UO!,lnq!J.lS!P JadoJd
au!wJa~ap O.l palsanbaJ All np::>adsaJ S! ,lJnO) a4.1
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1 97 3
Dec.
197 4
' XN THE COURT OF COMMON PLEAS OF WASHXNGTON COUNTY~ PENNSYLVANlA
ORPHANS' COURT DIV~SION
ESTATE
OF
JANE A. COLEMAN,
Decea,sed
FIRST AND FINAL ACCOU~T OF GARRETT E. COLEMAN,
ADMtNISTRATOR OF THE ESTATE OF JANE A· COLEMAN,
DECEASED
PERSONALTY
RECE.l'PTS
To a.mount of Inventory qnd Appraisement
15 Joseph l. Hoffma.nn
DlSBURSEMENTS
Reimbursement for
advertising letters 26.50
$1308.00
Jan. 14 Joseph w. Wilson, M.D. Compromi$e of claim 1050.00
14
14
1 4
14
14
Ga.rrett E,. Colemqn
Betty E.
Register
~oseph L.
Register
Register
Wenzel
of Wills
H'Offma.nn
of w i 11 s
of Wills
Receipts
Disbursements
Ba.lance
y. decedent
Administra.tor's
expenses
Nota.r,v fees
rnventory
Attorney's fees
Filing account
E~timated costs of
Audit
SUMMARY .
$1308.00
1308.00
0.00
75.00
3.00
3.00
110.00
18.00
22.50 1308.00
T,HE DA!L Y REPUBLICAN
MONONGAHELA, PA.
1'.,,
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 } ss:
State of Pennsylvania
Personally ~eared before me, a Notary Public in and for said county and state,
~-~-~-----A·----~------------~~-~-!;;-+ ~ho, being duly sworn, deposes and says: thaL------~-h~L... is
the b_QQ_kke_e_pe_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:
Q_c __ tQ_b~_;r ____ _a_, _____ l5 _____ an.d ___ 22_, ____ J.9.7.0 .. _______________________________________________________________________________________ _
AJ?MIN_.l_~ __ 'rBATQ.JL!_S ____ N_Q_TI.CE __ :__ _____ E_a __ t_a_t~L __ o.f _____ .Ia.n~L_A ... ____ c_a_l_e_ma.n
that the affiant or the corporation in behalf of which _______ she ___ 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 the time, place _and~~ of t public~ti~.are ~ . , ~--a--~----------------------------------------------~--------
this
~-----------196 :2 °C. REID DOU 1-1 G. ,£RTY, Notary Pub lin
MONONGAHELA, WASHINGTON CO ~:
. My Commission expires July 29, 1~~-2 .
~~ AOMtNtf..,fil.:t;o~•s NO'Ttc~ 71 Estate of JANE A. COLEMAN./ deceased, late ot Monongahela ''Washington County, Penna. I
Letters Of Administration UPon the above estate having been granted to the Undersigned, notice is hereby,-given to those indebted thereto tol make immediate .Payment and to' those having claims or demands to' .Present them for settlement. /
Garrett E. Coleman Administrator 608 Sheridan Street Monongahela, Pa. 15063 Joseph L. 1Ioffmann. Attorney 242 West Main Street Monongahela. Pa. 15063 Oct. 8, 15, 22, 1970.
W !dlS~aPri C®IDlllll!ty Rel!Doris
"~~~M~~
Washington, Pennsylvania
(PUBLISHED ElY WASHINGTON COUNTY BAR ASSOCIATION)
PROOF OF PUBLICATION
In compliance with the Newspaper Advertising Act of May 16, 1929, P. L.
1784 Sec. 3, paragraphs (3) and (25).
CouNTY OF WAsHINGTON)
STATE OF PENNSYLVANIA ( SS.
Personally appeared before me, a Notary Public in and for <aid County and
Commonwealth, CHARLES C. KELLER, who. being duly sworn, deposes and
says: that he is the Editor of the WASHINGrON COUNTY REPORTS, the
official legal periodical for said Washington County, publis'hed weekly having its
place of business at Washington, Washington County, Pennsylvania, and is act-
ing as its agent in this behalf; that the said WASHINGTON 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:
... .Q.~J.9.~.~.r....~ ..•.. .J.5. .•.... ZZ .•... .J9.1Q ................ .
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·vf the al.legations of
this affidavit as to the time, place and char_actel;'~of the publication ai'e· J;nie. ; /}
·,, ·""'r' {--· ;''"/I' ' " ,. • -1 ? .,.,.. ....(,. _.. t.-/' '-' ~ I ;-...:__ _..,.l/ ...... ·(
................. -:-...... :~ ... :::-......... ;; ................. ,~.:.[ ........... :i7.;ji~~: ~
Sworn to and subscribed befor~ me this ~ · • · ~ ·-. --'•
~::z~·
_J_QSEPHINE..l:... S_Cif.MA.~_"iJ!
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 them
for settlement to the Executors or Admin-
istrators or their Attorneys.
•••••••••••••••• 41
-----------, I COLEMAN, JANE A., Dec' d. .
Late of Monongahe-la, Washington I County, Penna. Administrator: Garrett E. Coleman.
L608 Sheridan Street, Monongahela, Penna. 15063 Attorney: Joseph L. Hoffmann, 242 West Main Street. Monongahela,
Penna. 15063 -----~-
lJu tijt UDrpijau.a' Q!nurt nf llla.aijiugtnu Q!nuuty
In the matter of the Audit of Account in
Estate of ....... ~.A.N.s .... A.~ _____ t:._Q_!:.c_~_M8.N .. , ...................... .. No ................. , ............................................ , 19 ............ , A.A.
Deceased
TO THE AUDITING JUDGE:
Enter ..................... ~Y. ......................... appearance for .......... ~-~-r_r_gJ!: ... J .. ~ ..... t:..9.J.g_fll.~.X! .. L .. A9.mj .. fJJ~ .. t .. r.~.t.9 .. r. .......... .
--------~z~~ -----------J.'~ -,
---------·-··----~~day of -----------~-'l--------~-ry_ _____________________________ ,
N.B.-Counsel shall, by separatie/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 Counsel suggesting proper distribution shall file
a separate concise statement in that regard.
J
No ................. , ............................................ , 19 ............ , A.A.
In re Audit of Account in Estate of
JAN~ A. C0LEMAN,
••••u•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••··••••••••••••••••••••••••
Deceased
AUDIT
Jrardpr fnr i\ppraranrr
FOR
__ G_g_r_r_~ _ _t_:t; _____ ~ __ ! ..... C.Q_l_gm_gJl.L ................................... .
A.dm.t.nt.s .. t.r.a..t.o.r. .......................... _______________________________ _
~oseph L. Hoff:Ql&U
Attorn.:--,~ '~'!',w
142 \7, :: .. II ·•ot
oououra.bola., ~'"· uoe&
Attorney
.•
(Form where decedent died Intestate) J
Ju tqr ®rp~ans' <t1nurt nf Bas~tngtnn <tinunty
ESTATE OF No. Term, 19 74 , A. A.
In the audit of the First q n d Fin q 1
~.AN.E. .... IL ..... C.O.l..E.M.AN.# .............................................................. . Acrountcl Gqrrett E. Coleman,
State (I) whether de-
cedent was married or
unmarried; (2) if mar-
ried, whether a husband
or wife survived and
his or her name; (3)
whether or not there
was any marriage settle-
ment; ( 4) whether or
not family relation was
maintained until deced-
ent's death; and (5)
whether the decedent
left children or issue of
deceased children.
Deceased
The petition of ............ ~-~.r.'.t.~ .. ~t ... ~.~-----·~-9 .. J .. ~.l].~.D .. ~ ......................................................................... .
(Name of Petitioner)
respectfully represents: ........................................................................................................................................... .
(a) The decedent died ............ A.pr..LL .. l9 .. ,____l.9.1.0 ............................... , intestate and
(Date)
letters of administration on .. .h.e.r ............ estate were granted . .S.e.p.temb.e.r ... ,.l-.5.., .... -l!H 0
(Date)
as per record thereof appearing in Administration and Bond Book No ..................... .
at page ............................................................ .
Decedent was survived by q son, Garrett E. Co 1 em an
(b) At the time of death, the decedent's domicile was =:~the Com-
mon wealth of Penns y 1 v ani a, to-wit, a t .... M9..!1Q.I1.9.g.h ~.l9.t., ..... P..~t! ... L .. !J. ..•. S. .. !.A.~ .. -'·········
(Town or Township, State and Nation)
and residence was at.~_.Q§ ..... ~--~-~ . .r . .1..g .. ~.D .... ~-~--~ ... L .. M.9..D.Q.0 . .9.~ .. b.~J..g .. ~ .... P..~ .. ~ ......................... ..
(Town or Township, State and Nation)
(c) The names of all persons having any interest as heirs or next of kin
with the names of their deceased parents, to show relationship if they take by
representation are as follows:
NAMES Relationship Interest
Of age, sui-
juris, or not,
(write yes or
no).
N arne of Guardian, Trustee or Committee, if
any, or beneficiary, mam:er and place of
i-ecord of appointment and is bound suffi-
cient to cover and protect share.
Gqrrett E. Colemqn sen entire yes
State exceptions, if any,
giving names and dates
of death and the names
of their executors or
administrators, or the
names of, their issue as
the same may be mater-
ial.
Describe type of notice.
All of said parties m interest are living, ~~~
(d) All parties having any interest have had ... q.c.tu.q.lnotice of the filing
oftheaccountby C!!lp,Y of a,cceunt delivered person&lly to accountant,
the sole benef1c1ary of decedent.
... _ .. -..
(e) Balance for distribution per Account $ ............... 9 .. : .. 9 . .9.
(f) Additional debits, not shown by Account
(Itemize)
$ ........... 0. 00 ~-·················
(g) Additional credits, not shown by Account
(Itemize)
$ ............... Q .. ! .. O .. Q ..
n o t $ ............... ~ .. :.g __ ~--
rnsert word "not" where I (h) Claim for exemption has/been made, and has ........................ been paid.
necessary. (i) The estate is ... .n.o.t .... subject to the payment of inheritance tax to the
State of Pennsylvania.
rr taxable state w~eth-1 (j) The estate is ..... n.o . .t ............ subj ect to the payment of the county 4 mills
er tax has been patd.
11 too many for the
space, annex a list there-
of; if no such claims,
insert the word "none." If any creditor or other
claimant has not re-
ceived actual notice, that
fact must be stated.
Indicate such claims as
may be secured or en-
titled to a preference,
and give detailed infor-
mation concerning such
security or preference.
Here insert a reference
to all questions requir-
ing adjudication, and a
~tatement of any mater-
ial facts n·ot already
given. If none insert the
word "none."
If any share has been
assigned or attached
that fact should also be
stated here.
State kind, form and
character of property
composing the balance
for distribution, and if
any part thereof is not
cash, whether or not
there has been any elec-
tion to take such part
in kind.
tax.
(k) The estate is ..... D..Q.t ........... subject to the payment of Federal inheritance
tax.
(I) All creditors (and other persons who have complied with Rule II,
Sec. 9), of whose claims the accountant... .. b .. ~.~---············· notice or knowledge, have
........................ received actual notice of this audit; the amounts of their claims and
whether or not they are admitted to be correct are as follows:
All creditors of the decedent or her est~te h~ve been paid
by accountant, either from amounts set forth in Inventory or
from his own funds. Accountant does not seek any re1mbursement.
(m)
None
(n) The balance for distribution consists of property in kind, form and
character, as follows:
No balance for 'distribution; Accountant reserved
estim~ted ~udit fees of $22.50. If insufficient, Accountant
will defray the difference .
:-
Are there any advance-
ments by decedent to be
considered on distribu-
tion and has any distri-
bution on account been
made by accountant to
any distributtee?
(p) None
( q) Give brief location of any real estate sold.
If prior accounts have
heen filed, list number
and term.
(r)
None
None
Wherefore your petitioner asks that distribution of principal and income
be awarded to the persons thereunto entitled and suggests that the balance of
principal and income should be awarded respectively as follows (shares being
stated in proportions but not in amounts) :-
No balance for distribution
County of Washington, ss.
The above named petitioner being duly
sworn doth depose and say that the
facts set forth in the foregoing petition are true
to the best of h.J.~---···· ......... knowledge and belief.
Sworn to and subscribed before me this
;< f ~ay oL ... ~--~-~-~--~-q:' ... ~ .............. , 19 . ..!..~ ...... .
.:ffi~rf.~
DETTY E. WENZEL. NOTARY PUBLIC
li'IONONGAHELA, WASHINGTON COUNTY
... I ~JUii/IMI~~ION E.xt'IHtS MAY 9 • 1976 Member, PennsylvaniaAssociationot Notaries
And your petitioner will, etc.,
AI'~.~~~················· (Signature of Petitioner) Administrator of the Estate of
Jane A. Coleman, deceased
FORM IN CASES OF INTESTACY
No ..................... , ................................ Term, 19 ........ , A. A.
IN THE
ORPHANS' COURT
WASHINGTON COUNTY, PA.
Estate of .JAN.E ... .A ....... c.a~LE.MAN.~························· Deceased.
sur account of .... G.Q..r.r.e. t.t .... E ..•..... C..o.l..em.~.n..,.: ...
................................. A~m.1 .. fl.1.t~.r~-~.9..r. .............. .
PETITION SUR AUDIT
In Conformity with Court Rule Ill,
Sec. 5 (B)
COUNSEL FOR THE ACCOUNTANT WILL
SUBMIT HEREWITH
1. The letters of administration.
2. A copy of the inventory and appraisement.
3. Proof of advertisement of the grant of letters,
if not filed with accountant. f'; 1 e d
4. An appearance for those. represented.
5. htlwll'ikPK>e -t<MC-recei"J'ts,-if-lmY·
6. Ce pt i'iea.t~ ef -1 i.e ~-i ~ eaee-2tt17' ~f-th e-fU'IHts-f'cm
dii>"'i.Qio!ti.()R .a.~.~.~~el-~"" :tll:e-serle -of-r-ei!"I--Eistatei-,
7. .C.Op.y_at..F.ede.caJ. .E•tata ..t<WC-r•twr>fl,-i4 -ea-tat·e-.-i&-~
s~t.:t.R~&te.
8.. . S1gQ ~\+of'ls-~-t~ -i"" k-i rtd; H' -any:
Joseph L. Hoffmo.q
r ~·v
. 1t -···------------------~03t.:;..:;--.,;..;:-~_--,·;~-----~--;~-----~-7\-;r·~,,-----------------
o Attorney· ..l.fi:>TV.&ccountant.
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IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY, PENN1 .
:! z o( ~ >-Ill z z 1&1 D.
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IN RE:
ESTATE OF
JANE A. COLEMAN,
Deceased.
~ BEFORE: o(
3:
..: ~ 0: ~ APPEARANCES:
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·~
ORPHANS' COURT DIVISION
)
)
)
) No. ti3-70-545
)
)
)
HEARING 00 AUDIT
THE HONORABLE PAUL A. SIMMONS, Judge
of the said Court.
JOSEPHL.HOFFMANN, ESQ., of Monongahela
Pa., representing the Accountant .
Monday, March 18, 1974, at 1:30 P.M., EDST
The estate of Jane A. Coleman. Would you
1&1 0:
1-0:
:J
announce that please, Mr. Zermani?
8 MR. ZERMA NI: ~ (Court Crier)
~ THE COURT: II.
0
Your Honor, I received no response.
Is anybody in the Courtroom interested in the
estate of Jane A. Coleman?
( NO::RESPONSE )
THE COURT: Inasmuch as ·Mr. Hoffmann is out of town, the
Ill ... ~ ' • 1 ' ~ ..
audit of this estate shall be continued until 1:30 on April 1st, 197 .
( AUDIT CONTINUED )
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1 hereli?y certify that tne proceedings ~nd evidence are· contained ,'i
~ ' zfully and accUI'ately in the notes tahen by me on the hearing of the above
~ '
.J >-~cause~ anci that trw copy iS a correct transcript of the same.
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The foregcing record of the proceedings upon t11e hearing of
~the above cause is ~aereby approved and directed to be filed.
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By the Court,
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RE.GISi Fi (;t-Vf\LLS
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IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNT\, PENNP .
IN RE:
ESTATE OF
JANE A. COLEMAN, ~ z ~ Deceased.
> Ill z z Ill II.
i 0 .... (!) z
:r ~ BEFORE:
~
..: 0
0:
Iii a APPEARANCES:
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:t ::: TIME:
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rsi 0: Ill li: THE COURT:
0 II. Ill ~ MR. HOFFMANN:
0: :J 0 ~ THE COURT:
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l ihe that.
MR. HOFFMANN:
ORPHANS' COURT DIVISION
)
)
)
)
)
)
)
)
No. 63-70-545
HEARING ON AUDIT
THE HONORABLE PAUL A. SIMMONS,
Judge of the said Court.
JOSEPH L. HOFFMANN, ESQ., of Monongahel~,
Pa., representing the Accountant.
Monday, April1, 1973, at 1:30 P.M.
The estate of Jane A. Coleman. Mr. Hoffmanr.
This is one in which you were interested.
But I don't think I handled the estate or anythin1
No. I took out the Letters, and the firm paid m!:>
J
a certain sum of money, $1308.00, and advertisement and sofo th.
The doctor's claim was compromised in the amount of $1050. OC,
leaving a balance of nothing. I reserved sufficient money to pay
the audit costs.
THE COURT: In other words, this estate would be insolvent,
. ..
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is that right?
MR. HOFFMANN: This estate is virtually insolvent. Since filing
the account, I have fouhd that Mrs. Coleman owed the Departmellt
of Welfare a certain sum of money, upon which her son Gary an(
his wife also signed. So there are no assets available. And I
believe the son and his wife are liable for her indebtedness to
• -f
' , c. ... • • ;. ... ~ ... '. .. •
the Commonwealth on the' Department of Welfare claim-. There
are no complications.
I t '
~ THE COURT: Do you want to announce the estate of Jane A.
z
Coleman, deceased?
~ MR. ZERMANI: Your Honor, I received no response
a: Iii (Court Crier)
a
..1
< THE COURT: 0
Is anyone in the Courtroom interested in the
0
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estate of Jane A. Coleman, deceased?
,..
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ui a: Ill 1-~ THE COURT:
II. Ill a: ~ ordered closed.
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( NO RESPONSE)
Hearing no response, the audit of this estate is
(AUDIT CLOSED)
2
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1 hereby certify that the proceedings and evidence are contained
~ ~fully and accurately in the notes taken by me on the hearing of the above
..1 ~ ' . ~cause, and that this copy is a .correct transcript of the sa~ e.
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"' The foregoing record of the proceedings upon the hearing of the
ui ~above cause is hereby approved and directed to be filed. 0: 0 D. ~ By the Court,
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ESTATE OF 63-70-545 No·---------------
j
Jane A. Coleman, In the matter of the:~F_ir_s_t_a_n_d_F_i_n_a_l __ _
Deceased Account of Garrett E. Coleman, Admr.
ADJUDICATION AND DECREE
An now January 2-P , 19~, this matter came on for hearing,
audit and distribution of this session and testimony taken; and thereupon, upon due consideration
thereof of Jhe balance for distribution in the hands of the Accountant is determined to be
$ 2Z ·50 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 an appeal be taken herefrom sec. leg.
~·· ~:;z~~·
~ J.
SCHEDULE OF DISTRIBUTION
Balance per account
~
Balance
Deduct Clerk's Costs & Receipts & Advertising $ 25.00
Attorney .Joseph L. Hoffmann
Contribution by Garrett E. Coleman to settle estate 2.50
$ 22.50
..
$ 22.50
(2.50)
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LANCE' NO BA
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMEtojT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX DIVISION
INHERITANCE TAX RETURN
FOR IN SOL VENT ESTATES ONLY
OF RESIDENT DECEDENTS COUNTY OF __ W_A_S_H_I_N_G_T_O_N __ _
This return must be completed In detail end flied In duplicate, with the Register of Wills In the County where the decedent resided within one
year after dote of death, unless an extension Is granted by the Secretory of Revenue.
Will
Admn. No. ___ l9 __ I,_G_a_r_r_e_t_t--::-:E_ • ..,..c_o_l_e_m_a_n ______ of Monongahela , p a. ,
(Name) (Address) Misc.
being du I y sworn according_ to I a.:H,.., dnctUJi and $ay s that he is the --=s-=o-=1=-e=--h...:...:.e.::i~r~a.:..;t=-:--,.:l=-a=w:.:_ __ ---:-----------;:rANK W • L:\.JL.t~MfU\J , al.SO known as (Exec., Adm., Legatee, etc.)
of the estate of J'ANE A. COLEMAN, late of --=M~o=-n=o;::n:::=g~..:a::.;h::.e=l~a'-',~P~a~.-!-'-:-:---------
(City, Borough, ar Township)
deceased, and that the whole of the estafe of s(lid decedent, who died on_A:..:.=.p..=r:....:~=.;·l=--=1:...:6:....,'r,-=:lc::9~7~0:....L, _________ _
(Date)
consisted of the assets listed below and that allowable debts and deductions exceeded the fair ma~ket value of the assets and
no Pennsylvania Transfer Inheritance Tax is due.
Sworn and subscribed hefore me
(Signature) Sole Heir at (Title) Law
Type of Ass t:
Real Estate, Pers.
Property ,Jointly
Held Prop. or
Transfers
Personal
ASSETS
{Attach additional sheets if necessary)
Description of Asset
United States Treasury -Income Tax
Cash on person
Mon River Towing Company -wages
1960 Chevrolet Sedan Mfgs. No.
' 016193113196
r~A u
I
TOTALS
REPORT OF INHERITANCE TAX APPRAISER
Estimated e!
Mark~'t ~ ~.
Value
494.75
•• ; . Department
Valuation
CAUTION
{Do not writ.e
in this space)
/.fll_s-
/oo. c6
,S7, oO
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I, the undersigned duly appointee! Inheritance Tax Apprc:liser in and for the above County do respectfu ly report that I have
appraised real and personal property as reported in the foregoing sc ul at the ues opposite each item in
the last c lu n tot right. ,q 70 ~ ~ 1(
Dated: /'
L. M. Frye
J'. P. Hughes, M.D.
C. F. Melenyzer
Kay Mart
Ferrara's Shoe Store
Memorial Hospital
Dr. McGee
J·ewel Tea Company
Signorini Garage
Robert BolgerTV
Underwood Cleaning
Service ·
Vilette Wright
Mon Valley Cemetery
George H. Giles,. D.D.
Administration costs
Funeral expenses
Professional services
Account vs. decedent
Account vs. decedent
Account vs. decedent
Account vs. decedent
Professional services
Account vs. decedent
Account vs. decedent
Account vs. decedent
Account vs. decedent
Account vs. decedent
Grave marker
Honorarium
TOTALS
1430.00
45.00
25.00
174.61
16.65
228.96
15.00
42.76
132.78
4.50
4.00
120~00
265.00
10.00
$2567.26
Amount Approved
by Register t ..30· oo
?{\_. 66
£ S'. 66
/7 {/ t/
/?-6-.1.~
~e:;_,f. ft.
/S-06
//'.:/. 7t
/J-2, 7J -?(so
~, 6Ci
/-<fO·CiO
_;I t;:.._s-. 0 0
/C>~ 0 6
S3-oo
Will )
Administration No. Year __
IN THE
MATTER OF THE APPRAISEMENT
OF-THE
ESTATE OF
JANE W. COLEMAN, also known as
JANE A. COLEMAN, Deceased
Late of Monongahela
County of Washington
..... ~--, . ,.,. .
Commonweal.flt Q'J-'P.e.nnsylvnn-M """f'-1 CIJ 'Tl ~-~.-• __ 0c:::--.... ::::: c;; (I) .:::::J: ~ v) ~ r--REP~f~~D APYAI~~l
~Q I -,.1 .,_ I--.. 0 ~-"-'-...J ,-....,. -.;,;;-. ~ ~ ~ ~ -~..... ~--.: ---"'J -.-1.,. -o r-:;:: -.l:>.r-.c. -(f)C'.>
"v
-&::-
Joseph L. Hoffmcnn
Attorney at Ln.-v
B42 W . .Maia S • .-.·ct
OOJlODgahela, Pa. 15063
R c c-a 1 (2-64)
COM~ONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
NOTICE OF FILING OF APPRAISEMENT
IN YOUR REPLY PLEADE
REEP'ER TO
GARRETT E.COLEMAN Informant
In Re : Estate o f __ __;:;.J:=.:.A=NE=-,:..;t::;....:1•::...._::C:...:::O:.=:LE==::~~ ~MA=N~a~/~k~/-'!:!a~· __
___ _:tl::::.A.:.::S:..::.:H~l:=.:.N.::...GT=-O=N:.:__ ____ County -File No. 63• 70•545
' Dear Mr. ColemQtl:
You are hereby notified that the original
appraisement in the estate of. Jane 9' • Coleftn ~
has been filed .in the office of ');he Register of Wills qf ~shington
County on . July 30 , 1970. Said appraisement reflects the
following valuations:
Real Estate ---'-------.,...,..~--
Personal Property _____ ..;::;4..:::9.;;:4_;::;:;._;::;7...l!:!S:......
Transfers ______________ r=~~--
Total _________ ~-----4~94~.7~5~
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 (6%) percent per annum is charged.
Any party in interest who is aggrieved by an appraisement may
appeal therefrom as provided by law.
Date ____ ·J_u_:l;L.Y~lO_:· :z.._; .....;:;1=9;.....:;.7....::;0 __ Signed
Title
DATE OF DEATH; Ap.-il 16:, '1970
ESTATE INSOLVENT
Note: This is not a bill.
J
· CC•39 (~681
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
~:state of COLE:t-lAN, JANE
(Last Name) (First Name) '". (Initial)
SUMMARY
DATE OF DEATH 4-16-70
REPORT OF INHERITANCE TAX APPRAISER
FILE NO. 63-70-545
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of ivashington
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: ___ 0_7_=_2_0_=_7_0 ___ _
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for \vashington 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: ____ ..._7_-=2=0_-....... 7=0 ___ _
REGISTER OF WILLS
INVENTORY VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISED
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
$
4Q4 7.c;
$ $ ____________ ~---
494 '75
Joint-Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
494 75
") r!C.'7 ")C.
Est
annuities................... $--------+--
EST ATE TAX ASSESSMENTS $ ---------..L.--
494 75
':) ~h'7 ?h
at e Insolven1
FOR USE OF REGISTER ONLY COMPUTATION OF TAX
Taxon$ ________________ ~---$ ______________ ~_
Tax on $ ---------+-~ -6% $ _________ ~---
Tax on$ 5% $ ______________ ~_
Tax on$ 10% $ _____________ ~_
fiXM$ 1~ $ ______________ ~_
~~ptiMS *
Total Estate--------+---
TOTAL TAX $--------------~-
Less tax previously paid $======!==
BALANCE $----------+--
Less 5% of tax if paid within
3 months after death $=====~==
Add interest at rate of 6% from
-----to -------
AMOUNT OF ESTATE TAX ASSESSED $----------+---
Estate tax paid $ _____ ---.~. __
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
BALANCE DUE $ __________ ---.~. __ __
Add interest at rate of 6% from
----------~10--------$------+--
TOTALTAX 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.
Will
Administration ! No ..
IN THE.
Year ........... .
MA TIER OF THE APPRAISEMENT
OF THE
ESTATE OF
JANE lv •... COLE}IAN .. . . ..
Deceased
Late of . . . . . . HONQNC.AJm:L.A.
County of . WASHINGTON
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
v
t
.,
Fonn RCC-2
COMMONWEALTH OF PENNSYLVANIA q· J,lATil .............. ~-~-!.Y .... ~.9. .. t...J .. ~_?...9. ............. .
• DEF."l-RTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA. 1 7 1 2 7
..
RESIDENT INHERITANCE TAX
APPRAISEMENT
COUNTY .......................... JY~-~ .. h.t.P.:g_~-2 .. !1 .................. .
FILE NO ........................ §.}:: .. 7.9.: .. :?..4..?. ............................. .
Whereas, ........................ J.an.e .... W: ........ C.o.l.eman ............................................................. late of ................................... M.ono.ngah.ela ............................ .
in the County of ......................... W:a.shingt.o.n ..................................................................... Commonwealth of Pennsylvania, having died on
the ........................ 1.6 ...... th ............................................... day of ......... m ....... A:p.:r.il .................................. 19 ... 7.0., seized and possessed of an estate
I
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, .......................... .JY. .... R ........ C.ha.n.~.Y ............................................................ , an appraiser duly appointed according to law,
I having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
1 inheritance taxes at the lawful collateral rate on any such future interest.
Description of Anet
PERSONALTY:
SPP C".cmv nf annrai ~ement filed
Tctal
Unit
Values
$
Appraisement Made for In herltance
Tax Purpoaes
4Q4 7.~
494 75
'----------------------------------------------------------------------------+-------~----------+-----
1------------E=i S:....:T:.:.A:..:T:..=E~IN~JS-=-0=-=L=-.:V:..=E::..:..:N:.::.T _________ -+----it-----JI.....---
1'/ASHINGTON County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
JANE W. COL~}~N .................... .
Deceased. •
Late of
................ XNXXNXHX ... JfONON.G.AHELA .....
i
Date of Death, ............. .A.p.r.il ... l'l ..... l.9.7.0. ....... .
Appraisemel!t Docket Vol., ...... J... ...................................... .
Page, .%.'.9....= ~--............... No ...... 6.3.,.,.7.0.~ .. 5.4.5 .... .
Filed ill Register's Office, July .. 3..0 ......... 19 .. 7..0
Amount of tax due, $ ................................................................... .
DEPARTMENT OF REVENUE
Received,
Examined and Approved,
Wrote abo.ut Appra-isement,
Appeal f1'om Appraisement,
Entered and charged,
l
..
Form No. R{:C-62 (4-71) THIS FORK REQUIRED IN ALL ESTATES WI'l'H' GROS8 ASSETS UNDER .10,000, UNDER SECTION 701 OF ACT OF JUNE 16, 1961,
EFVECTIVI!: .JANUARY 1, 1982. (FILE IN DUPUCATE WITH COPY OF WILL ATTACHED) J ~.3-7cJ _ __s-y~ ..
,-
OFFICE OF THE REGISTER OF WILLS
County of .... WASH. I ~~.T.ON ......... .
. G~.r.r: ~ .t. t. ~-·· . ~.o.1 ~!ll.q IJ ...•.• · •.••.•.....•..•.••. of 9.0.~. S.h e r.i. c;t ~.n. S.t, •. .Mo fl.Q n g.a..h e.l.!l •.. P.a .. .1. 5o 63
(Name) (Addreaa)
being duly ---------~-W_9_rn ___________________ .according tO law, deposes and says tluit he is the ________ 8_g_[IJ_i_n_t~_tt'_~_t_9_r ___________________ _
(Exec., Adm., Legatee, Etc.)
of the estate of ------~AN.f. __ A_. ____ C_CU • .E.MAli _________________ whose last residence was ___ 6DB .. .S.he.r.i.d.an---~-t-~--------------------<No.> (!treet)
M_Q.fl_Q_fi_CI_Q..h_e_] _ _g __________________________ .deceased, and that the whole of the estate of said decedent, who died __ 8.p.r..i.L.J.6.~ ___ l.9J 0 ,
!f:iey, Borough or Township) (Date) .
consisted 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 A~lD RELATIONSHIP OF OTHER OWNERS.
: Estimated Real Estate Value
None 0.00
Personal Property
To amount received from Hormell. Temoest. Simmons. Biai &
Melenvzer. Attornevs at Law:
Settlement of nealiaence case
Travelers Ins. Co. check No. 05468259 _$]750.00
Aetna Ins Co check No M35968372 750 00
2500 00
Exnenses $35Q nn AI-M vir~
_ _/!::J'IJ 117~··
AttnY'nPv~1 fpp~ A11 nn 1192 00 / $1308.00
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, account number and the exact name or names in
which the account is registered, '
----------~----------------------------------------,
-.
Jointly Held Property Estim!p.ted
Value "'
.._": . ..,
None 0 00 -
-
-
Transfers within TWO YEARS Prior to Death
None n oo
That at the time of death there was no safe deposit box registered ih decedent's individual name, or jointly with, or as agent or deputy of
another, or in decedent's individual name, with right of access by another as agent or deputy, with the exception of the following:-
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
Non~
-
BENEFICIARIES
'i f!# tfE~bkiARIES 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
Garrett P C:oleman son ves Entire
. ~ r ' . \ . : ~
" •i. ,_
' '
RESIDENT DECF;DENT DEBTS AND DEDUCTIONS CLAIMED
,.NOT:if:' List first five items in the spaces so provided, observe notations thereon, and instructions
DEBT OR CLAIM NATURE OF SAME AMOUNT THIS COLUMN .-------~~~~~~--------~------------~~~--~------------.---------r--mKEGISTERONLY
Joseoh L. Hoffmann
Garrett E. Coleman
OTHER DEBTS AND CLAIMS
Joseph w. Wilson, M.D.
Funeral expenses paid
Family exemption (will not be allowed unless
decedent died residing with a spouse or children.)
Administration Expenses •
Counsel fees •
Fiduciary commission •
( • ) See Note below
Compromise of claim v.
decedent
Total
$
Inn
11 0 bol
75 bo
1 050 PO
1308 DO
Note: The estate agrees t.o advise the Register of Wills if the amount actually paid in settlement of any fee, commission or debt is greater
or less than the estimated amount claimed and allowed. k . /} /
Subscribed and sworn to before me this . . . . . . . . . . . . . . . . . . . . . . . . .#..~~~~ ......... . :;:t;:h_} . . fK~~()9'-Administrator)
...... 2.~!.~··········· dayo~f ~ ... J.anu.ar.y., ........ , 19.7.4 .~O.~ .. ~h~.r.lc;ltul .. S.tr.e.~~ .................. .
. · (Street Number)
.. • .. .. .. . .. .. . . .. ... :. . .. . . ...• BEWl· £ .. WENZEL. NPTARY PUBLIC
Not y Puboll~t<t1AHELA, wAsHINGToNcouNTY .Mo.no.rJgg_h~.lA, .. P.Cl. .•.. .1.5.06.J ............. .
. UYlMI::i~lON E.l>.f'IRES MAY 9, 19lS . (City or T.own and State)
.vll " 1 tN t ies tVIEl110t;i. f eih,jJ to olti&Assasiatjognn ar
rtify that the above appraisement is made in conformity with law on this
........... --:t:f.::.. ... '0/~ .. ' 19. ~t / .... u ..... c.J~.~~·-······ .f&..~ .... U Appraiser
ln the event that any future interest in this estate is transferred in possession or enjoyment to collateraJ heirs of the decedent after the
expiration of any estate for life or for yean,_the Commonwealth het·eby 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 REG~~TER 0 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 cl~ime~ by deponent as to those items where a greater or lesser amount
is set fort~ in the last column to the right in said schedule above, which greater or Jesse . o1t repre nts the sum allowed as a deduction.
Dated: ....... ~~~.?J.W?.f.~Y~.~~~~~!v1~~.r~g.... .. ............ ~ .. • ... • ~ .k ~ ~.
Register of~
' t· H
!
r form No. RCC-62 (4-71)
Will Administration }No. · · · · ...... Year .... .
IN THE
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
.aANE A CO'L.E.f':1AN., ............ ed ..... . "' . · • · · Deceas
Late of ... J1o'n.O.IJ 9.ttheJ.q ............. .
County of .... W.q ~ h i n 9 t 0 n • 0 0 •• 0 ~ • 0 • 0 • • 0 • • • • • • •
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
:E;.u l>rn:::O
<f>C)C ::c -,,...,
-(.fj(j)
:Z--irr; c,:,rn,
..
--J
-t:="
c._ :::z:::a
"Z
,.......,
t.O '-l ;o ,----~0.
...c... -r·~ ::e.: ~
0 -:r.. ::X: o<:::n . --en • I...,.. Jos~1. ~-~.:~ffm""..!!..
At,.;::: ...c::-
242 -~
m:ononga.he:..~., .. ·~ 15063
-n
r
m
0 ...
Form RC C-10
~
OFFICE OF THE
REGISTER OF WILLS
oF Washington COUNTY
AND AGENT OF THE COMMONWEALTH
DEDUCTIONS ALLOWED IN J
THE SUM OF ............ $ /U2',/2'C~
DATE APPROVED . . . . . . . . 1-:=:?i.:_?? f?~~('v'
DATE OF FILING APPRAISEMENT DATE OF DEATH AnY'il 16 1 97n " -, /-c.J
\~ L-P~ \.. -" w~OUNT DATE NO. OF NAME OF PAYEE VOUCHEIIt
T97J
Dec .
••
·1974 Ian.
0
15 Joseph L. Hoffmqnn Reimbursement for
Advertising letters 26
14 Joseph w. Wilson, M.D. Comoromise of claim v.
decedent 1050
14 Garrett E. Coleman Admini<:<tY'~tnr 1 <:< ~11nw~nrA 7r:.
14 Betty E. Wenzel Notary fees 3
14 Register of Wills tnventory 3
14 Joseph L. Hoffmann Attornev 1 s fees 1 1 0
14 Register of W11ls f'il inCJ Account 18
·ReC'.Ii<:<ti!IY' n-¥ hlil1c: E<~timated Audit coc;t<:< (??
1308
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF W'AS·H'tNGT0N
1, GC~rrett r;. Co1ema.n. Admjnjstra.tor. HEREBY CERTIFY, THAT. TO THE BEOT OF
114Y KNOWLEDGE AND BELIEF, THE FOREGOING IS A JUST AND TRUE STATEMENT OF DEBTS, FUNERAL EXPENSES AND EXPENSES 01"
ADMINISTRATION SUBMITTED TO THE ESTATE OF -...l.LICUL...._.Q..o---loULI...._~.l.'l-t'------
INHERITANCE TAX PURPOSES.
rr d-J -~~~~~~t--J~~~~~~~::::.,_-___,.<L. s.l
SWORN AND SUBSCRIBED I!IEFORE ME THIS ,72, L DAY ~
·'• ouo rt, ~G:o/=
BETTY E. WENZEl. NOTARY PUBLIC
MONONGAHELA, WASHINGTON COUNTY
MY COMMISSION L\jJiki:.S MAY 9, 1976
Member, Pennsylvania Association of Notaries
,Joae.,h L. ;
' " .i.,.Jonun" _
50
loo
lao
00
00
00
00
~
00-
I
I
'Vd ··oo NOl~NIHSVM
S lll A\ .:! 0 i:l31 S I ~ 3 tl
ON\Wir'i -ll3SSntl
~I 9 Wd 6 2 ti~r ~l,
'(]3ll:l
RCC-81 (6-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
NOTICE OF FILING OF APPRAISEMENT
GARRET'Jr E. COLEMAN
(Executor or Administrator)
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
In Re: Estate of JANE A. COLEMA.N
___ W._l_SH_IN_G_TO_N __ County-File No. __ 6_l3_-7_0.._5_45 ____ _
Dear SIR:
You are hereby notified that the ____ O_R_IG_INAL __ · __________ _
appraisement in the estate of ___ .....:J~ANE~~A~·~C~O!!!!IEMAN!!:!2~------------
has been filed in the offi'ce of the Register of Wills of WASBINGTQBI
County on JANUARY 3-'>a , 19 74, Said appraisement reflects the following
valuations:
Real Estate --------"t-~'!10--f!tt!'r-------
personal Property 1,.308.00 ----------------------Transfers ______________ __
Jointly Owned-------..---------
Total _______ l~~3J).O!!.!!S~·~oo~----
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22, 1965 to June 16, 1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act a/ 1961,72 P. S. 2485.1001, P. l~ . ~ Da~"'CJ c3o,tfU. s,~ _,
THie ~ •· ,......._, 7::
DATE OF DEATH: APRIL 16, 1970 ESTATE INSOLVENT
Note: This is not a bi II.
RCC•39 (5-~8)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
'( '.
SUMMARY
Estate of COLEMAN, JANE A. DATE OF DEATH 4-16-70 FILE NO. 63-70.,.,545
(Last Name) (First Name) (Initial)
REPORT OF INHERITANCE TAX APPRAISER
WASHINGTON I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of _____________ _
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the values set forth opposite each item in the last column to the right in Schedules "A", "B", "C", and "E".
Dated: JANUAR.Y 30~ 1974 FRED TOSI
INHERITANCE TAX APPRAISER
~s(c?~~
I, the undersigned duly elected Register of Wills in and for Hashi ngton 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 a• a deduction. ("'; ~
Dated, ~ ~ ~ ~974RUSSELL MARINO \.GITE~t~ ~~
INVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISED
$ $ $------------~---~,3Q,J::l 'liT.
Joint-Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
annuities . . . . . . • . . . . . • . . • • . . $-----~---
EST ATE TAX ASSESSMENTS $ -,--------...1.--
1,308. 00
1.308 00
ESTATE INSOI WENT
I
FOR USE OF REGISTER ONLY COMPUTATION OF TAX
Tax on $---------4--2%
Tax on$ @
$ ___________ -4----
$ ___________ -4----
Tax on$ 5% $------------4----
Tax on$ 10% $ ____________ -4----
Tu~$ 1~ $ _____________ ~ ___
&e~ti~s •
Total Estate--------+---
TOTAL TAX $-------------~---
Less tax previously paid $======!===-
BALANCE $--------+----
Less 5% of tax if paid within
3 months after death $=========
Add interest at rate of 6% from
-----to -------
AMOUNT OF ESTATE TAX ASSESSED $--------+----
Estate tax paid $ _____ ___. __
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
BALANCE DUE $--------~---
Add interest at rate of 6% from
---------~10---------
FOR USE OF REGISTER ONLY
$--------+--4~
TOTAL TAX BALANCE $ ------4--PAID $ _______ _.J... __
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 ...... .
IN THE
... Year ........... .
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
JANE A. COlEMAN
. . . . . . . . . . . . . . . . .
Deceased
Late of . . . . MONONGAHELA ....................................... ··················
County of WASHINGTON
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
'
)'"
<
!
f..'.
----------------------~-----------------------------,
Fonn RCC-2
~DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS ..
HARRISBURG. PENNA. 77 1 2 7
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE ....... ~~~.~! .... ?..2.~ ...... ;.?.?.4. ........................ .
COUNTY ...... W.AS.H.ING.T.ON ............................................ ..
FILE NO ................................................................................................. ..
Whereas, .............................. J~~ .... ~.! ..... 9.9.~ ................................................................ late of ..... : .......... ~.N9..NG~A ..................................................... .
in the County of ........................................... W.4$.RJ.N.O:~.Ol\L ....................................................... Commonwealth of Pennsylvania, having died on
the ................................................... l6.th .............................. day of ........................... ~~.~~ .............................. 19.7.~ ..... seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, ........................... F..RED. .... TO.S.I ............................................................................ , an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Description of Aaset Unit
Values
$
Appraisement
Made for Inheritance
Tax Purpoaes
PERSONAL 1--~~~~E~C~O~PY~O~F~~~p~~~I~~~·~T------------------------~------~----.-~1~.~~0~~~00,,_1
ESTATE INSOLVENT
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WASHINGTON
County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
JANE A. COLEM.AH
Deceased.
Late of
MONONGAHELA
Date of Death, ................ ~~~---~-~" __ 197Q;
Appraisemellt Docket Vol. 3Jf························· . ' ..................................................... .
Page, _g_1....=. (p ................. No. . .... ((~.~.'7.~~:4.~ .......... .
Filed in Register's Office, ...... ~A.J:l..-. .... J..f:.>..'-....... 19 .... '1.4
Amount of tax dtte, $ .................................................................... .
DEPARTMENT OF REVENUE
Received,
Examined and Approved,
Wrote abo.ut Appra-isement,
Appeal j1'om Appraisement,
Entered and charged,
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