HomeMy WebLinkAboutOC1970-0893 - ESTATE OF TELLECKCOUNTY ~~.~.h:.~.~g.~.~..~.
FILE NO ?}.:::..?.9..:..~.~..~..
.,
Fonn RCC-2
..DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG.PENNA.17 127
...I.•\'1:
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE September 15,1970.........................................".
Whereas,J..:tJ.l..i.a.T..e.11.e..c..k.,late of 9..h~..:r.~.~:r..9..:i,.
in the County of Ji.~.$..h.i.ngt.Q.n Commonwealth of Pennsylvania,having died on
the !.~~.~day of ~.':l:1.y 19"".7..9,seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore,I,W..,..R~."O'.ha..ne.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 foIlowing 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
JT.HELD:
FEDERAL SAVINGS AND LOAN ASSOCIATION.CHARLEROI
OFFICE.CHARLEROI.PENNSYLVANIA.In the name~of
JULIA TELLECK or STEPHEN TELLECK or NICK TELLECK.
Onened.3-5-51.Balance as of dea1:of cip.:I.t:h
$12,427.08 (One-third is taxable)
Total
Unit
Values
$
Appraisement
Made for Inheritance
Tax Purpoles
4.142 36
4 142 1h
'iASa.JNQlrQN ....County
Date of Death,
L
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
JULIA TEL~ECK
Deceased.
Late of
(;.'::'C".!\RLER9.I~.
July 11,1970
Appraisemel!t Docket Vol.,.
Page,No §..~.~.7.Q.~.e.~.~.
Filed in Register's Office,..s..~.p.t..L ...l.5.J9 7.0
Amount of tax due,$..
DEPARTMENT OF REVENUE
Received,
Examined and Approved,..
Wrote abo.ut Appraisement,.
Appeal f1'Qm Appraisement,..
Entered and charged,..
:"....
..
•
..
RCC-43 (5-65)
'~~COMMONWEALTH OF PENNSYLVANIADEP~TMENT OF REVENUE
HARRISBURG
J
NOTE:TO BE SUBMITTED IN TRIPLICATE
Pennsylvania Department of Revenue
Bureau of County Collections
26,S.4th Street
Harrisburg,Pennsylvania
Dear Sir:
Pursuant to Section 742,Pennsylvania Inheritance and Estate Tax Act of 1961,
we herewith submit the following report:
NAME OF REPORTING
FINANCIAL INSTITUTION -~':':":'=':p.:fl---H~~~~trl¥i-J,,;.A.i,~~I:-----
ADDRESS ..=.:..:.:..:.:.:.::.=....,:....+~..---........;:.-.-----
ACCOUNT NO.OF JOINT,
TRUST OR INVESTMENT DEPOSIT ~_
NAMES ON ACCOUNT Julia Tel1eck or Stpphen Telleckor Nick TelleekORINVESTMENT_
DECEASED JOINT DEPOSITOR,Julia TellcckTRUSTEEORINVESTOR _
ADDRESS 809 Center Ave.,North fllarleroi,Pa.15022
DATE OF DEATH _J_ul_y_,_1l_,_1_97_0 _
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR __St_,e_p_ho_n_,_To_l_l_oc_k_or_U:l_'c_k_T.o_'_l_le_c_k _
ADDRESS Stephen-R.D.#2,Charleroi~Fa.Nick-Taylor Run Rd.11onongahcla.,Fa.
RELATIONSHIP TO DECEDENT SODS to Julia Te11eek
DATE DEPOSIT OR INVESTMENT Harch.5'1951
WAS ESTABLISHED #
BALANCE,INCLUDING INTEREST 12,427.08
DUE,AT DATE OF DEATH $_
Y,/y,<.J Co =
~/07 j,j f @ tX~
5/:,.()~-/0 ~//·;/O
Signature TITLE
110nager
Charleroi Fed I(..:;/L era SaVings and
oan AaSOciation
,.::?~~~u/~xI~~0/c-<'/'7kd ~
Date:__A_U=.IU_s_t_31--"r.-·_1_9_10_._
County __Wi_&_s_·'M_.._'n..;,:g::;.t_o_''l'l_.'_'_
15022
OFFICIAL NOTICE OF INHERITANCE TAX
APPRAISEMENT AND ASSESSMENT OF
ASSETS NOT SUBJECT TO ADMINISTRATION
N.CHARLEROI.PENNSYLVANIA
TO:_S~T:;..;.;E....:;..pg;;:;:,.··...;..~N...;...'1'...;..E....:.;.L...;..LE_C_K_·_
a09 CENTER AVENUE
County File No._
Bureau File No.t:;3 ~lo 'f'1.3
We have received notice that,mxmXXXXxmxxx:unXXXXUU
on ,July 11 ...1970,you came into ownership of certain property through~DmLlU~~
~~tra:mttel't'roltl.JULIA TELt.~CK,detea.aed..,;
RCC-134 (1-69)
COMMONWEAL TH OF PENNSYLVAtllA
DEPARTMENT OF REVENUE -'
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable
and the Iiability for the payment of the inheritance tax due is imposed upon you,as transferee.
The 'p'rope!.ty.on whichtax is hereby assessed consists of:,Jt.BaV!ftgaAeeount #3666,helc1i1'l '
the ,cHARLlSROI,FEDERAL SAVNQS'AND LOAN ASSOCIATION,CHARLEROI OFFICE,s CHARLEROI,
PENNSYLVANIA...1.the'~of JULIA nELIBCK or STEPHEN T!ttECK ~r NICK
appraised by the Commonwealth,as of the date of death,at $12,421.08
1/3Xi of this amount is taxable at the rate of §,%
ORIGINAL ASSESSMENT
DATE OF ASSESSMENT1/Jof 12,4%1.08 ,'!\it 4t142,.36~~------
TAXABLE AMOUNT 1/2 of 4,142.36 -2,0'1.18 $2.011.19
tESS:ALLOWED DEBTS
NET TAXABLE AMOUNT
AMOUNT OF TAX .DUE
AMENDED ASSESSMENT
o If you pay the above amount within three (3)months
of the datec~tdeahof the dec16ent,or on or
before .".19··'you may deduct a
discount of 5%of the amount of tax due,or
o This tax became delinquent,fifteen (15)months
after the date of death and,in addition to the
tax,statutory interest at the rate of 6%of the
tax per annum is also due as of * _
19__in the amount of
*If the tax is not paid by the above date additional
interest is due at the rate of 6%per annum unti I
paid
TOTAL AMOUNT DUE $124.21
APPRAI SED BY:,.:,.\~~-4-----\:~~~~~ASSESSED BY:_
(Agent for the Commonwealth)
INSTRUCTIONS TO TAXPAYERS
Make checks or money orders payable to:
~&y//9/,1...J-O AS
P /~~O'9
.~«/y.?<:l
-
To insure proper credit to your account
thiS Official Notice must accompany
yolirp~rment.Mail or bring it to:
--
If you have already pa id th is tax to an executor,admi nistrator,attorney or other personaI representative of the
decedent for forward ing to the Commonwealth,Iist below the date paid,name and !lddr~ss of the person to whom
you made payment,their official title and the amount..#•.-
Date Paid Name and Address of Payee Official Title Amount Paid
Under certain circumstances,if,after the date of death of the decedent,you personally paid funeral expenses
or other just debts of the decedent,with funds derived from the property herein taxed,such amounts expended
by you may qualify as deductions against the gross value of the property in the computation of tax due.If any
,such expenditures meet aU of the three following tests,it is recommended that you itemize the payments below,
execute the affidavit,and return this notice.The Register of Wills will examine the debts claimed and allow
those which he determines to be proper.The tax will then be recomputed and you will receive an amended
assessment of tax.
THE THREE TESTS WHICH MUST BE MET ARE THAT:
1-You were personally legally responsible for these debts,and
2-You actually paid these debts out of the account or property described above and can furnish proof
of such payment,if required,and
3 -These same debts are not also claimed,for tax purposes,by an executor,administrator or other
personal representative of the decedent handling the administration of the general estate of the
decedent or any other transferee.
Date Paid
SCHEDULE OF DEBTS
Name of Payee Description'of Obi igation
//........
Amount Paid
.J:r 00
//_1-.G 6
(attach separate sheet if requ ired)
COMMONWEALTH OF PENNSYLVANIA)
SS:
TOTAL $/tJO~.S-;;
COUNTY Of _
I,hereby certify that the foregoing is a just and true statement of
funeral expenses and other debts of the decedent,,for which I
was legally responsible and which I did payout of the property herein taxed.I further certify,that to the
best of my knowledge and belief,these same debts will not be claimed by any other person,for inheritance
tax purposes.
SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF
19_
Si gnature of Taxpayer
REPORT OF REGISTER OF WILLS
I,the undersigned,duly elected Register of Wills in and for the above county,do respectfully report that I
have allowed deductions listed above in the total amount of $•
Date of Approval:_
Register of Wi lis
TO:NICK TELLECK
-TA.:¥L9ft RUN-ReAD ,Pd,go/cl~0
MON9NGABGtA ,~PENNSYLVANIA 1:5&i&-
~~~.A~o.2.z
Date:August '31.,1910
County liashington
County File No._
Bureau File No.?J -26 .-F,73
RCC-134 (1-691
-COMMONWEALTH OF PENNSYLVANIA
','DEPARTMENT OF REVENUE"..
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
•OFFiCiAL NOTICE OF INHERITANCE TAX
APPRAISEMENT AND ASSESSMENT OF
ASSETS NOT SUBJECT TO ADMINISTRATION
J
We have received notice that,t,xxxmxxxx
on July 11197,,0 ,you cam,e intoownershipof certain propertlthroug ',,',,''1"',,r ..ax "'",,transfer from.,Julia Telleek,4eeeased.,
Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable
and the liability for the payment of the inheritance tax due is imposed upon you,as transferee.
The p{operty on which tax is hereby assessed consists of:Jt ..Savings Account IJ ~G66 h~ld itl
the CHARLEROI FEDERAL SAVlNOSAND tAON ASSOCIATION,CHARLEROI QIRIY$X OFFICE.
CHARLEnOl,'PENNSYLVANIA.,On thcf tmtnes of'JULIA TEtLECK ,or STEPHENTELLECK.or'NICK .TELLECK ..,Opened ,3...5.51.,llalance aa of date ofd$atb,.$12 j 42'1.08
appraised 'by the Commonwealth,as of the date of death,at $12.,427.08
1/3 ¥of this amount is taxable at the rate of 6 %
.'ORIGINAL ASSESSMENT~~:~BO:E A:~~~~TE17~3 ott4~i4~~i60~~:~~:f:$:&.071,1$
LESS:ALLOWED DEBTS
"NET TAXABLE AMOUNT
ASSESSED BY:_
(Agent for the Commonwealth)
AMOUNT OF TAX DUE
o If you pay the above amount within three (3)months
of the date of d,eathof the decedent,or on or
before Oct..11 ,19 70 you may deduct a
discount of 5%of the amount of tax due,or
o This tax became delinquent,fifteen (15)months
after the date of death and,in addition to the
tax,statutory interest at the rate of 6%of the
tax per annum is also due as of*_
19__in the amount of
*If the tax is not paid by the above date additional
interest is due at the rate of 6%per annum until
paid
$
124 ..21
6.21
------'----
124.27
AMENDED ASSESSMENT
s/l-----------
$====~=6=.::::t.L=:==:=
-
Make checks or money orders payable to:
~AIR /<1.r 6.,£3
~~~6(J,CY
/'/~/(f
To insure proper credit to your account
thiS Official Notice must accompany
your payment.Mai I or bring it to:
If you have already paid this tax to on executor,administrater,atfcirney or other personal representative of the
decedent for forwarding to the Commonwealth,list below the dote paid,name and address of the person to whom.,
you mode payment,their official title and the amount.•..•.
Dote Paid Name and Address of Payee Official Title Amount Paid
Under certain circumstances,if,after the dote of death ofthe decedent,you personally paid funeral expenses
or other just debts of the decedent,with funds derived from the property herein taxed,such amounts expended
by you may qualify as deductions against the gross value of the property in the computation of tax due.If any
such expenditures meet all of the three following tests,it is recommended that you itemize the payments below,
execute the affidavit,and return this notice.The Register of Wills will examine the debts claimed and allow
those which he determines to be proper.The tax will then be recomputed and you will receive an amended
assessment of tax.
THE THREE TESTS WHICH MUST BE MET ARE THAT:
1 -You were personally legally responsible for these debts,and
2 -You actually paid these debts out of the account or property described above and can furnish proof
of such payment,if required,and
3-These some debts are not also claimed,for tax purposes,by on executor,administrator or other
persona I representative of the decedent handl ing the admin istration of the general estate of the
decedent or any other transferee.
SCHEDULE OF DEBTS
Dote Paid Name of Payee -Description of Obligation Amount Paid
?-/(;'""7rJ I/Z/"""~A AJ~-~...:h.../x:Z-./l.A/-,A ....1700
1'7_-,/..-76 ~~.A"J--://'.J 'J:.,/",j e--1 /?<--J~/-7 A7--?/-r/",...,~S:C)O
'j;r '7"":..'76 IvY;h:""",L-AL '-7%,.....-'%-'.J ~/~~~""-',')3 ~y/
Ie -26'70 1-./~.~4 ;'./;.1/-:hAl,~.A'_____;,J.."~~-/'-J'.>'L ~0 '"'1-,-t:..-'7,-')1'-~~*.J.111 ''---/P-'d .,..//"-J1 -/1 ,;?-:;:;:;lr.Jc..~-70 "/"J../A'/;;;~.VA .,?',A1 n
./....~~/P ///~~';"4 __7~.,i
/v /'"
"'.
TOTAL $/f OO?'-.r7
(attach separate sheet if required)
COMMONWEALTH OF PENNSYLVANIA)
COUNTY Of _
SS:
I,hereby certify that the foregoing is a just and true statement of
funeral expenses and other debts of the decedent,,for which I
was legally responsible and which I did payout of the property herein taxed.I further certify,that to the
best of my knowledge and belief,these some debts will not be claimed by any other person,for inheritance
tax purposes.
SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF____________19 __.
Signature of Taxpayer
REPORT OF REGISTER OF WILLS
I,the undersigned,duly elected Register of Wills in and for the above county,do respectfully report that I
have allowed deductions listed above in the total amount of $--------e
Date of Approval:_
Register of Wi lis
N.CHARLEROI,PENNSYLVANIA
OFFiCiAL NOTICE OF INHERITANCE TAX
APPRAISEMENT AND ASSESSMENT OF
ASSETS NOT SUBJECT TO ADMINISTRATION
Date:A_u=g_u_s_t_2_5--,-,_1_9_7_0 _
County __~W:.;.;;A~S;;..::H=I=N.:..;:;G-=T-=O=N _
County File No.3%-/~;6 -.3
Bureau File No.&.3-70 -tf3»
15022
TO:STEVE TELLECK
809 CENTER AVENUE
COMMONWEALTH OF PENNSYLVANIA
,l:1EPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
We have recited notice th&t,aU&UJI~Ut~XXXX~XXXXXXXXXXXXX.XXXXXXXXXXXXXXXXXXXX.
on July 192-,you came Into ownership of certain property through ~~HJ,XBmxx
~~i~XJMoc~transfer from,JULIA ~ELLECK,DECEASED.
Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable
and the Iiability for the payment of the inheritance tax due is imposed upon you,as transferee.
The property on which tax is hereby assessed consists of:It I Checking Acct.#02 03250 3 09
held in the FIRST NATIONAL BANK &TRUST COMPANY,WASHINGTON PA.,CHARLEROI
OFFICE,CHARLEROI.PENNSYLVANIA.In the names of Julia Telleck or Steve
Telleck.Opned,12-4-45.Balance as of date of death,$1,478.37.-
appraised by the Commonwealth,as of the date of death,at $1,478.3T
50 %of this amount is taxable at the rate of 6 %
ORIGINAL ASSESSMENT AMENDED ASSESSMENT
DATE OF ASSESSMENT
TAXABLE AMOUNT
LESS:ALLOWED DEBTS
NET TAXABLE AMOUNT
$..L7w..39"""'......1....9l--_$--------
AMOUNT OF TAX DUE 44.35
D If you pay the above amount within three (3)months
of the date of death of the decedent,or on or
before Oct.11 19 70 you may deduct a
discount of 5%of the amount of tax due,or - -----~~~--
D This tax became delinquent,fifteen (15)months
after the date of death and,in addition to the
tax,statutory interest at the rate of 6%of the
tax per annum is also due as of *_
19__in the amount of
*If the tax is not paid by the above date additional
interest is due at the rate of 6%per annum until
paid
INSTRUCTIONS TO TAXPAYERS
ASSESSED BY:_
(Agent for the Commonwe.alth)
$-=====Lt:::./~::=:::t:/:::=:.}======44.35$TOTAL AMOUNT DUE
Make checks or money orders payable to:To insure proper credit to your account
thiS Official Notice must accompany
your payment.Mail or bring it to:
COURT HOUSE
WASHINGTON,PENNA.15301
~.
If you have already paid this tax to an executor,administrator,attorney or other personal representative o-~~"~
decedent for forwarding to the Commonwealth,list below the date paid,name and address of the person to whom
you made payment,their official title and the amount.•.
Date Paid Name and Address of Payee Official Title Amount Paid ii
Under certain circumstances,if,after the date of death of the decedent,you personally paid funeral expenses
or other just debts of the decedent,with funds derived from the property herein taxed,such amounts expended
by you may qualify as deductions against the gross value of the property in the computation of tax due.If any
such expenditures meet all of the three following tests,it is recommended that you itemize the payments below'---
execute the affidavit,and return this notice.The Register of Wills will examine the debts claimed and allow
those which he determines to be proper.The tax will 'then be recomputed and you will receive an amended
assessment of tax.
THE THREE TESTS WHICH MUST BE MET ARE THAT:.'
1 -You were p~r~onally legally responsible for these debts,and
2-You actually paid these debts 'out of the account or'property described above and can furnish proof
of such payment,if,required,and '1:'
3-These same debts are not also claimed,for tax purposes,by an executor,administrator or other
personal representative of the decedent handling the administration of the general estate of the
decedent or any other transferee,
SCHEDULE OF DEBTS
J J
Date Paid Name of Payee"Description of Obligation Amount Paid
TOTAL $
(attach separate sheet If reqUired)
COMMONWEALTH OF PENNSYLVAN'IA)
COUNTY Of _
SS:
I,hereby certify that the foregoing is a just and true statement of
funeral expenses and other debts of the decedent,,for which I
was legally responsible and which I did payout of the property herein taxed.I further certify,that to the
best of my knowledge and belief,these same debts will not be claimed by any other person,for inheritance
tax purposes.
SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF____________19__
REPORT OF REGISTER OF WILLS
Signature of Taxpayer
.\.~
I,the und:ersi'goe:d;duly elected Register of Wills in and for the above county,do respectfully report that I
have allowed deductions listed above in the total amount of $•
Date of Approval:_
Register of Wi lis
-----------.
TO:MR.&MRS.STEVE TELLECK
.SO!eluR5B AYENYE-:fj)-I~.80/S/S'Jl
If.CHARLEROI,PENNSYLVANIA 15022
OFFICIAL NOTICE OF INHERITANCE TAX
APPRAISEMENT AND ASSESSMENT OF
ASSETS NOT SUBJECT TO ADMINISTRATION
Date:__...::.A::.;:u=g:>.:;u=s-::t'---=.3=1••--'1=9:-7.:..;0=--__
County W_A_S_H_I_N_G_T_ON _
County File No ....3 g-/tJ~-~
Bureau File No.'t:,3 -ZtJ -q 3
We have received notice that,~~XXXXXXXXXXXXXxx.xXXXXXXXXXXXXXX
on Ju1y 11 191.0-.,you came into ownership of certain property throug~IJiB~
~X1~~~~~transfer from,JULIA TELLECK,deceased.
"';-.:c.RCC-13411-69),.""-COMMONWEAL TH OF PENNSYLVANIA
•.,rtEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable
and the liability for the payment of the inheritance tax due is imposed upon you,as transferee.
The property on which tax is hereby assessed consists of:Jt.Savings Account #14636,held in
the CHARLEROI FEDERAL SAVINGS &LOAN ASSOCIATION,CHARLEROI OFFICE,CHARLEROI
PENNSYLVANIA.In the names of JULIA TELLECK or STEVE TELLECK or·FRANCES
TELLECK.Opened,12-31-65.Balance as of date of death,$7,326.60.
appraised by the Commonwealth,as of the date of death,at $7,326.60
1/3 ~of this amount is taxable at the rate of 6 %
ORIGINAL ASSESSMENT AMENDED ASSESSMENT
DATE OF ASSESSMENT
TAXABLE AMOUNT
LESS:ALLOWED DEBTS
NET TAXABLE AMOUNT
$_--:2:.;,,-4.:...,;4:..:2:.,:•.=2:.:::;0__$---------
AMOUNT OF TAX DUE 146.53
o If you pay the above amount within three (3)months
of the date of death of the decedent,or on or
before Oct.11 19 70 you may deduct a
discount of 5%of the amount of tax due,or
o This tax became delinquent,fifteen (15)months
after the date of death and,in addition to the
tax,statutory interest at the rate of 6%of the
tax per annum is also due as of *_
19__in the amount of
*If the tax is not paid by the above date additional
interest is due at the rate of 6%per annum until
paid
TOTAL AMOUNT DUE $146.53
APPR AISED BY:~-Y-:---tq.......-l.e;:::!~~!:::¥-ASSESSED BY:_
(Agent for the Commonwealth)
Make checks or money orders payable to:To insure proper credit to your account
thiS Official Notice must accompany
your payment.Mai I or bring it to:
•.,i::.\Jr.i iVl~N~_£AdH
COURT HOUSE
WASHINGTON,PENNA.15301
,~
If you have already paid this tax to an executor,administrator,attorney or other personal representative of the ,,,,,,
decedent for forwarding to the Commonwealth,list below the date paid,name and address of the person to whom 4-
you made payment,their official title and the amount.~.,,•
Date Paid Name and Address of Payee Official Title Amount Paid
Under certain circumstances,if,after the date of death of the decedent,you personally paid funeral expenses
or other just debts of the decedent,with funds derived from the property herein taxed,such amounts expended
by you may qualify as deductions against the gross value of the property in the computation of tax due.If any
such expenditures meet all of the three following tests,it is recommended that you itemize the payments below,
execute the affidavit,and retur.n th~s notice.:The Register of Wills will examine the debts claimed and allow
those which he determines to be proper.The tax will then be recomputed and you will receive an amended
assessment of tax.
THE THREE TESTS WHICH MUST BE MET ARE THAT:
1 •You were personally legally responsible for these debts,and
2-You actually paid these debts out of the account or property describ~d above and can furnish proof
of such payment,if required,and
3 .These same debts are not also claimed,for tax purposes,by an executor,administrator or other
personal representative of the decedent handling the administration of the general estate of the
decedent or any other transferee.
SCHEDULE OF DEBTS
Date Paid Name of Payee Description of Obligation Amount Paid
-
TOTAL $
(attach separate sheet if required)
COMMONWEALTH OF PENNSYLVANIA)
COUNTY Of _
SS:
I,hereby certify that the foregoing is a just and true statement of
funeral expenses and other debts of the decedent,,for which I
was legally responsible and which I did payout of the property herein taxed.I further certify,that to the
best of my knowledge and belief,these same debts will not be claimed by any other person,for inheritance
tax purposes..,
SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF____________19__
REPORT OF REGISTER OF WILLS
Si gnoture of Taxpayer
I,the undersigned,duly elected Register of Wills in and for the above county,do respectfully report that I
have allowed deductions listed above in the total amount of $p
Date of Approval:_
Register of Wi lis