HomeMy WebLinkAboutOC1970-1091 - ESTATE OF ANDREASIKRC~-134 (1-69)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
•BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
OFFICIAL NOTICE OF fNHERI:rANCE TAX
APPRAISEMENT AND ASSESSMENT OF
ASSETS NOT SUBJECT TO ADMINISTRATION
TO:GENEVIEVE KERNER
lS3NORTH SPIINO VALLEY ROAD
McMURRAY I PENNSYLVANIA 15317
Oat.__O.::..:o~t~o~b~'e~r~2~9~,_,lo!!o.;9!i!..J7u:O!......-__
County W_'_'_h_lft_g=-t_O_b _
County File No._
Bureau File No.?.3-26 r-/Op
~e have received notice that,~~~~~~~~~~~~~~~~~~~~~~~~~~~on September 23 19 70 ,you came into ownership of certain property through
_~tran.ftr from.ANNIE ANDWSIK.'decea'sed.
Uri~er theJnheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable
,\and the liability for the paymen,~of the inheritance tax due is imposed upon you,as transferee.
,I,
.,Th~propertyon which tax ,is hereby assessed consists of:Jt.Bank Account #3922 •held in ,he
;''SJ:,(1VENIAN SAlINOS AND "LOAN ASSOCIATION ,-STRABANE OFFIOE,STRABANE.
,appraised by the Commonwealth,as of the date of death,at $11.381 ~48
50 %of thi s amount is taxable at the rate of 6 %
ORIGINAL ASSESSMENT AMENDED ASSESSMENT
DATE OF ASSESSMENT
TAXABLE AMOUNT
LESS:.ALLOWED DEBTS
NET TAXABLE AMOUNT
$__......5'+.6a.z.9;,J,o;3....'80+1..4--
1,975.27
3.118.41
AMOUNT OF TAX DUE,
o If you pay the above amount within three (3)months
of the date of death of the decedent,or on or
before Dee..23 19 70 you may deduct a
discount of 5%of the amount of tax due,or
,'11.1$
211,96
(Agent for the Commonwealth)
341 ..62
"
$
ASSESSED BY:---,--_
TOTAL AMOUNT DUE
~APPRAISED BY:-1...G.='-'-A--.---\--,,,,,,,A,.'__~~"-"-+--
{Inheritance Tax Ap aiser)
..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
*1£the tax is not paid by the above date additional
interest is due at the rate of 6%per annum until
paid ""'t","'"-_
TRUCTIONS TO TAXPAYERS
Make checks or money orders payable to:
~o1//t
~~/2~/~~
To insure proper cred it to your account
this Official Notice must accompany
your payment.Mai I or bring it to:
AGENT 1-0,;T£{E ..or"M:.N.,i:.A ..t ,.
COURT HOUSE
WASHINGTON,PENNA.16301
-''''-1'"'i,.~.,,",...,
If you have already paid this tax to an executor,administrator;-atterri~y or other personal representative of the..
decedent for forwarding to the Commonwealth,list ~~Iow the <{ate paid,name tmd address oLthe person to whom,
you made payment,their official title and the amOl:'nf~~<.~~•'.
Date Paid Name and Address of Payee '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 return this notice.The Register of Wills will examin~."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.-', ,.J ",
,,
THE THREE TESTS WHICH MUST BE MET ARE THAT:
1 -,You were personally legally responsible for these debts,~nd
2-You actually paid these debts out ofthe account or proper'ty 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,admir'listratonjr other
personaI representative of the decedent hand Iing the adm in istration of tpe generaI estate ,of thE!
decedent or any other transferee.".
SCHEDULE OF DEBTS
Date Paid Name 'of,Payee Description of ObligQtioll "Amount Paid
10...1\.'70 .'_.,1 HAml1il --1..140.00,
10..7;"'0 St....Pa+.-4 ...1r bnu,n.:;S''"-,-,,:;"-,'=-;;;:75.00[I '.,I."V·1.•.:I111
11.9·70 KUrtz,Monulitbettt Co..na:rav .Wt on Stone l~.00'
,0.7.10 llail;,A ...•.c ..d \''"~..(-0vaL\"n_~,_,.,n Ill'''',,',,~,-,.'....)4'i ..Jr.'"....IH1','"J7·..
LU..-fO ("..\llllb:Ja Gal co.F:naJ _.~a•UUI •lU"0....S...r(l wast penn Electr1c Final Eltetri.c B.111 '·3 ..33I..'6.0 water &Sewaa.Bill '1.'17....~o Zu.ver Flover Sho'D Floral SiraY''10.00
.2 •o Jefferlon Room.Recention followintt-tuneral 218.00
.21 "'"'0 Fa.ther BlelcUlIl Funeral.S.rvlce.'25.00
TOTAL $'l,91S.27
(attach separate sheet if requ ired)
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF:_
SS:
I,hereby certify that the foregoing isa 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__
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 $"
Date of Approval:_
Register of Wills
.'
RCC-43 (5-65)
~."{,f /'
(
COMMONW~ALTH OF.p'~NNSY.LVANIA\Rfe
DEPARTMENT OF REVENUE t(Jj1JNf.iJ~E~~£~
HARRISBURG r LV;1"Y-.'.t:I',-'.Ocr lJ :iONs
406 fl1 'ill
j
NOTE:TO BE SUBMITTED IN TRIPLICATE
Pennsylvania Deportment 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:I
NAME OF REPORTING,',
FINANCIAL INSTITUTION Sloveman SQ,tt••aAd.Loaa Moee1a.&ioft
ADDRESS _107 Latimer Avenue,strabaQe.PeMtiJ¥4wm&lSa1?
ACCOUNT NO.OF JOINT,
TRUST OR INVESTMENT DEPOSIT=,,-..,__3~9=22!:!..,'_--'--_
NAMES ON ACCOUNT "'
OR INVESTMENT Annie Andreasik or Genevieve Kerner
~f~'
Signature TITLE
Albert L.70111810.Manager
\
ADDRESS 15)North Sprinc Valley Bd••t.tc}1Urray,PeMsylya nta 1'317
DATE OF DEATH Septembel'2l,198
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR Genmdeve KevMr
ADDRESS lS3 North Spr1,ng Valloy Road,McMurray.PeQ~PVlvQA1a 15)17
RELATIONSHIP TO DECEDENT 1la::::.:,'="Mh:::li::C:"::"W.:r::',,~'_
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED June aOt 1964 #
BALANCE,INCLUDING INTEREST I
DUE,AT DATE OF DEATH $U.)S7.4S -5.--~~7J.71
.1"{,7i 1 ~t.1..1,7/::sf/,to ~
j-7tJ dfJ~,--r/J,()f
..........,."..~.,.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
HARRISBURG
RCC-43 (5-65)
NOTE:TO BE SUBMITTED IN TRIPLICATE September 28,1970
Pennsylvania Department of Revenue
Bureau of County Collections
26 S.4th Street
Harrisburg,Pennsylvania
Dear Sir:
Pursuant to Section 742,Pennsylvania Inheritance and Estate Tax Act of 1961,
we herewith submit the following report:
DECEASED JOINT DEPOSITOR,..~'TRUSTEE OR INVESTOR __An_·,_n_El_An_·_d_r_e_8s_i_k_'__~--.;..;....
103 1'1 S'·. ../--ADDRESS .Qrgan treat,,canonsburg ,1:>a..15317 ~;9):;L-
_.__._...._~DATEOF-DEATH Sop'tGlnber23;'1970
SURVIVING DEPOSITOR,BENEFICIARY OR INVESTOR __G_en_e_v_i_o_v_e_l<e_r_n_e_t'_
ADDRESS __1_03_'_~_~o_r_9_a.n__S_t_:;r_e_e_t._'__c_a_n_O_n_$b_.u_r_9_,,_ii'_a 1_5-..3_1_7__
NAME OF REPORTING .,FINANCIAL INSTITUTION Pit.tsburgh National Bank
ADDRESS 4 W.Pike Streett Canonsburg,Pat 15317
ACCOUNT NO.OF JOINT,
TRUST OR INVESTMENT DEPOSIT_8_2-_2_0_1_7_76_2_.-----:------------
NAMES ON ACCOUNTn ...'d'•.~,i·OR INVESTMENT lU.na An reaa k or Genevieve Ke~ner
l\ss1stant Sec.
TITLE
RELATIONSHIP TO DECEDENT __D_a_u_9_h_te_r__,~_
DATE DEPOSIT OR INVESTMENT August 1 1966
WAS ESTABLISHED t .
BALANCE,INCLUDING IN 'E~13 ~l""'.X _PI)I IIJI 7/
DUE,ATDATEOFDEAT $"•.",,:L ~1j VJ l ,"
'II.----.\,.
;1 it .1,;'F3.1/J \rP ~dL.,...~~14{~If/,7/~')7t.50 J •""'--v<'"\-I"'V\f·~.
"\Si gnature
S ~clj)~l ::tlJ31 r~
R.CC-134 (1-69)
.COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
-.-..."--.:'".~.OFFICIAL NOTICE OF INfiERITANCE TAX
APPRAISEMENT AND ASSESSMENT OF
ASSETS NOT SU BJ ECT TO ADMINISTRA TION
Date:October 7,.19'10
County \lla$h:l.mlton
County File No._
Bureau File No.&3'/6'!a 9/
We have received notice that,as a result of the death of_·..EI.An~M~·.::r._..-.f,A~nUild~r.lolieaa$ii:.Li~k:l:_·_
on Septembet'2;19..12.,you came into ownership of certain property through right of survivorship,which
was formerly owned by the decedent.
Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable
and the liability for the payment of the inheritance tax due is imposed upon you,as transferee.
Th.e_E.L~p.er!y'on which tax is hereby..a~..e~~~Si.sts ..0i:Jt•.Sa~g AeccuntlJe2~20l7'62Jheld in
PIT'l'PBURuH NATIONAL W.NKj~oNSDtlRG'-~CEJ CA'NONSBURG~~YLVANU.In the ~$of
appraised by the Commonwealth,as of the date of death,at $---L9~.2:8:o:.lil:..l'E,=U=·....,-:---
SO %of this amount is taxable at the rate of 6 '%
.ORIGINAL ASSESSMENT AMENDED ASSESSMENT
ASSESSED BY:_
(Agent for the Commonwealth)
DATE OF ASSESSMENT
TAXABLE AMOUNT
LESS:ALLOWED DEBTS
NET TAXABLE AMOUNT
AMOUNT OF TAX DU E
o If you pay the above amount within three (3)months
of the date of death of the decedent,or on or
before December ·23 19 10 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 a&ove date additional
interest is due at the rate of 6%per annum until
paid
TOTAL AMOUNT DUE;\,
APPRAISED BY:---1::;;....:::::.(/,~f_?_·a_U_1,~_'!:_~'';:l-::'::':'1-=--
(Inheritance Tax Ap aiser)
$
rza'fi$O
---l~92-----
$--------
$-=================
INSTRUCTIONS TO TAXPAYERS
Make checks or money orders payable to:;J;!~&c/c:-/s?At!-///O",zYdZ?//-/d~?<'f
.~'~!1~(,I N-Ji...,,,>.~;a;~·
.,.....",.
To insure proper credit to your account
thiS Official Notice must accompany'
your payment.Mail or bring it to:
'.
\;",u•.T riO:;S2
r,ASHING10N,PENNA.Ib3.7,)
If you have already paid this tax to an executor,administrator,attorney or other personal representative of the
decedent for forwarding to the Commonwealth,~ist.b.el,,~.rtfle·d{r.'e paid,nome 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
Under cerfain 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 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 '~ther
personal representative of the decedent handling the administration of the general estate of the
decedent or any other transferee.
SCHEDULE OF DEBTS
(attach separate sheet if requ ired)
Date Paid Name of Payee Description of Obligation Amount Paid
.,./li::r.,
'''2·'':i·~::W''
(c'"'-~
I!
-'II'
.'.."".~\,'\{'.\TOTAL $.."
COMMONWEALTH OF PENNSYLVANIA)
COUNTY Of _
SS:
I,hereby certify that the foregoing is a just and true statement of
funeral expenses and other debts of the decedent,,for wh ich I
was legally responsible and which I did payout of the property herein taxed.I further certify,that to the
best of my knowledge and belief,these same debts wi~~not be claimed by any other person,for inheritance
tax purposes..
SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF____________19__.
Signature of Taxpayer.
Register of Wi lis
.~;:.
......:..',-'
,~l~
1".-...............'"
t •,\~;.I----...,---------....;..,---------:;.,:.::;".!il"',~-.~~------.........:.:.'....i.....--'------·l:Ilj~;b,,:O:·ifo"''''',;;,:"'~;,.."..----:"l r.;ff
•f""".4 ,~~"REPORT OF REGISTER OF WILLS .,,'-.'~',!'l'f">':.r"':,}J '~.;,\~I
I,the undersigned,'du Iy elette:d :~gister .of Wi lis il'l~.and for the abov~co~~ty!:~~~t$l:t;uLI~:;~'~'~rt that I"
have allowed deductions'.Jisie~~~b'Q,~~.i.:~i~t~total amo'unt of $:',.
Date of Approval:t".~y"~·
Fonn RCC-2-.COMMONWEALTH OF PENNSYLVANIA DATE ............................................................................................
"DEPARTMENT OF REVENUE •-.;1,..Washington,RESIDENT INHERITANCE TAX COUNTYBUREAUOFCOUNTYCOLLECTIONS .......................,..................................................................
HARRISBURG.PENNA.17127 APPRAISEMENT
FILE NO.................??..:..?..2.=.!.9...~.!...._................
I
Whereas,..............Ann.i.~.....A.n.d..r..e..as.ik........................................................................late of ......................................M9..M~.r..r.~y .......................................
in the County of ..............~~~.~.~.~~.g~..Q.P.:..............................................................................Commonwealth of Pennsylvania,having died on
the .....................~.;?.....r..g......................................................day of ...........s..e.pt.e.mber..............................19.7..0...,seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
I Therefore,I,...............Ji.....R........C.h.a.n.ey......................................................................,an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate,and to assess and fix
the cash value of all annuities and life estates growing out of said estate,hereby file the following appraisement:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years,the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit Appraisement
,Description of Asset Values Made for Inheritance
Tax Purposes
$
JT.HELD:
.IT H;-anlr AC"iJ-"O??held in the SLOVENIAN
SAVINGS AND LOAN ASSOCIATION STRhRdNR (HfF'J(:ti
STRABANE.PENNSYLVANIA.In t:hp nf'ANNTF.
ANDREASIK or GENEVIEVE KERNER.On""nArl 6-26-64...
Balance as of date of death,$11.387.48.(One half TaxO 5.693 74
Jt.Savings Account #82-2017762.held in the
PITTSBURGH NATIONAL.BANK,CANONSBURG OFFICE.CANONSBURG
PENNSYLVANIA.In the names of ANNA ANDREASIK OR
I GENEVIEVE KERNER.Opened,.;8-1-66.Balan€p ;-a~nf',
(bnedateofdeath.$9.283.41 half taxahle)4,641 71..,
...
.'
f•.,
..
,
;..'T9 tal 10,335 45
,./
.-
fonn~;v~~~::fh~Sw~~~o.~w,~.~o~~~~ntism~del~n.~n9...............'............................7··..·~i·8~~
?ZJr-~Z,jE:ji?;;,dm;;.').................................................._.........cY''';;'<.j"..................,Penna.
JiMHI:r.NQ'J:'O~r County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
ANNA ANDREASIK
Deceased.
Late of
'McMURRAY
Date of Death,~.~.p.~.~.~?.~.r 23,1970..........................................
Appraisemei!t Docket VolOJ ••••••••••••••••••••••••••••••••••••••••••••••••••
Page,..No..(j3-70-1091..
"1,....."".
Filed in Register's Office,19 .
Amount of tax due,$.
DEPARTMENT OF REVENUE
Received,
Examined and Approved,..
Wrote abo.!It Appra.isement,
Appeal f1'om Appraisement,..
Entered and charged,.
"
~..
R CC-43 (6-64)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
HARRISBURG
j
NOTE:TO BE SUBMITTED IN TRIPLICATE
Pennsylvania Department of Revenue
Bureau of County Collections
Financ~Building
Harrisburg,Pennsylvania
Dear Sir:
Pursuant to Section 742,Pennsylvania Inheritance and Estate Tax Act of 1961,we
herewith submit the following report:
REPORTING
FINANCIAL INSTITUTIONS M(,ltllon Natt()'rtalBank .and True'Company
ADDRESS t West Pi.ke Street,Canonsburg.Pa,IS311
ACCOUNTl'lO.OF JOINT OR"..
TRUST DEPOSIT OR INVESTMENT 5avtnga Account No.066..t,013
NAMES ON ACCOUNT
OR INVESTMENT Antla An.dreaaik or Cenevieve Kemei'
DECEASED JOINT DEPOSITOR,~--c,/'
TRUSTEE OR INVESTOR A_n_J1_a~An_·._,d_r_c_a_o_i_k_.,-----:V:::--_
ADDR ESS __1_03~_.M_~o-'-'tg!:!..a::..n:.::..:.::..£!,:.::..·t=_.,~C:::..;a:.::..n;:..:o:..::n;:..:$:.::b:..:::q:.::t.!!!g~•...;:P=--=.a=--•...;1:..::.5:.::3:...:1..:..7 _
L.
DATE OF DEATH Sept.23,1970
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR _0=,.=en=·e=v.:::..:i:::c::e"--'v--"e:....:K::.::·:.:e~rn~~e,.=_··_
ADDR ESS _-=1:...::5:...:::3-=N~··~•....::S:.z::P::=.!"..:::in:=J!S::L'-=.V-=a..:::U~eLy...:Ro~~a~d~·,_M~',~e~M~u.~r~:r~a~y..L'~p~·a.~.!-~1!!...5~31~?~·_
,..~i
RELATIONSHIP TO DECEDENT daughte1'DATE DEPOSIT OR INVESTMEN-T--~--:...;-,....--------------
WAS ESTABLISH ED __---'--_-=-A::..::u=g=u=$-=-t-=lCL..~_1~9!...::'6:..::b:e.-'.=-v ~_
BALANCE AT DATE OF DEATH $:1,2:10.91_...::..---:...;-=-----------~-----
RCC·...134 (1-691
COMMONWEAL TH OF PENNSYLVANIA
~I;lEF'ART<ttENT OF REVENUE
BUREAU OF tOtlNTY COLLECTIONS
INHERITANCE TAX DIVISION
OFFiCiAL NOTICE OF INHERITANCE TAX
APPRAISEMENT AND ASSESSMENT OF
ASSETS NOT SU BJ ECT TO ADMINISTRATION
TO:__G_c_"n_G_,\_,1_c_v_e_K_e_!'_n_e_X"_
15'3 N.Sprin~Valle"Road
Date:_....:D::.:e~c:::.::e:=m~b:.:::e~r_9L.L~1::..<97'_L~0~_
County _---..:.l'1:;:::·8.:,:s.:.,:h:=in:;:,f.t::J,;l~o::.:.n~_
Het~urray t Pennsylvania 15317
".
County File No.-....:;Y!-//6 -/
Bureau File No.t:J~ZLJ -/6V
W h . d . h YVv·YYYV1T.VYNZ,fYYVY",..:fyW£y....rvV\.YVvv·J'v,,·yvvvvVVxxryVVV'cVVy·vvv"'mx'"VVVVVVVVYeavereceIvenotIcetat,as"G-'f-e5O{H"'e'f'loJ'''e<''EJoEl'EH'I¥'El'l'~.t\.AJ\..,'!...IVJJ'''')..,:V>.A,....•..AAi\..l\.J\.U\..il.<'\Ai .t....v~.'I.A..........x..,,\AA.,~:
on September 23 19....1Q..,you came into ownership of certain property throughmbtxWX.~~
~~~transfer from &X AN~jA AlIDHU\SIK,deceased.
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.Sa.vings Account No.066-2013 held in
the HELLON NATIONAL DANK AND THUST COt,iPANY CANONSBURG,OFFICE,CANONSBURG,PENNSYLVANIA
In the names of ANNA A:NDREl,SIK Oll GEW:.ivIEVE KEHHEH.Opened AJJ.t,TUst 1.19661 Balance as
of date of death,$3,230.97.
appraised by the Commonwealth,as of the date of death,at $3,230.97
50 %of this amount is taxable at the rate of 6 %
ORIGINAL ASSESSMENT AMENDED ASSESSMENT
ASSESSED BY:_
(Agent for the Commonwealth)
DATE OF ASSESSMENT
TAXABLE AMOUNT
LESS:ALLOWED DEBTS
NET TAXABLE AMOUNT
AMOUNT OF TAX DUE
o If you pay the above amount within three (3)months
of the date of death of the decedent,or on or
before December 23 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
APPRAISED BY:........l...~!.....:-~~::::::!::::::~---
praiser)
$
96.93
96.93
$--------
$=============
INSTRUCTIONS TO TAXPAYERS
Make checks or money orders payable to:
#~70/0/
fl~·/s;/;7/,cJ
~#'~/4Y/s-,,3 e:P
To insure proper credit to your account
thiS Official Notice must accompany
your payment.Mai I or bring it to:
If you have aIready po id th is tax to an executor,admi nistrator,attorney or other persona I representat ive of tht1
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
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 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.
SCHEDULE OF DEBTS
Date Paid Name of Payee Description of Obligation Amount Paid
TOTAL $
(attach separate sheet if requ ired)
COMMONWEALTH OF PENNSYLVANI'A)
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 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 $--------0
Date of Approval:_
Register of Wi lis
,~Form RCC-2
,.4'COMMONWEALTH OF PENNSYLVANIA DATE December 15,1970.........................................................................................,....
DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX Washington••"-..·.......tt..COUNTYBUREAUOFCOUNTYCOLLECTIONS ..........................................................................................
HARRISBURG,PENNA.17127 APPRAISEMENT FILE NO.63-70-1091.............................................................................................
I Whereas,...................................~.~~....~~~!.~.a.:.~.~.~.................................................................late of .........."........g.~P.:9.P.:~p.:t:l!g,.......................................................
in the County of ...........................WashingtQn.........................................................................Commonwealth of Pennsylvania,having died on
the ....................................2..3.d.................................................day of ...................~........~.~p.t..It.....................19...7.9..,seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore,I,...................................JJIl..R•.GH.AN.EY..............................................................,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
I the cash value of all annuities and life estates growing out of said estate,hereby file the following appraisement:
I
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 transferinheritancetaxesatthelawfulcollateralrateonanysuchfutureinterest.
Unit Appraisement
I Description of Asset Values Made for Inheritance
I Tax Purpol8s
$
JT.SAVINGS ACCOUNT NO.066-201'3 held in the 1.fE110N NATIONAL
BANK AND TRUST CONPANY CANONSBURG.OFFICE.CANONSBURG,PENNSYLVANIA
IN THE NAMES OF ANNA ANDREASIK OR GENEVIEVE KERNER,OPENED 8-1-66.
Balance as of date of death,$3,230.97.3,230 97
->
-",;
......,.
,.;"
>
I
.-
,
Having been duly sworn according to law,I do hereby certify that the above appraisement is made in con-
formity with Jaw on this ............../3:'~..day of .....................A:J~...........................19.7<1.
...........................4.J............,......................................................~~
Appra'r.....................i:]....................................................................................................................
............................~d...~.~~~t.)....................................,Penna.(Post mee)
-.-
}1'l.:3htJ:lgtc:>J:lH...........County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
Anna Andreasik..........
Deceased.
Late of
.,..q<:l.l}9.J:l~p.:u.!g .
Date of Death,~:':':':9:'.?2.':'~7.Q .
Appraisemel!t Docket Vol.,
.....,
Page,.....HH H No 63-70-1091.............................................
Filed in Register's OfJi.ce,?~~.~~.?.~J9 70
Amount of tax dtte,$.
DEPARTMENT OF REVENUE
Received,
Examined and Approved,.
Wrote ab(),ut Appra.isement,
Appeal f,.om Appraisement,.
Entered and chnrged,
}-
r .
~.f
•
12.Net Value of Estate (Line 8minus Line 11)
13.Charitable and Govemmental Bequests/Sec 9113 Trusts forwhich an election totax has not been
made (Schedule J)
DATE
DATE
3-r-OQ
PA 15301
OFFICIAL USE ONLY
OFFICIAL USEONLY
o 3.Remainder Retum (dateofdealhpJiorIo12-13-82)o 5.Federal Estate Tax Retum Required
_8.Total Numberof Safe Deposn Boxes
o 11.Election to tax under Sec.9113(A)(Allach Sch 0)
THIS RETURN MUST BE FILED INDUPLICATEWITH THE
REGISTER OF WILLS
ADDRESS 30 East Beau Street,Suite 325
Washin ton PA 15301
IX!2.Supplemental Retumo4a.Future InterestCompromise (dateofdealhafter12-12-82)
o 7.Decedent Maintained aLiving Trust (Attach copy olTrus~
o 10.Spousal Poverty Credn (dateofdealh between 12-31-91 and 1-1-95)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
9.Funeral Expenses &Administrative Costs (Schedule H)
4.Mortgages &Notes Receivable (Schedule D)
5.Cash.Bank Deposits &Miscellaneous Personal Property
(Schedule E)
6.Jointly Owned Property (Schedule F)
7.Inter-Vivos Transfers &Miscellaneous Non-Probate Property
(Schedule Gor L)
8.Total Gross Assets (total Lines 1-7)
3.Closely Held Corporation.Partnership or Sole-Proprietorship
1.Real Estate (Schedule A)
2.Stocks and Bonds (Schedule B)
10.Debts ofDecedent.Mortgage Liabilities.&Liens (Schedule I)
15.Amount of line 14 taxable
at the spousal tax rate
See instructions on revers
16.Amount ofline 14 taxable
at6%rate
17.Amount ofline 14 taxable
at 15%rate
11.Total Deductions (total Lines 9&10)
18.Tax Due
o 1.Original Retum
o 4.Limited Estateo6.DecedentDied Testate (Allachcopy ofWiD)
o 9.Litigation Proceeds Received
NAME COMPLETE MAILING ADDRESS
i-=E~d::::-w~a:::-:rd::::=-::A~n=dr:;::e~a~si;.;,,;k.&....;.;.;ln;.;,,;fo:;.;.r;.;.m;.;:;a;.;,,;n.;..t -----------i 30 East Beau Street
FIRMNAME (If Applicable)
J.:.P~a;,::tr~ic:::,:k;."C~.D~e~rr.:.::ic;:;:oJ..::E=s::J.:u::.:i:.:re~-1 Suite 325
TELEPHONE NUMBER
724-225-7660
zo
~::l!:::
Q.<t:()
W
0::
r-zw
Cw()wc
I t Adddt'CDeceensample e ress:.
STREET ADDRESS ~
103 Morgan Street
CITY ISTATE IZIPCanonsburgPA 15317
Tax Payments and Credits:
1.Tax Due (Page 1Line 18)
2.Credits/Payments
A.Spousal Poverty Credit
B.Prior Payments
C.Discount
(1)478.80
Total Credits (A +B+C)(2)
3.Interest/Penalty if applicable
D.lnterest
E.Penalty
478.80
810.60
1,289.40
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1.Did decedent make a transfer and:Yes
a.retain the use or income ofthe property transferred;D
b.retain the right to designate who shall use the property transferred or its income;D
c.retain a reversionary interest;or D
d.receive the promise for life of either payments,benefits or care?D
2.Ifdeath occurred on or before December 12,1982,did decedent within two years
preceding death transfer property without receiving adequate consideration?If death occurred
after December 12,1982,did decedent transfer property within one year ofdeath without
receiving adequate consideration?D
3.Did decedent own an "in trust for"or payable upon death bank account or security
at his or her death?D
4.Did decedent own an individual retirement account,annuity,orother non-probate property?D
No
DDD
D
D
DD
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
72 P.S.§9116 (a)(1.1)(i)provided for the reduction of the tax rate imposed on the net value oftransfers to or for the use ofthe
surviving spouse from 6%to 3%for dates of death on orafter July 1,1994 and before January 1,1995.
72 P.S.§9116 (a)(1.1)(ii)provided for the reduction of the rate imposed on the net value of transfers to or for the use ofthe surviving
spouse from 3%to 0%for dates ofdeath on or after January 1,1995.The statute does not exempt a transfer to a surviving spouse
from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse
is the only beneficiary.
FOR DATES OF DEATH ON OR AFTER JANUARY 1,1995 •Please answer the following question by placing an "x"in the
appropriate space.
Did the decedent create a trust or similar arrangement which is soley forthe surviving spouse's benefit for his or her entire
lifetime?Yes D No D
If you answered yes to the above question,the tax on the trust or similar arrangement is postponed until the death ofthe second
spouse,at which time it will be fully taxable at the rate(s)applicable to the remainder beneficiary(ies).Enter the value of the trust on
Schedule J,Part II,in order to remove it from the calculation ofthe tax due in this estate.You may wish to file Schedule 0 in order to
make the election available under Section 9113.Ifthe election is made,the trust or similar arrangement is taxed in the estate of the
first decedent spouse,the portion ofthe trust orsimilar arrangement which benefits the surviving spouse is taxed at the zero tax rate,
and the remainder is taxed at the rate(s)applicable to the remainder beneficiary(ies).Ifyou choose to make the election,you must
attach Schedule 0 to a timely-filed tax return,along with Schedule(s)K and/or M in order to show the apportionment of the trust or
similar arrangement between the surviving spouse and the remainder beneficiary(ies).. ,
..L-'.u<.t:"-if~...~..'k ",•..:''I,~.,"'!"'1',....~'.."J i.
~'-''''''*
COMMONWEALTH OFPENNSYLVANIA
INHERITANCE TAX RETURN
RE IDENT DECEDENT
SCHEDULE A
.REAL ESTATE
ESTATE OF FILE NUMBER
Andreasik.Annie 63 70 1091
All real property owned solely oras atenant in common mustbe reported at fair marketvalue.Fair market value is defined as the price at which propertywould be exchanged
between awilling buyerand awilling seller,neitherbeing compelled to bUy or sell,both having reasonable knowledge ofthe relevantfacts.Real property which is jointly-owned with right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
DESCRIPTION
Life interest in property situate in North Strabane Township,Washington Co.,PA
DB 1243,P.1045
See copy of 1967 tax notice for assessment 300 x 4 =
Life interest in property situate 3rd Ward,Borough of Canonsburg,being Lot No.268,
Canonsburg Land &Improvement Co.,DB 1243,P.1049
See copy of 1967 tax notice for assessment 1,695.x 4=
TOTAL (Also enter on line 1,Recapitulation)$
(If more space is needed,insert additional sheets ofthe same size)
VALUE AT DATE
OF DEATH
1,200.00
6,780.00
7980.00
··52THIS·'NOTICE.RECEIPT BECOMES A RECEIPT ONLY WHEN VALIDATED BY COUNTYTREASURERASTODATEANDAMOUNTPAID•.
O.0 2 I 3 1 Washington County Taxes 1961 NORTH
LEVY:COUNTY TAX~EAt:.t~TATE 14 MILLS STRABANE
Payable To:RUSSElLMA,UNOi Co.Treasurer
COURT HOUSE•.WASHiNG"i'ON,PA.ASSESSMENT DISTRICT
:I:u·tD5 I'zjoL
D3.99
•
PA,IO TO CORR·EcT ADDRESS OR PROPER'tY DESCRIPTION.NOTIFY TAX
ASSESSMENT OFF'C£~COURT HOUSE,WASHINGTQN,"PA,.
15%Dlscou~i ..PAio"ON'ornJiEFoREAUGUST I~PAYABLE AT FACE DURING AUGUST.PENALTY ADDED TO.FACE·ON·SI;:PTEMBER 1ST OF 10%...'
'DO NOTbETACH·~~-.--RETURN THIS FORM WITH REMITTANCE.D.JUN 19 '67 VALU~i-~oN FAtE 'i:'DIS2~UNT.'.PENALriNET .
WA,9HIHGTON COUN1Y300 4~"2U ..21
RUSSELL HARINQ ."""r"...
COUNTY TftEASURfttERrlsR,GEN8:VIEVE:%::'ANfit~ANDRES'll
TAXPAYER 103 MORGAN st.\t ..":';",'.
C.ANOU.SBURG.P'A.''5-2~15-543
.;~DO NOT DETA'CH
i AeRE 'SURFAC'E
52-15':'543 DB 124~l'O'4i'
._._..._...._~:.:.....-.
300.1201
;.0·.•.
:-,
,~~--~.c",-...".'.~~...""',...c'.'_"'-.•"7,.~.....-o-,;--~_.~..--;-.~_._.....__._-_..-...._--_._-,
'.:'.'S NQ".C..E R5x..n;-j~~til\iES A RECEIf'i o~Ly WliENVALIDATEo BY COUNTY--.,":,;/~,~-.·TREASURER AS TQ'DATE AND AMOUNT PAID..11o002':0"'5'Washington CountyTa~!~·1961 CANONSBURG~
LEVY:COUNTYJAX REAL EfjT:AT.E 14 MILLS 3n1 W..."
.-'·PayableTo:RUS§ELL MARINO;-Co.Treasurer '...•..'.
COURT HOUSE,WASHINGTON;.PA.ASSESSME~DI$TRI<;T
.-..~
'3'20
:1:'Ue
D
5z
oD·'
';
VALUATION
TO CORRECT ADDRI;SS OR PROPERTY DESCRIPTION.NOTIFY .~Ax
ASSESSMENT OFFICE,COURT HOUSE,WASHINGTQN.PA..
.~%DISCOUNT IF PAID"ON OR BE.FORE AUGUST I.PAYABl,E A:r PA~DURING A,UG\lsT,PENALTY ADDED .TO FACE ON SEPTEMBER ISTOP 10%.'
DO NOT DEYACH'- - - - -RETURN THIS FORM WITH REMllTANCE.
5%unFACE.DISCOUNT PENALTY .~
1.19 22.54
;.
~.
.'.
....•
,.
..;-~!:,-
I;
\---....._---
."Beginnin«-l65·feet S.37-56'W.of a point where the south Une of Morgan -
Street intersects the west llne of SmUt Street;thence along line of other land of
as follows,to-wU:-
Str~ban~Township,Washington County,Pennsylvania and bounded and described
the grantor~S.37-56'W.,124.5 feet to a "point;thence by the same N.52"04'
___,,;.,,;,;.________grantee j.
lI'lTNESS~TlI.That in ~nsideration of ---------oNE and no{100-----
-----------------------------~$1.00)------------~----------------Oollan
in hand paid,the receipt whe~eof is hereby acknowledged,the said grantor does hereby
grant and CORVe}"to the said grantee •ALL that certain tract of land sUuate in North
Road,Canonsburg,Washington county,Pennsylvania,_.---------------------
--_.---.------------••----._••_••_._.-----._•••_•••-._._•••grantor ,and
GENEVl~VE KERNER,(claughter of.the wUhin Grantor),of 153 N.Spring Vaner
emyOk in the
rear Ninetl."en hundred and_-----1/
BETWEEN ANNIE ANDRESIK,also known as ANNIE ANDREASlK,Widow,
.of the Borough of Canonsburg,Washington County,Pennsylvania,
-"~<This'Deed
Q
-"...-._----~.__..._.__.__._..-.-
M.4DE the_·__J3 dayof
Form No.I (1964)GENERAL WAJUlANTY DEED......
.W.,3~O feet to a po.nt;.thenceby t~e ilame -N,"3"-56'E.124.5 feet to other land
."-
~.-
Il ..of grantees~th~~ce by tb~!lameS.62004'E.350~reetlothe place of b~ginnbig.<-i.~,,:.
i".~-~~.:~;··~;·~~~·~·:~:···:~:~k~;:·,-:\.·:·;:,"~~i!.:~:.;:.:~~'-"7~'~:-~~......,.....:-',.:..~·:~:~::~':7:-_::~~'··:7;:~~'-~/~::'~::·-~:;~~i;~~rf~~,'1
i ;"t:\>·~XCEPTtNG,aDdcRESEaV1NG.there(fOlQf _aUre ~iltate to'Anril.Ar1drestk.:.~·Te,..l~,~'%~·~~{~t~~~~;"~""';~~~~i~'"
The said Jolu1
Annie n reaSl
,26th day of April,1920,In Deed~ook Vol.478,page S94.
Andreslk '(also known as John ·Andreaslk),died on ---'
NOTICE-THIS DOCUMENT MAY NOT SELL.CONVEY.TRANSFER,INCLUDE OR :NSURE THE TITLE TO THE COAL
AND RIGHT OF SUPPORT UNDERNE~TH THE SURFACE LANO DESCRIBED OR REFERRED TO HEREIN,AND THE
OWNER OR OWNERI OF SUCH COAL MAY HAVE THE COMPLETE LEGAL RIGHTTO REMOVE ALL OF IUCH COAL AND,
IN THAT CONNECTION.DAMAGE MAY RESULT TO THE SURFACE OF THE LAND AND ANY HOUlE,BUILDING OR
OTHER STRUCTURE ON OR IN SUCH LAND.THE INCLUSION OF THII NOTICI DOli NOT ENLARGE,IIEITRICT OR
MODIFY ANY LEGAL RIGHTS OR ESTATES OTHERWISE CREATED,TRANSFERRED,EXCEPTED oa RESEIIVED BV
THIS INSTRUMENT,(T....MUM ..Nt fertll ........-te Aot N..2M,.",.....~,~o,,....)./
(H the Grantor has not certified there'is such a right of support,the Grantee should note the follow-
ing:)
N OTIC E-Grantee (hereinafter,whether one or more,cal1~d ''Grantee'')'hereby·
>lall'>lhat he lIIay not he ubtainin~lht'ri:.:htuf prolM:lion against subsidence resulting from coal mining
operations'and thal·the purch:lSeli propert}'may be protected from damage due to mine subsidence by a
prh'ate contract wilh the owners of the econo&lic interests in the coal.,•L~~:'I~t ~h *~.,1;';3.:.~!=:v7ie::::~::;:e::::~;;K=e~rn::"e-;J=...;::;::..:::=:;..:=...::..__....:.-
-------...--_..,~---.-..
of the Grantee berein.
':April 24,1920,and recordedlnthe Recorder's Office for w'ashlnitc.n County on the.
and W.F.Bolle,her hUSban~'andHarl'1 W.Johnston and Stella U.Johnston.~i•.·:;':
:'wtre,to John Andresik andA~teAndresik,his,~lte,whl~h'said,deecfla dated'~:,.
said Annie Andresik.also known as Annie Andreaslk,Grantor,Is the mother
The true consideration.for this conveyance Is One ($1.00)Dollar;the
deeds in the cbaln of title.
vesting title to the above described premises In Annie And~eslk,also known as
Annie Andrellslk,his widow,ali surviving tenant of the tenancy by the ~ntlreties.
SUBJECT TO such exceptions and reservations as may appear in prior
The Grantor (hereinafter,whether one or more,called "Grantor")'does hereby certify that any
structure now or hereafter erected on the land herein conveyed ~(is not)entitled tosupport from the
underlying coal,anything to the contral'}'contained herein notwithstanding.
.d,z'''1/0 LdJv:v:t~
Annie Andresik
The following notices are set lorth In the manner provided by Section 14 of "The Bituminous Mine
Subsidence and Land Conservation Act of 1966",as enacted April 27,1966.
I,
"
!.i I
--_.---_.'--':~.*~~:,:~:~
"'~.....
",,'
..
--.i~~'.-~~~J~_.~-(Seao.
.4 1JdJ.at·-'....M-(....-._(SeaJ)Annie A'rea.lk .
-----:.--.•-·_(Seal)
---------.-..---..-:.{Seal)
--~--:-----'--__~.(Seal)
----------(Seal)
55.
--j ......
.'J
•"'••.:.i~r:',j~jF~:,·:"......
':,',".,....
lV~dOWt-··_···_·······_··_···__·_··__·_·_··~··_·.~_•••_•..•...••••.••
;.~f~~tio~~;p;rI~>~f;?1M>a~na~~:1."..,.'
~~-':'Ind itkJiOwledieCl~tlili she>;"riiecUtrdtht lame
)~~1~'~f;~arad"~~ciJ)"..' . . ",".
IN WITNESS WllEREOF,the said grantor has hereunto set her band .and,
seal.,the da}'.and year first above written.
Sealed and delivered..3K'.in presen eof _.._C~_~,~_.
....•••••~•••••••_•••••~._-~~-----_••_•••_•••_••_-•••_••~.·_····_·_·~antor
will warral1t gene~ally the property hereby conveyed,
.,
And ihe said ANNIE ANDRESIK,also known as ANNIE ANDREASIK,Widow,
NOTICE-THIS DOCUMENT MAY NOT SELL,CONYEY,TRANSFER,INCLUDE OR INSURE THE TITLE
TO THE COAL AND RIGHT OF SUPPORT UNDERNEATH THE SURFACE LAND DESCRIBED OR REFERRED
TO HEAEIN.AND THE OWNER OR OWNERS OF SUCH COAL MAY HAVE THE COMPLETE LEGAL RIGHT
TO REMOVE ALL OF SUCH COAL AND.IN THAT CONNECTION,DAMAGE MAY RESULT TO THE SURFACE
OF THE LAND AND ANY HOUSE,BUILDING OR OTHER STRUCTURE ON OR IN SI/CH LAND.(Ull.DoUce I.'
••t 'Drib ID lbe mallller proylded ID Sectloll 1 of lb.Act of Jab'17.U57,P.L..1•.)
On this,the_'-2.:LtlQ..._day of...-L.(/7~.;!..?:...._...·J9.~~_...,'~fore
me,JhI1J..,.J!(...1;,.1I/dLL&(L...._-._.......-.-__,'he unde~ign~officer,personally',
appeared ············ANNIE ANDRESIK,also known as ANNIE ANDREASIK.
SlaU ofPrnnsylflQnia
County of.-..'!!!I:~~.!~~__.
"-'-'-'-"--'---
."..
".__......J __,......__._._0_._._
",,;-
..".
!i{.
..',,:"t'
".
5,'}.1';This Deed
.'xxxxxxx=&XXXXXaXX~xxxxxx .x.-.---~-----------lQl------------------grantor ,and
,_No.1 (1964)
GENrJlAL WARRANTY DEED
~a
••--.--••-•••••--.;.-••••-.--.----.----•••--•••-.-.-._.---••-.grantee
II'ITNESSETH,nat in consideration of .··-··-----QNE and no'l 00·------·
·----·;.··-·--·-·---------·-($1.00)··--------··_---------;.------.DolJan >'
in hand paid,the receipt whereof is bereby acknowledged,the said grantor •OOes hereby ,
grant and convey 10 the said grantee ,ALL that certain lot 01 ground situate in the
Third W&,rdof the Borough or Canonsburg,Washington County and State'01 ~ennllJl"..•'
:;:-~:.':<.,-~c>.~·-;·":-.~"_".'-",.."....:'..',..·:<;\::::.5::~.l~~>
.vania.-ber",tot No.26801 the p1otollot8 laid out b1 THE CANONSBURG LAND":;'~:O;'
AND IMPROvEMENT COMPANY and ~corded 1n the Recorder',office or WaBh~
,iogton Count1.P ..~tn PJot Book No.3,Page 48 and bounded and de8cribed a8
~.. ..
--~.'
i .'j
J
-_..t _MADltfJe:~":"p ~··ciaYOf .,"tb.:';.~:.;:~>;'.'"',:in th;!;£~;;~~i~.:,..,yeatNineteen hundred "nd .Sixty·six (1968)J,."."..:'"",....'!..,.~;,./:.BtrIYEEN "AInu'):""AN'nREASIK,Wi'do..:',.
.~1 ...'-i~;:+.;;~~,m:.L:w~~COllnty.lenn811.,anla.,······~..··~~~-:S~7.~.~··h·~:-····..:~¢~~t~1};
~
GENEVIEVE KERNER,(daughter or the within Grantor),or 153 N.Spring Valley
l;~;-.....R.....,..."....."Wm'.....C......P.....,........~••,_••__••_••_-.--"'.d~~4«-
i
BEING "t'ae··same traet ot land whleb was cORveyecl"by de~of Tbom M08eovlcit-..-:..
'Annie Andreasik,Widow,Grantor,Is the mother or the within named Grantee.
'and Mery Moscorlch,bis 'wife,to·JOhn Andreasik and Annle,Andreasik,.bla wife.
which said deed Is dated April I,1918,and recorded In t"l.Recorder's OOlce for
Washington C;un~on the 2nd day of AFI1,'I~18,hi Deed Book Vo~454,page 473.'
The said John Andreaslk died on --',vesUng title to the,'
above described premises In Annie Andreaslk,.bls widow,as's~rviring tenant at
the tenancy by the entireties.
The following notices are set forth in the manner provided by Sr.ction 14 of "'Ine Bituminous Mine
Subsidence and Land Conservation Act of 1966",as enacted April i7,1966.
The Grantor (hereinafter,whether one or more,called "Grantor")does hereby certify tbat any
structure.now or hereafter erected on the land herein convc)'ed (~(is not)entitled'to suPPort from the
underlring coal,anrthing to the contral'};contained herein notwithstanding.
ArrEST'::'tMa~/t!.tllktlwllL()ik
•[Armle Andreasilt
\&>-;"\"-"Cd'~'---------
.(If thc Grantor has not certified there is such a right of support,theGrantee should note the follow-
ing:)'"',f i,,",, ''c'l.\'"',
N QTIC E~Grantee'(hereinafter,whether one or 1J19.:e.all~"Grantee")i~rebY:siat~~tliat he lIIay nq,!be t?htaining the rigt\t of prOlection against SUbsl~rcsukingfrom coal mininl
operations and tharthe purchased propeffy ma)'be prorected from damage due to mine subsidrnce by a
private contract with the owners .of lhe'econoJDic interesuin themal ..,'.":'
AITFST,~..~~_.C--""-__S Genevieve Kerner
NOTICE-THIS DOCUMENT MAY NOT SELL,CONVEY.TRAN8FER.INCLUDE OR INSURE THE TITLETO THE COAL.
AND RIGHT OF SUPPORT UNDERNEATH THE SURFACE LAND·DESCRIBED OR REFERRED TO HEREIN.AND THEOWNEROROWNERSOFSUCHCOALMAYHAVETHECOMPLETELEGALRIGHTTOREMOVEA'LL OF SUCH COAL AND,
tN THAT·CONNECTION.DAMAGE MAY'RESULT TO THE SURFACE OF THE LAND AND ANY HOUSE.aUILDIN.OR.OTHER STRUCTURE ON OR IN SUCH UND.THE INCLUIION OF THIS NOTICE DOEI NOT ENURGao IlESTIllCT 011
MODIFY ANY LEGAL RIGHTI 011 EITATU OTHERWISE CREATED.TRAJlIFEllllEo,UCEI'TED 0"IlEIE"VEO IVTHISINSTRUMENT.1""11 _...,Iot .....-'"..Ad "!-IIB,....-....--Wo,""",':"'~~-.d:~:."··'·~::-,,~..4 ,"•"••••"••,".','i,-:,··r~-::;····:":f.:.~~·~:-·.fj,:··
.\,
/;
NOTICE-THIS DOCUMENT MAY NOT SELL.CONVEY,TRANSFER,INCLUDE DR INSURE THE TITLE
TO THE COAL ANO RIGHT OF SUPPORT UNDERNEATH THE SURFACE LAND DESCRIBED OR REFERRED.
TO HEREIN:AND THE OWNER DR OWNERS OF SUCH COAL MAY HAVE THE COMPLETE LEGAL RIGHT
TO REMOVE ALL OF SUCH COAL AND.IN THAT CONNECTION.DAMAGE MAY RESULT TO THE SURFACEOFTHELANDANDANYHOUSE,BUILDING OR OTHER STRUCTURE ON OR IN IUCH LAND.(lbh DoUce h
lot lorlll ID ,....maDDer proYkl04 18 _.....I or 11M Ac'of 11IIJ n.IU'.P.L."L)
And the said
seal
EASlK
I
lVldow,_._.-_••~•••••••_••__._•••_._.~.
'-.
\IiI;,
executed the lame
~.....
.....\
'"
~Q
Mr Commission Expires
..---........-._-':."'_._---_..._~--.
.'
Given under my hand and ~al of the said office.. .---r)b~./}.tu~~tJ.;.
..R~!~r..\;
Page
..;
Sta;{¥P;;:~l(l';71~'-'t',.'-/::rV8lIhi....bw.-p ••,s,.;..__.
COllnty0,.),~=---'.
Rec:orded on this 26th day .August A.J?19 66 '.
in the Recorder's Office of the said county.in Deed &ofVol .!12l1J_..
1049 .- - - -
"
:::.·.;l····.~.,,,~..-.'i kn.ow~to.me.for-;a~s.f~ct~riiy j;;o\'en).to be tbe penon'whose name·
;iJj;,;}~of.'r .subscnbed to;the WIthin Instrument,and acknowledged that
..}...'.'.fo;~he PlIrPOlrt tbereincontained.. .
.In Wilness Wh~reof.I hereunto set my·hand and official seal.
·..-."
,BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT.Z80601
HARRISBURG,PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT,ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1S47 EX AFP U2-99)
J
PATRICK C DERRICO ESQ
STE 325
30 E BEAU ST
WASHINGTON PA 15301
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-17-2000
ANDREASIK
09-23-1970
63 70-1091
WASHINGTON
101
Amount Remitted
ANNIE
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WIllS
WASHINGTON CO COURT HOUSE
WASHINGTON,PA15301
CUT ALONG THIS LINE ~RETAIN LOWER PORTION FOR YOUR RECORDS ~REv=is'4j-Ex-iFP--[i"2:99Y-NoTicE--oF-YNHEifiTANCE-TAX-A-PPRAisEMEN:r;-iLi-oWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ANDREASIK ANNIE FILE NO.63 70-1091 ACN 101 DATE 04-17-2000
TAX RETURN WAS:(X)ACCEPTED AS FILED )CHANGED
NOTE:To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
RESERVATION CONCERNING FUTURE INTEREST -SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON:ORIGINAL RETURN
1.\Real Estate (Schedule A)
2.Stocks and Bonds (Schedule B)
3.Closely Held Stock/Partnership Interest (Schedule C)
4.Mortgages/Notes Receivable (Schedule D)
5.Cash/Bank Deposits/Misc.Personal Property (Schedule E)
6.Jointly Owned Property (Schedule F)
7.Transfers (Schedule G)
8.Total Assets
(1)..:.7"""~9.:.8.::.0.:.,..0:.:0::-
(2).:..:0~0::..
(3).....:..;.O~O::..
(4).:..:0~0::..
(5).:..:0~0::..
(6).:..:0~0::..
(7).....:..;.O~O::..
(8).....;.7...:.,..;;.9.;;.8.;;.0..;;...;;.0..;;.,0
NOTE:I~an assessment was issued previously,lines 14,15 and/or 16,17 and 18
re~lect ~igures that include the totalo~ALL returns assessed to date.
ASSESSMENT OF TAX:
15.Amount of Line 14 at Spousal rate (15)-=-=~·0,:""0,:",,X.OO=-=~.,:""0,:,,,,0_
16.Amount of Line 14 taxable at Lineal/Class A rate (16)7,980 .00 x,06=..;.4~7.;;.8.;...8~0_
17.Amount of Line 14 taxable at Collateral/Class B rate (17).00 X .15=.....;...;;.0.;;.0_
18.Principal Tax Due (18)..;.4~7.;;.8~.8~0__
APPROVED DEDUCTIONS AND EXEMPTIONS:.009.Funeral Expenses/Adm.CostslMisc.Expenses (Schedule H)(9)_
10.DebtslMortgage Liabilities/Liens (Schedule I)(10):..:.0~0::..
11.Total Deductions (11)-..0...0'-
12.Net Value of Tax Return (12).....;.7~,~9~8~0~.0~0~
13.Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J)(13)~.O~O~
14.Net Value of Estate Subject to Tax (14).....;.7~,~9~8~0~.~00~
will
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)AMOUNT PAIDDATENUMBERINTEREST/PEN PAID (-)
01-18-1996 AMNP PEN 175.38 .00 NOTE:AMNESTY N03-08-2000 AA387129 810.60-1,289.40 PENALTY ASSESSE
BALANCE OF UNPAID INTEREST/PENALTY AS OF 03-09-2000 TOTAL TAX CREDIT 478.80,
BALANCE OF TAX DUE .00
INTEREST AND PEN.173.80
TOTAL DUE 173.80
P
D
•IF PAID AFTER DATE INDICATED,SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(IF TOTAL DUE IS LESS THAN $1,NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT"(CR),YOU MAY BE DUE
A REFUND.SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:Estates of decedents dying on or before Decellber lZ,198Z --if any future interest in the estate is transferred
in possession or enjoy.ent to Class B (collateral)beneficiaries of the decedent after the expiration of any estate for
life or for years,the eo..onwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the,lawful Class B (collateral)rate on any such future interest.
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
To fulfill the require.ents of Section Z140 of the Inheritance and Estate Tax Act,Act Zl of 1995.(7Z P.S.
Section 9140).
Detach the top portion of this Notice and sub.it with your pay.ent to the Register of Wills printed on the reverse side.
--Hake check or .oney order payable to:REGISTER OF HILLS,AGENT
A refund of a tax credit,which was not requested on the Tax Return,.ay be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax"(REV-13l3).Applications are available at the Office
of the Register of Wills,any of the Z3 Revenue District Offices,or by calling the special Z4-hour
answering service nu.bers for for.s ordering:In Pennsylvania l-800-36Z-Z050,outside Pennsylvania and within
local Harrisburg area (717)787-8094,Services for taxpayers with special hearing and speaking needs:
l-800-447-30Z0 (TT only).
Any party in interest not satisfied with the appraise.ent,allowance or disallowance of deductions,or assess.ent
of tax (including discount or interest)as shown on this Notice .ust object within sixty (60)days of receipt of
this Notice by:
--written protest to the PA Depart.ent of Revenue,Board of Appeals,Dept.Z8l0Zl,Harrisburg,PA l7lZ8-l0Zl,OR
--election to have the .atter deter.ined at audit of the account of the personal representative,OR
--appeal to the Orphans'Court.
ADHIN
ISTRATIVE
CORRECTIONS:Factual errors discovered on this assess.ent should be addressed in writing to:PA Depart-ent of Revenue,
Bureau of Individual Taxes,ATTN:Post Assess.ent Review Unit,Dept.Z8060l,Harrisburg,PA l7lZ8-060l
Phone (717)787-6505.See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent"(REV-150l)for an explanation of ad.inistrativelY correctable errors.
DISCOUNT:If any tax due is paid within three (3)calendar .onths after the decedent's death,a five percent (5%)discount of
the tax paid is allowed.
PENALTY:
INTEREST:
The 15%tax a~esty non-participation penalty is computed on the total of ~he tax and interest assessed,and not
paid before January 18,1996,the first day after the end of the tax a.nesty period.This non-participation
penalty is appealable in the sa.e .anner and in the the sa.e time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency,or nine (9).onths and one (1)day from the date of
death,to the date of pay.ent.Taxes which became delinquent before January 1,198Z bear interest at the rate of
six (6%)percent per annum calculated at a daily rate of .000164.All taxes which became delinquent on and after
January 1,198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Depart.ent of Revenue.The applicable interest rates for 198Z through ZOOO are:
~Interest Rate Daily Interest Factor !!!r Interest Rate Daily Interest Factor
198Z ZO%.000548 1988-1991 11%.000301
1983 167-.000438 199Z 9%.000Z47
1984 11%.000301 1993-1994 r.t..00019Z
1985 13%.000356 1995-1998 9%.000Z47
1986 10%.OOOZ74 1999 7Z .OOO19Z
1987 9%.OOOZ47 ZOOO 8%.OOOZ19
--Interest is calculated as follows:
INTEREST =BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax beco.es delinquent will reflect an interest calculation to fifteen (15)days
beyond the date of the assessment.If payment is made after the interest computation date shown on the
Notice,additional interest .ust be calculated.
COMMONWEALTH OF PENNSYLVANIADEPARTMENTOFREVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT.Z80601
HARRISBURG,PA 171Z8-0601
PA 15301
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-17-2000
ANDREASIK
09"':"23-1970
63 70-1091
WASHINGTON
101
Amount Remitted
REV-1547 EX AFP Cl2-99)
ANNIE
J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
WASHINGTON CO COURT HOUSE
WASHINGTON,PA 15301
CUT ALONG THIS LINE ~RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV:is47-E3f-AFP--fi'2:99Y-riioYicE--OF-YtiHER-iTiifcE-YAX-A-PPRAis~MEriiT-:--Ai:.1~owiiicE-.OR--~-------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ANDREASIK ANNIE FILE NO.63 70-1091 ACN 101 DATE 04-17-2000
NOTE:To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
TAX RETURN WAS:(X)ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST -SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON:ORIGINAL RETURN
1.Real Estate (Schedule A)
2.Stocks and Bonds"(Schedule B)
3.Closely Held stock/Partnership Interest (Schedule C)
4."ortgages/Notes Receivable (Schedule D)
5.Cash/Bank Deposits/"isc.Personal Property (Schedule E)
6.Jointly Owned Property (Schedule F)
7.Transfers (Schedule G)
8.Total Assets
)CHANGED
(1).:..7J.,~9::::.8:::.0.:.;.O::.:O~
(2)~......:.;.O::.:O~
(3)......:.;.O::.:O~
(4)......:.;.O::.:O~
(5).:.;.0:.,:0::-
(6)__........:.;.0:.,:0::-
(7).:.;.0:.,:0::-
(8).....;.7...,,;;,.9,;;;,8,;;;,0,;;,..,;;,.00,;...
NOTE:
APPROVED DEDUCTIONS AND EXEMPTIONS:
t .009.Funeral Expenses/Adm.Cos s/"isc.Expenses (Schedule H)(9)__
10.Debts/"ortgage Liabilities/Liens (Schedule I)(10).:.;.0::.,:0::-
11.Total Deductions (1lJ _---......OI.loOL..
12.Net Value of Tax Return (12)7 ,,;;,.9,;;,.8..;.0..;....;.0,;...0
13.Charitable/Governmental Bequests;Non-elected 9113 Trusts (Schedule J)(13)--..;..,;;,.0.;...0
14.Net Value of Estate Subject to Tax (14)7 ,_9_8_0_...;.0,;...0
IT an assessment was iitsued previously,lines-14,15 and/or '16,17-and-18-will-
re~lect ~igures that include the total o~ALL returns assessed to date.
ASSESSMENT OF TAX:
15.Amount of Line 14 at Spousal rate (15)~=~'~0~0 X .00=-.-0-0--
16.Amount of Line 14 taxable at Lineal/Class A rate (16)7,980.00 X .06=478.80------~-17.Amount of Line 14 taxable at Collateral/Class B rate (17).00 X .15=~.~O~O__
18.Principal Tax Due (18)~4.;.7~8.;..8~0_
TAX CREDITS:
PAY"ENT RECEIPT DISCOUNT (+)A"OUNT PAIDDATENU"BER INTEREST/PEN PAID (-),I
01-18-1996 AMNP PEN 175.38 .00 NOTE:AMNESTY N03-08-2000 AA387129 810.60-1,289.40 PENALTY ASSESSE
BALANCE OF UNPAID INTEREST/PENALTY AS OF 03-09-2000 TOTAL TAX CREDIT 478.80
BALANCE OF TAX DUE .00
INTEREST AND PEN.173.80
TOTAL"DUE 173.80
P
D
•IF PAID AFTER DATE INDICATED,SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(IF TOTAL DUE IS LESS THAN $1,NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT"(CR),YOU "AY BE DUE
A REFUND.SEE REVERSE SIDE OF THIS FOR"FOR INSTRUCTIONS.)
--------------------
RESERVATION:Estates of decedents dying on or before DecB8ber 12,1982 --if any future interest in the estate is transferred
in possession or enjo~ent to Class B (collateral)beneficiaries 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 Class B (collateral)rate on any such future interest.
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
To fulfill the require.ents of Section 2140 of the Inheritance and Estate Tax Act,Act 21 of 1995.(72 P.S.
Section 9140),
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or money order payable to:REGISTER OF HILLS,AGENT
A refund of a tax credit,which was not requested on the Tax Return,may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax"(REV-1313).Applications are available at the Office
of the Register of Wills,any of the 23 Revenue District Offices,or by calling the special 24-hour
answering service numbers for forms ordering:In Pennsylvania 1-800-362-2050,outside Pennsylvania and within
local Harrisburg area (717)787-8094,Services for taxpayers with special hearing and speaking needs:
1-800-447-3020 (TT only).
OBJECTIONS:Any party in interest not satisfied with the appraisement,allowance or disallowance of deductions,or assessment
of tax (including discount or interest)as shown on this Notice must object within sixty (60)days of receipt of
this Notice by:
--written protest to the PA Department of Revenue,Board of Appeals,Dept.281021,Harrisburg,PA 17128-1021,OR
--election to have the matter determined at audit of the account of the personal representative,OR
--appeal to the Orphans'Court.
ADMIN
ISTRATIVE
CORRECTIONS:Factual errors discovered'on this assessment should be addressed in writing to:PA Department of Revenue,
Bureau of Individual Taxes,ATTN:Post Assessment Review Unit,Dept.280601,Harrisburg,PA 17128-0601
Phone (717)787-6505.See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent"(REV-1501)for an explanation of administratively correctable errors.
DISCOUNT:If any tax due is paid within three (3)calendar months after the decedent's death,a five percent (57-)discount of
the tax paid is allowed.
I
PENALTY:
INTEREST:
The 157-tax amnesty non-participation penalty is computed on the total of the tax and interest assessed,and not
paid before January 18,1996,the first day after the end of the tax amnesty period.This non-participation
penalty is appealable in the same manner and in the the same time period as yOU would appeal the tax and interest
'that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency,or nine (9)months and one (1)day from the date of
death,to the date of payment.Taxes which became delinquent before January 1,1982 bear interest at the rate of
six (67-)percent per annum calculated at a daily rate of .000164.All taxes which became delinquent on and after
January 1,1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue.The applicable interest rates for 1982 through 2000 are:
'!!!!:Interest Rate Daily Interest Factor ~Interest Rate Daily Interest Factor
1982 207-.000548 1988-1991 117-.000301
1983 167-.000438 1992 97-.000247
1984 117-.000301 1993-1994 n .000192
1985 137-.000356 1995-1998 97-.000247
1986 107-.000274 1999 n .000192
1987 97-.000247 2000 87-.000219
--Interest is calculated as follows:
INTEREST =BALANCE OF ,TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15)days
beyond the date of the assessment.If payment is made after the interest computation date shown on the
Notice,additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT.280601HARRISBURG,PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REY~NUE",
INHERITANCE TAX
STATEMENT OF ACCOUNT
j
REY-16D7 EX AFP 112-99)
PATRICK C DERRICO ESQ
STE 325
30 E BEAU ST
WASHINGTON PA 15301
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-19-2000
ANDREASIK
09-23-1970
63 70-1091
WASHINGTON
101
Amount Remitted
ANNIE
MAKE CHECK PAYABLE AND REMIT PAYMENT"TO:
REGISTER OF WILLS
WASHINGTON CO COURT HOUSE
WASHINGTON,PA 15301
NOTE:To insure proper credit to your account,submit the uppe~portion of this form with your tax payment.
CUT ALONG THIS LINE ~RETAIN LOWER PORTION FOR YOUR RECORDS ~REY=i60j-ix-AFP-n'2-:99Y------•••--iNHERifANCE-YAX--STAfEMENY-OF"-Accouiif--i"i.---------------------
ESTATE OF ANDREASIK ANNIE FILE NO.63 70-1091 ACN 101 DATE 06-19-2000
THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATEDACN IN THE NA"ED ESTATE.SHOWN BELOW
IS A SU""ARV OF THE PRINCIPAL TAX DUE,APPLICATION OF ALL PAV"ENTS,THE CURRENT BALANCE,AND,IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT:04-10-2000
PRINCIPAL TAX DUE:........_... .__._....__.478.80
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+)AMOUNT PAIDDATENUMBERINTEREST/PEN PAID (-)
01-18-1996 AMNP PEN 175.38 .00
03-08-2000 AA387129 810.60-1,289.40
05-12-2000 AA424641 173.80-173.80
'c
~
TOTAL TAX CREDIT 478.80
BALANCE OF TAX DUE .00
ESTY NON-PARTICIPATION PENALTY HAS BEEN ASSESSED INTEREST AND PEN..00
:It IF PAID AFTER THIS DATE,SEE REVERSE TOTAL'DUE .00
AMN
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
(IF TOTAL DUE IS LESS THAN $1,
NO PAV"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS"A "CREDIT'"(CRl,
YOU "AY BE DUE A REFUND.SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
PAYMENT:Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
If RESIDENT DECEDENT make check or money order payable to:REGISTER OF WILLS,AGENT.
If NON-RESIDENT DECEDENT make check or money order payable to:COMMONWEALTH OF'PENNSYLVANIA.
REFUND (CR):A refund of a tax credit,which was 'not requested on the Tax Return,may be requested by completing an
"Application for Refund of PennSYlvania Inheritance and Estate Tax"(REV-13l3).Applications are available at
the Office of the Register of Wills,any of the 23 Revenue District Offices or from the Department's 24-hour
answering service numbers for forms ordering:In Pennsylvania 1-800-362-2050,outside Pennsylvania and
within local Harrisburg area (717)787-8094,Services for taxpayers with special hearin~and speaking
needs:1-800-447-3020 (TT only).
If payment is made after the interest computation date shown on the,~~\
REPLY TO:
DISCOUNT:
PENALTY:
INTEREST:
Questions regarding errors contained on this notice should be addressed to:PA Department of Revenue,Bureau
of Individual Taxes,ATTN:Post Assessment Review Unit,Dept.280601,Harrisburg,PA 17128-0601,phone
(717)787-6505.
If any tax due is paid within three (3)calendar months after the decedent's,death,a five percent (570)discount
of the tax paid is allowed.
The 1570 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed,and not
paid before January 18,1996,the first day after the end of the tax amnesty period.
Interest is charged beginning with first day of delinquency,or nine (9)months and one (1)day from the date of
death,to the date of payment.Taxes which became delinquent before January 1,1982 bear interest at the rate of
six (670)percent per annum calculated at a daily rate of .000164.All taxes which became delinquent on and after
January 1,1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue.The applicable interest rates for 1982 through 2000 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 2070 .000548 1988-1991 1170 .000301
1983 1670 .000438 1992 970 .000247
1984 1170 .000301 1993-1994 77-.000192
1985 137-.000356 1995-1998 970 .000247
1986 lOX .000274 1999 77-.000192
1987 970 .000247 2000 870 .000219
--Interest is calculated as follows:,
INTEREST =BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15)days
beyond the date of the assessment.
Notice,additional interest must be calculated.
OFFICIAL RECEIPT
No.AA 387129REV-1162EX(11-96)PENNSYLVANIA
INHERITANCE AND ESTATE TAX
I (Y/•---,-
l,COMMON.l"EALTH OF PENNSYLVANIA A ~-J
DEPARTMENT OF REVENUE -~j
BUREAU OF INDIVIDUALTAXES
DEPT.280601
HARRISBURG,PA 17128-0601
RECEIVED FROM:
I
PATRICK C DERRICO ESQ
30 East Beau Street
Washington PA 15301
ACN
ASSESSMENT
CONTROL
NUMBER
101
AMOUNT
$1,289.40
,~
FOLD HERE FOLD HERE --
ESTATE INFORMATION:I
FILE NUMBER
63...70....1091
NAME ~F.\@E<::EOEN'VII,~LAST)
\\\,~-:"'1 ~.........RE7\C"TU
.,"/"'>U'~..:/~~.1X\.
(FIRST)(MI)
ANNlE
()ATE-'QF'PA'YM~~""'<..,r,'/"~..."......~.~.t."\I'~.v'....::.
;1 c".',M£>rcn-;·9,"".,J il..""',2000
./
pd~TMARKDATE--...
..•COlJNTY .__
W~sh¥t,gton."-.•.:
"DATE,€l~DEATH .septeftber 23,1970..~.-'~,)".
REM~RKS.- . ,..'S.'g.N/A
'It.f,."~•i 1\,\
TOTAL AMOUNT PAID $1,289.40
~('~
RECEIVED BY -:a~:-t&.~I)~~
SEAL REGISTER OF WILLSI__~~__~_"_~~.---~__"_"._~~.~"__.__..._,_~,_,_"'__~.__.__
,,\
-
II
j
FOLD HERE
t73.itO
AMOUNT
NO.AA 424641 REV-1162 EX (11-96)
ACN
ASSESSMENT
CONTROL
NUMBER
t'
101
/
TOTALAMOUNTPAIIl /173.flO
RECEIVEDBV/'~,~~~#!
(MI)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
(FIRST)iAnne
1970
.'.-"
Patrick C.Derrico
~East Beau Street
Wasbitlgton.FA t ,}301
OF PAYMENT '
May.'2,,2000,
TV •
Washington :
OF DEATH •",September 2?
MA~K DATE'-••••..••.\,~...'"
ATE INFORMATION:
.
ARK?S :If.....s.<t .•
NUMBER6~...70...\09t
E OF DECEDENT (LAST)
Andreas!\(
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
ARRISBURG,PA 17128-0601
RECEIVED FROM:
I
---FOLD HERE
EST)!
FILE N
NAME
DATE 1
posn
COUN'
DATE'I
REM
I SEAL
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