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Home My WebLink AboutOC1971-0237 - ESTATE OF CAMPBELL.. • Form RCC-33 ~ 3-7/ COMMONWEAlTH Of PENNSVlVANLA DEPARTM~NT Of REVENUE BUREAU Of COUNTY COlLECTIONS RESIDENT DECEDENT COUNTY OF .......... Wa.s.hingt.on ....................................... . IMPORTANT: This return must be completed in detail and filed in duplicate, with will attached, with the ·Register of Wills of the County where decedent resided; Return is due within on~ year after date of death, unless an extension is granted by the Secretary of Revenue, (Section 703 of the Inheritance. and E.state .Tax Act of 1991.) IN THE MATTER OF THE ·ESTATE OF } AFFIDAVIT OF -············ANNA. ..... BREHL ..... CAMPBELL................................................................................ EXECUTOR . (State fuli name of decedent) Late of ................... W.?..§.h.:i,.P..gt.On ........................................................................ Comlty ADMl!N!STRATOR Informant State of .................... ~~.?.:?.:.?.Y..~.Y.c::l.?.: .. ~?. ......................................... :.} . • ss: County of ........... W.?..§J:~~l).g_:f::.91). ................................................... . \ ........................ E.l.i.?..9.be.t..h ..... B.r.e.hl .. , ....... .informa.nt................................................. .. ................................ _ ................................................ ~ Administrator of the estate of the above-named decedent being duly sworn, depose and say Decedent· dJed ............. ;J:?..~~?.F.Y ...... ?. .. ?. .. L.... ......................... .. ........ , 19 .. ..7J ....... ,F testate .leaving a last will, copy of which is hereto attached. } (Month) (ll11y) (Y~ar) l intestate · :::::~·;.:::~~.::::::::::::~;; ::} . ... ~j9.~~ ~~~~g~~~!!t .. .. . ......... .................. .... .......... .... .. ...................... . mailed. ··washington~ Pennsylvania ············ ...... .. ....................................... __ _ That as such ......... ~.n.f9.E.~?.n.:t .......... deponent is familiar with the affairs of said estate and the property con- < Executor-Administrator) stituting the assets thereof and their fair market value. That at the time of death there was no safe deposit box registered in decedent's 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 NONE NONR That the contents of said safe deposit box or boxes are itemized under Schedules ______ of this return, with the exception of the following, for the reasons hereinafter set forth: That Sc.hedu!e A attached hereto and made part hereof sets/ forth fullv and in'·detail all the real property in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof as of date of death o·f decedent. That Schedule 8 attached hereto and made part hereof sets forth fully and in detail all personal property wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of death, whether in decedent's immediate possession, standing to decedent's credit in banks -of deposit, savings banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal savings, treasury certificates or notes and other evidence of in- debtedness of the United States to the decedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States, or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death; all wearing apparel, jewelry, silv~rware, pic- tures, books, works of art, household furniture, horses,. carriages, automobiles, boats, and any and all other personal chattels of whatsoever kind or nature, left by decedent, together with the fairly estimated market value thereof; all bonds and mortgae:es held by decedent and of all claims due and owing decedent ,at the time of death, and all promissory notes or other instruments in writing for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if any, giving the face value and estimated fair market value thereof, and if such estimated fair market value be less than the face value, it sets forth briefly the reasons for such depreciation· as ·.;o· each i tern; all moneys payable to the estate from life insurance polici·es carri'ed by ·decedent; all annuity anrl endowment contracts the proceeds of which were payab1~ upon the death of the rlecedent; and .all the corporate stocks and dividends rlue thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of dece- dent's death and other investment securities owned by the decedent at the time of death, with the market value thereof at such time. 'l In the case of securities of close or family corporations, the values reported are as far as possible substantiaterl by financial statements of the corporations, showing the assets and liabilities thereof as of the· date of death. The schedule also sets forth the interest of cl.ecedent at the time of death in any co-partnership or business, and in support of the value of such interest there is annexed to said schedule, financial statements showing the assets and liabilities of said co-partnership or business. A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement) together with a statement setting forth the character of the business, its location, and such other facts pertaining to the l;msiness as may be pertinent to a fair and just appraisal of the .decedent's interest therein must be submitted. It should also set forth in itemized form, together with the fair market value thereof, any other property owned or bequeathed by the decedent at the time of death. The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry contained therein and in the case of transfers ofproperty, real or personal, within two years of decedent's death, in contemplation of decedent's death, or intended to take effect in .possession or enjoyment at or after death, said schedule sets forth the nature and value of such property, to whom transferred, the relationship of the transferees to the decedent, the proportionate ·share received by each transfe~ee and all other facts of a pertinent nature regarding said transfers, In the case of transfers intended to take effect in possession or enjoyment at or after death, there is also attached to the schedule a co~y of the deed, trust agreement or other instrument creating the trust. TherA is also set forth in said schedule a list of all property, real and personal, with its value, which pa~ses at decedent's death by virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint- ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another, with a copy of the instrtooent creating such power attached to the schedule. That Schedule D attached hereto and made part hereof sets forth the names and addresses of all persons beneficially interested in this estate at the time of decedent's death, the nature of their res- pective interests, their reiationship, if any, to the decedent, together with the ages at the time of decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior to decedent, the dates of their death, their issue, andthe relationship of such issue to the beneficiary. That Schedule E attached hereto .and made a part hereof sets forth all property, real and per- sonal, owned by the decedent jointly with another or others, including intangible, standing in the name of the decedent and others, plus the date and place of record of instruments effecting the vestiture of real estate and the date of acquisition of personalty, plus the name, address and relationship, if any, of co-owners to the decedent. That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts and deductions claimed for and on behalf of this decedent's estate, including funeral expenses paid; family exemption, where applicable; costs of administration of this estate; counsel fees and fudiciary's commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli- gious services, in ·consequence of the death of the decedent; debts and claims owing ancl. unpaicl. at time of death; taxes accru;d· charge.able for period prior to decedent's death (":xcept. those allowed under Section 651 of the Inheritance and Estate Tax Act); . together with a statement of collateral pledged for obliga- tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re- quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that the amount of tax assessed can be reassessed in accordance therewith. That the totals of the appropriate columns in Schedules "A", "B", "C", "E", and "F" as directed therein,. have been carried forward and properly registered in the Summary. Subscribed and sworn to before me this ........... .1.9. ............. . --'-···~ daftf .......... li.~PE!!~l'Y ..... 19 .... Zl ...................................... ·Not~ .................... .. Washington, vlashington.County, Pennsylvania My commission expires Feb. 20, 1971 £0~#K!?~ .. ....... ~J.t%:?..9.b..~.t.b. ..... Bx.e..hl ......................................................... . (Executor-Administrator) ..... 7S. .. :V,r.i.ls.on .... Av.e-nue ...................................................... ._ . (Street Number) · .... W.9.s..h:i.ngt.on., ..... P.e.nns.y.lv.ania .......................... . (City or Town and State) NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are filled in with details or the word "None", and in case the assets include rare and unlisted securiti·es, securities of close or family corporations or an interest in any co-partnership or business, that the data and statements.requirecl. under the paragraph above relating to Schedule "B" are attached. Also make certain that column #1 in the "Summary" has been properly completed as above-directed. ,,.·c c-34 0-64) COMM'ONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEPENI SCHEDULE "A" R-EAL PROPERTY Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at deotn of dece- dent. Where property held as ioint tenant or tenancy by entireties, report on Schedule "E". Property ht:'ld by the de.cedent as tenant in common with another or others1 should _be identified as to quantum of interest and the estimated value should be that of the decedent's interest only. The real property located in the Commo[lwealth of Pennsylvania should be described by lot and block number, street and-street number, together with a general description of the property, with a reference to the record of the conveyance by which the decedent took title; if a form state number of a- cres; also statement of mortgage encumbrances upon each parcel at death of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are to be listed on Schedule "F" and must not be deducted from this schedule. NONE (1) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH Insert this total opposite "real property", Schedule ''A" in the X X X X X "As Reported" column on the lest page of this return. (2) (3) DEPARTMENT VALUATION ESTIMATED CAUTION MARKET VALUE (Do not write In thIs s'poce) NONE I CmL\rbNWEALTii OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" PERSONAL PROPERTY Ii\STRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned j ndividually by the decedent, at the time of his death. Property owned by the decedent jointly with another or others must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but payable at death to another or others, including but not limited to P.O. D. u. S. Savings Bonds and tenta- tive trust accounts, must be listed, despite the fact that they are not of the administered estate. Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household goods, and furnishings, books, paintings, automobiles, boats, etc.) Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank, . . stocks:. ·mortgages, cnotes, together with accrued interest or ciividends, salaries or wages, insurance pay- able to the estate or ficiuciary in said capacity, partnership interests, interest in anyundistributed estate of or income from any property held in trust under the will or agreement of another, even though located outside of the State, at the time of death, should be listed in this schedule. Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION No. List and describe fully VALUE MARKET VALUE (Do not write in this space) NONE I .. /. - ' - Insert this total opposite "Personal Property", Schedule "B" in X X NONE the "As Reported" column on the last page of this return. I l I . RCC·-36 CmP.IfO~'\'EALTH OF PENNSYLVANIA TTUNSFEH. INHE!UTANCE TAX SCHEDULE "C" TRA.NSFEll.S R.'SSIDENT DECEDENT ( 1) (2) ( 3) Did decedent, within two years of death, make any transfer of any material part of his estate, without receiving a valuable and adequate consideration therefor? (Answer yes or no) no Did decedent, within two years of death, transfer property from himself to himself and another or others (including a spouse) in joint ownership? (Answer yes or no) no If the answer to (1) or (2) above is in the affirmative state: (a) Age of decedent at time of transfer------ (b) State of decedent's health at time of making the transfer. (Note 1). (c) Cause of decedent's death. (Note 1). (4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate consideration therefor which was to take effect in possession or enjoym~nt at or after his death? (Answer yes or no) no (a) Was there any possibility that the property transferred might return to transferer or his estate or be subject to his power of disposition? (Answer yes or no) no (b) What was the transferee's age at time of decedent's death? not applicable, (5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves for his life or any period which does not in fact end before his death: (a) The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no) no (b) The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer yes or no) no · (6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent alone or others _____________________________________ ~------- (7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to pay income to or for the benefit of care of transferor? (Answer yes or no) --------- (8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change, because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of law? (Answer yes or no) no (9) If th~ answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter- est of the beneficiary reserved in the decedent alone or the decedent and others? (Answer yes or no) _________ __ NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as well as a copy of the death certificate. NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans- fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based. NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E. ITEM DESCRIPTION NONE Inser·t this total opposite "Transfers", Schedule "C" in the 11 As Reported" column on the last page of this return. MARKET VALUE (Estimated) NONE DEPT. VALUATION (Dept. Only) ,. ,:-;.(f-~~~~ .. c.::•.\j\1!1\'v;-~ \LT![ t)F l'EK\'::3YI.V,\N.L\ ~:~ \\.: ~< 'FH I\.: !!FlU T \;'\ C'E T ,\\ SCHEDULE "E" JOINTLY 0\VNED PROPERTY I\~TH\'CTil1\S: This schedule must disclose all property, real and personal, owned by the rlecedent ,jointly with another or others, including intangibles, standing in the name of the decedent and others. List :-eal estate first, as entireties, or joint tenants, giving brief description, as indicated under Schedule. ":\".• 11lus the elate and place of record of instrument effecting vestiture, but flo not include entireties or out of st.;ltt' real estate value in estate valuation column. Personal property should be listed as in . Schedule "B", plus rl;tte of acquisition, and .the name, address and relationship (if any) of co-awners to the decedent. Descri.pttnn of P;operty, D~te oi Acquisjt-ion, --N~me! Unit 1--perc;~-t~ge---~ EStat.e r Address 1U1d Relationship of Co-Owners, and Place : Value Share Valuation nf 1\t'corri of Instrl_l_me_n_!, where Real Estate. ! i 1 1 . -c&2x~"x'\:..,..cr<~<:~>x'>: , "". A . ---··· --x-: -r· -----:-;r.z . w::?'S< x ;x:z. x:-, · ~ ·(-A 'A.A. XX '>( M '>( XX XXX I I Pa. i BreHl Joint savings account 83 2044736. in Pittsburgh National Bank, Washington Office, Washington, In the names of Miss Elizabeth or Mrs. Ann Brehl Campbell Balance as of date of death i I ll (1/2 taxable --bill received 2/2/71 fron Inheritance· tax department) Joint savings account 196 in Mt. 1 Lebanon Federal Savings and Loan / Association, Mt. Lebanon, Pennsylvanl ia, in the names of Miss Elizabeth Brehl or Mrs. Ann Brehl Campbell I (] 6Kd,.;t. . DEPART~fENT VALUATION CAUTION-Do not \Vri te In This Space. Value of Entire Property Value of Decedent's Interest Opened more than 2 years prior to \ death. /fr S ..39 Y'J- Balance as of date of death l/2 taxable I I I Checking account in First National I Bank and Trust Company, Washington,j Pennsylvania in names of Miss Elizai- beth Brehl or Mrs. Ann Brehl J Campbell 1 Opened 8/8/68 ~ l Balance as date of death . I I I I ll-; 396 .9;) ,/.. fj,lo:.J. I 46 5 . 7? I-/ ~5' ? t I I I I I I ! I I I I i ! I I I . I -1!5 ~ 9 04 . 9 5 i I I I I I I I I I I ' I i I I I I I -! ! i i I. I Insert this total opposite "Jointly Owned Property", Schedule "E" in the n As Iteported" colur:m on t~1e last page of this return. L~----.......J r h f ",. RCC~.37 • (12-63) . C'OMMON\\"EALTH OF PENJ'\SYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT BENEFICIARIES AND ADDRESSES State full names and addresses of all who ave an interest, vested, contingent or other- wfse, in estate) 0 Miss Elizabeth Brehl 75 Wilson Avenue, Washington, SCHEDULE "D" BENEFICIARIES RELATIONSHIP. SURVIVED DATE (If step-children or INTEREST OF illegitimate children DECEDENT OF BENEFICIARY are involved, set STATE YES IN ESTATE forth this fact.) OR NO BIRTH sister ves -i oi_nt ten;:mt Pa. .. I I Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE (Executor-Administrator ~ must complete "As • 4 \\Vlill. . . . ~ No. . ... , ...... Year ············ ....... II Reported" column #1.) " .. ~ .. 1 • ~ c mtmstrahon ) 4' ~ ~ ~ ~ ~ P.-1 THE I I ~ :o § ;;; e._. Vl :!-'· Vl 0 ~ (;"' g '"0 ~lATTER OF THE APPRAISEt-.tENT II ~ ' ~. ~ ........ ,g &-~ ~~ OF THE I I (b : . .§ ~ 0" : (1) ESTATEOF II fi ~~ ~ ;:;. 0.. (1) • :• i-' A~NA :B.R.EHL .CAMJ?BELL . .. .. ... ....... 1::;- oeceased ~ rt -ru X ru Late of City oLt-lashington.. . .. ....... ....... II ;:_: (1) County of · .... . }7c:ts h~I1g~()n . .. ... .. ....... II . . ~ ~ CommomH·alth of Pennsylvania II 5; ..-.........--...--.>--<: (/) (/) (/) () () () ?" ?" ?" REPORT AND APPRAISAL II q ~ ~ .._.. .._.. .._.. -Y.}-(/)~-G)~-Y.} )-• : !---> : > ;VI: Ul: Vl ~: ~ . :0~ 0 0 .g,_ ·~ +'-~-(o to ? ~ i.n ........ -(/) -(/) ·(/) -(/) 0 ~ > :r. tl r:~ (! lV 3- ::l r. c... • '1:/ d '. 0 J N U 1 ':J N I H S '1 A\ s l J 1/,\ .;; f) ·~::? 1 s! ~ 3lJ 0 N I u :;· I i .i ·1 ~! ~; S !l 8 0 0 21 1-1 d S HV W l L .-' .. _, f .. • t '~ ' . COMMONWEALTH OF PENNSYLVANIA ' DEPARTMENT OF REVENUE HARRISBURG RCC-43 (5-65) Jan 27 1971 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 .Pittaburgb tlntiMal Bnok FINANCIAL INSTITUTION ~:ra~:-;htn~uw,...,·gt.on .... 1_,.;),.,.t O_t_r_t_ce ___________ _ ADDRESS ____________ w_as_1_li_ng_t_o_n_P_a __ lS_~_O_~---------------------- ACCOUNT NO. OF JOINT, TRUST OR INVESTMENT DEPOSIT_s~a~ld,;;wa~e:ors-i!83F-S-· -r2()BJ.44~. 'R'7J~6.-------- NAMES ON ACCOUNT OR INVESTMENT Mioo Elienbet.h Brelll. sp DECEASED JOINT DEPOSITOR, TRUSTEE OR INVESTORtra Anno Brehl ~;,...,.,1-.-;>ll ?S WUoon Avenue ·· ADDRESS tlanhington fa l5.3ol / DATEOFDEATH ____ ~J~oo~u~nl7~4?~~~,~.?~1l~------------------------ SURVIVING DEPOSITOR, BENE Fl C IARY OR I NVESTlfl\a.:,.;;:o;_t;.:;:;:"l::.i:.:::z.:::o.b~·o~t.u.h ...Lfi!.:,;• t•.:.:;"'"~'"------------- 75 Wilson Avonuo ADDRESS l(ae~ · At;ton i'_ :;)Ji RELATIONSHIP TO DECE~~------------- DATE DEPOSIT OR INVES'1:MfNT . WAS ESTABLISHED 5-:t>±:'v.'l'lh .. e lO 19:54 BALANCE, INCLUDING INTEREST 1. ~ DUE, AT DATE OF DEATH$ 4.01,2.2fl 1'-:; ,:;.,o~f, l 0 >I j~f; f ~ (),J_j, jt) Sf!~~. ~ ;; ...los, It Jf/5', It :, ...,./ t'/ -r' ~ ., .. • TITLE Plnt.f'om Assintant RCC-134 ( 1-69J._ .. COMMONWEALTH OF PENNSYLVANIA DfNtRTMENT OF REVENUE OOREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION OFFICIAL NOTICE OF INHERITANCE TAX APPRAISEMENT AND ASSESSMENT OF ASSETS NOT SUBJECT TO ADMINISTRATION TO: HISS ELIZABETH BnEHL 75 WILSON AVE..l'WE VlASHINGTON, PENNSYLVANIA 15301 Date: _ ___,F;.se..,b!.l..ru.M.S~oa:cy&.:.;~-~2.._,,'--""J.:).W-t..J""------ County _ ___,~;\'IwA...,S"-'H .... l.u.NG~.~.T.Io..lO~Nox._ ______ _ County File No. _ __,_ _______ _ Burea~ File No. ~3-Z/-~ J/ 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 1183 2044736 held in the PITTSBURGH rJATIONAL BANK, l•lASHING'roN QFFICE1 WN:JUNGTON1 PENNSVI.VANIA • In the names of HISS ELIZABETH BREHL OR ~lR.S. ANNE BHEHL CANJOB:ELL. Opened 9-10...54. Balance as of date of death, $4,042.20. appraised by the Commonwealth, as of the date of death, at $ 4,042,20 50 %of this amount is taxable at the rate of J 5 % DATE OF ASSESSMENT TAXABLE AMOUNT LESS: ALLOWED DEBTS NET TAXABLE AMOUNT AMOUNT OF TAX DUE 0 If you pay the above amount within three (3) months of the date of death of the decedent, or on or before April 22 19 71 you may deduct a discount of 5% of the amount of tax due, or 0 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 additionai interest is due at the rate of 6% per annum until paid TOTAL AMOUNT DUE $ ORIGINAL ASSESSMENT AMENDED ASSESSMENT $---=2~,0~21~·~1~0~--$------------ )Q3.16 ///~ --____ !2=!...1£..:._ 303.16 $ =========== ASSESSED BY: _____________ _ (Agent for the Commonwealth) INSTRUCTIONS TO TAXPAYERS Make checks or money orders payable to: To insure proper credit to your account thls Official Notice must accompany your payment. Mai I or bring it to: " ,....:, COURT Ho~.s;: WASHINGTON, PEffNA. -15301. If you have already paid this tax to an executor, administrator, attorne~ or other personal represen}a.ti'v.e of the decedent for forwarding to the Commonwealth, I ist below the date paid, iiame 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 1 red) COMMONWEALTH OF PENNSYLVANIA) SS: 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 pay out 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 Tax payer 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 iii Form RCC-2 DATE ............. ~et.!..~.~··· .. ? . .'-....... !.~.?..! DEPARTMENT OF REVENUE .. BUKEAU OF COUNTY COLLECTIONS COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT COUNTY .................... ~~--~-~-~-~-~~--~--~······················ HARRISBURG. PENNA. I 7 I 2 7 FILE NO. . .... § .. ~::.?..!..:.~.~.?. ............................................ . Whereas, ......... M.r..~ .. ~ ..... A~!l:.~ ..... ~.r..~.hl .... 9..~~P~.~JJ ...................................... late of ............... ~~~-~-~-~-~-g-~-~-~-··················································· in the County of ............... W.a.s.hingt.o.n ............................................................................. Commonwealth of Pennsylvania, having died on the .............................. 22 .... nd ............................................ day of ................ J.anuay ...................................... 19 ...... 7), seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, ...................... Al.fred ..... T.o.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 Asset Unit Values Appraisement Made for Inheritance Tax Purpoaes $ JT. HELD: Jt. Savin£s Acct. #83 2044736. held in the PITTSBURGH NATIONAL BANK~ WASHINGTON OFFICE~ WASHINGTON, PENN'SYI.VANTA Tn t:h~ names nf'_ MISS ELIZABETH BREHL OR MRS. ANNE BREHL CAMPBELL. Opened 9-10-54. Balance as of date of death $4,042.20 (One half taxable) 2,021 10 Total 2.021 10 -------------------------------------------------------------------------r-------H--·--------~---1 . ··'--.W.A~Hl.N.GTQN. .n • • • ••• ••• ••• •• county RESIDENT INHERITANCE TAX APPRAISEMENT Estate of MRS • ANNE BREHL CAMPBELL Deceased. Late of 'vASHINGTON Date of Death, ....... ~J..~:r:t:!l..~:t:Y. ..... :?.~., ..... .+..~.r?.l ....... . Appraisemel!t Docket Vol., Page, No. 63-71-237 Filed in Register's Office, ... J.la.r.c..h ..... S .. , ... J97.1 .. . Amount of tax due, $ .................................................................... . DEPARTMENT OF REVENUE Received, Examined and Approved, Wrote abo.ut Appra-isement, Appeal f1'om Appraisement, Entered and charged, ;. c, 3-//-c2. 37 ... COMMONWEALTH OF PENNSYLVANIA RfC£/V DEPARTMENT OF REVENUE . a·uR"EAiJ ~~ HARRISBURG COVN,Ty COLLE:. , C ft19#.~ .,.._~ • 4 RCC-43 (5-65) Fe~ j} J .40 FM ·'1J NOTE: TO BE SUBMITTED IN TRIPLICATE Pennsylvania Deportment of Revenue Bureau of County Collections 26 S. 4th Street Harrisburg, Pennsylvania 17101 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 Mt. Lebllnon Fcdcrnl Snvtnga and l.onn Association J ADDRESS _______ 7_33_~_a_sl_d_n~g_tw __ a_a_d~,_r_lt_t_n_~_r~e~h~,_P_e_~~oy~l_v_a_n_~ 1~~ JL ACCOUNT NO. OF JOINT, J ~ TRUST OR INVESTMENT DEPOSIT ___ l...;,..9o_"' -----------f /) NAMES ON ACCOUNT rf.-ORINVESTMENT _____ ~nn_o_B_r~_~_l_ca_~_b_~l_l_o_r __________ ___ DECEASED JOINT DEPOSITOR, TRUSTEEORINVESTOR ___ A_nn_o~Br_c~h~l_c~·e~mp~b~o~l~l ______________ __ ADDRESS _________________ 7_S __ wt_l_a_o_n_A_v_e_nu_e_. __ lffi_.,_h_i_ns_t_om __ ,_P_~_. __ l_.5_3_0_l DATEOFDEATH ____________ J_,_:n_un_r~y_2~2·~ __ 1_9_71 ____________ _ SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR ___ E_l_i_za_b_c_th_B_r_eh_l _________ _ ADDRESS ________________ 7_7 __ ~_l_son_· __ Av_c_n_~_e_,_·_w_n_hi_n_g_t_on_, __ P_a_. __ l_s_30_l RELATIONSHIP TO DECEDENT ____ si_s_t_er ________________ __ DATE DEPOSIT OR INVESTMENT WAS ESTABLISHED _____ F_cb_~.:_·n_Jr_y_l_6 •_1_95_6 _______ _ BALANCE, INCLUDING INTEREST DUE,ATDATEOFDEATH$ ______ $_1_1~•5_3_9._4_5 ________________ __ s 7~ 1 7.30 1sx;-.Y'?s-rc sz-£)~ f/-,<_:7~ 7/ "" 0. o(? ignoture Assistant Secretary 1 ~1u ~-- ------------------------------- RCC-134 ( 1-69) COM~0!4WI'i.AI., TH OF PENNSYLVANIA • DEPARTMENT OF REVENUE 'BUREAtf"OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION 'OFFICIAL NOTICE OF INHERITANCE TAX APPRAISEMENT AND ASSESSMENT OF ASSETS NOT SUBJECT TO ADMINISTRATION TO: __ E~Tw.I""Z.c.:A.~o.~.BEw.:TuHJ-....~.<Bilo.loREo.i!J• HLu.w.. ______ _ Dote: --:il~-«aF~e~h-.l:t:,1r-:l:l.¥97"+.l&.------- 77 l'fi.C:SObl AJW],Ulli \jASHINGTOI'l, PENNSYLVANIA 15301 County Washington County File No. ~/'-/)/?-. 2' Bureau File No. <{; ..7 -//-dJ l ~e hove received notice that, ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ on JB~nn"ry 22 19~, you come into ownership of certain property through D. Lt!xtl§eloomx!xoox~~WCXX ~-r re transfer from ANNA BREHL CAHPBELL, Deceased. Under the Inheritance and Estate Tax Lows of the Commonwealth of Pennsylvania such transfers ore 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 accmmt. #J 96 beJd :in the MT • r,r.sr>NAN EEDEfiAI. SAVIN}S Mm LOAN ASSOCUSION, PITTSBURGH OfFICE, PITTSBURGH, PENNSYLVANI lfl tfie :names ef MIN.'· • .BHEWL GAUPBEU. OR E:tiZA.1311TM BHli:ML. Ope:R:Qd. 2..J.6-56. Balance as of appraised by the Commonwealth, as of the dote of death, at $ ----'ll""'. ,._,:.;.53.J.9.;z..J•401o-;5L---- 50 %of this amount is taxable at the rote of_--.~lo715'---% DATE OF ASSESSMENT TAXABLE AMOUNT LESS: ALLOWED DEBTS NET TAXABLE AMOUNT AMOUNT OF TAX DUE D If you pay the above amount within three (3) months of the date of death of the decedent, or on or before A;RPil 22 19 71 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 ORIGINAL ASSESSMENT AMENDED ASSESSMENT $---------------- $ $-=================== TOTAL AMOUNT DUE APPRAISED BY: (]_y f)'=', cf \Ld «. ~(once Tax Appraiser) ASSESSED BY: ______________ _ (Agent for the Commonwealth) INSTRUCTIONS TO TAXPAYERS Make checks or money orders payable to: ~ >fS' Pc?oP-// cy~/;: /Y"7/ Jfr /¢; ~ '-;:;;__ 7fL 4/ _;? / .Pff To insure proper credit to your account this Official Notice must accompany your payment. Mail or bring it to: 153(rl 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, naiJle,anc!'<!ddress of the persou to ~.bpm 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 gener.al estate of the decedent or any other transferee. · · SCHEDULE OF DEBTS Date Paid Name of Payee Description of Obligation Amount Paid (attach separate sheet if required) COMMONWEALTH OF PENNSYLVANIA) COUNTY 0~-------- SS: " TOTAL $ 1, hereby certify that the foregoing .is a just and tr.ue statement of funeral expenses and other debts of the decedent, , for which I was legally responsible and which I did pay out 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 Wi lis Fonn RCC-2 COMMONWEALTH OF PENNSYLVANIA DATE ....... ~.~-~ ..... "+?...'. ...... "+.?.?..~ ................. . DEPARTMENT OF REVENUE ,. BUREAU.:. OF COUNTY COLLECTIONS HARRISBURG, PENNA. l 7 l 2 7 RESIDENT INHERITANCE TAX APPRAISEMENT COUNTY ................ ~~c:L.~.h=i.:.l]g~.9.~ ................................ . FILE NO .... ??..:.?.~=-~?..?. ................................................. .. Anna Brehl Campbell 1 Washington Whereas, ...................................................................................................................................................... ate of ............................................................................................................. . in the County of ............................................... .W.?.:~h~P:~9..P. ..................................................... Commonwealth of Pennsylvania, having died on the .................................... :?.~~ .............................................. day of ................... J..~n.1Ja.r.y ................................... 19 ... 71 .. , seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, .................................... .f.~F.G.~ .... -~.9 ........................................................... , 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. Appraisement Unit Description of Asset Values Made for Inheritance Tax Purpoua $ Jt. Savin,gs Account #196 held in the MT. LEBANON FEDERAL SAVINGS AND LOAN ASSOCIATION, PITTSBURGH OFFICE, PITTSBURGH. PENNSYLVANIA. In the names of ANNA B REHL OOll'BELL OR ELIZABETH BREHL. Opened 2-16-56. Balance as of date of death, $11,539.45 11.539 45 fonn:!;"!,~h ~: ~:~hi:wOl"D ~C(!(}~i~g~, ~~ o~~~~~c~~~d~ pprats ................... ........................................................................ ..................................................................... Number and r /c._/ ( St eet) ............................................................. ~ ........................ , Penna. (Post OfUZ7 WASHIICTON County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of ANNA BREHL CAJ.'.1PB ELL Deceased. Late of WA$li:I:N.G'r..9N .......................................................... .. Date of Death, ..................... l~22~7L ................................ . Appraisemel!t Docket Vol., .............. .38. ............................. . Page, ...... JA?.·:.?.. ..................... No. 63-71-237 Filed in Register's Office, .. M~~~~ ... ~?.. .... l 9 .. .?..~. Amount of tax dtte, $ .................................................................... . DEPARTMENT OF REVENUE Received, i Examined and Approved, Wrote abo.ut Appra.isement, Appeal f,.om Appraisement, Entered and charged, R c c-al (2-64) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION NOTICE OF FILING OF APPRAISEMENT MISS ELIZABETH BREHL -INFORMANI' IN YOUR REPLY PLEA.E REI"ER TO In Re: Estate of _______ AN __ NA __ ~B_REHL ____ C_AMP ___ B_R_T_J_. __________ __ ____ __.!.!:WAS~H~IN~G~T:..:O~N::.__ ____ County -File No. 63-71-237 Dear Miss Breh11 You are hereby notified that the original appraisement in the estate of ANNA BREHL CAMPBELL has been filed in the office of the Register of Wills qf WASHOOTON County on June 10 , 19~. Said appraisement reflects the following valuations: Jt. Hdl. ~ ----~46::...5....::•~76=------Personal Property __________________ __ Transfers ____________ ~~~~--------- Total ------------~~4~6~5~·~7~6~-------- 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~un~e~l~0~1~l~97~1~--------- DATE OF DEATH: January 221 197~ Note: This is not a bill. Signed Title FRANCES lEO, CHIEF APPRAISER J RCC-39 (5-68) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT , SUMMARY Estate of P.@PJ?.ELL (Last Name) ANNA B. (Initial) DATE OF DEATH 1-22-71 FILE NO. 63-71-237 (First Name) REPORT OF INHERITANCE TAX APPRAISER I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Washington 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' June 10, 1971 ~~ ~ ~ INHERITANCE TAXAPPRAISER1 . REPORT OF THE REGISTER OF WILLS I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect- fully report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or lesser amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents the sum allowed as a deduction. Dated: ____________________ __ REGISTER OF WILLS INVENTORY VALUE AS REPORTED VALUE AS APPRAISED Real Property (Schedule A) Personal Property (Schedule B) Transfers (Schedule C) Joint-Held Property (Schedule E) TOTAL GROSS ASSETS Less Debts and Deductions (SCHEDULE F) CLEAR VALUE OF ESTATE Valuation of life estates or $ 465 76 4.65 76 annuities................... $ ________ +--- ESTATE TAX ASSESSMENTS $ ______ _J_ __ $ 465 76 465 76 FOR USE OF REGISTER ONLY COMPUTATION OF TAX Tax on $ ------------+---- Taxon$----------------+---- Taxon$--------------+---- 2% 6% 5% $ __________ -4--- $ _____________ -4--- $---------4-----$ _______ -4-- $ __________ 4----- VALUE AS REAPPRAISED $ ______________ 4---- Tax on $ ------------------+------~ Tax on $ ----------------+----'t ( 15% Exemptions=========F== Total Estate ____________ ---1--- TOTAL TAX $----------~---- (*) As evidenced by Chari table Exemption Certificates issued by the Secretary of Revenue. Less tax previously paid $=====~F== 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 $ _________ ---1---- BALANCE DUE $---------~---- Add interest at rate of 6% from -------~10---------$-----------4---- TOTAL TAX BALANCE $ --------+---- pAID $ -------------~--- FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills, for proper reason, same should be noted below, with short explanation. Will Administration ( No. IN THE Year .......... .. MATTER OF THE APPRAISEMENT OF THE ESTATE OF ANNA BREHL CAMPBEIJ.. Deceased Late of ..... WMlfl..J:P.'l'ON County of . . WJ\.SfUNG'l'ON . Commonwealth of Pennsylvania REPORT AND APPRAISAL ,, Fonn RCC-2 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE ·······---~~~-·---~_9.-~------~.?.?~ ...................... . . DE~ARTMENT OF REVENUE . . BUREAU OF COUNTY COLLECTIONS HARRISBmtG. PENNA. 1 7 1 2 7 COUNTY . .Washi'llgtoh: ............................................... . FILE NO. . ...... ?.?.:?..!:.?.?.?... ............................................... . Whereas, ........................................... ANNA. .. BREHL .... CAMP.B.m. ...................................... late of .................... Y.i.~~~~-~~~---···················································· in the County of ................................................. WA~-~-~9:~9.~---················································· Commonwealth of Pennsylvania, having died on the ........................................ ?.?.4 .............................................. day of ............... cJ..~~---···································· 19 .. 7.~---• seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Th f I FRANCES LEO I ere ore, • ········································ .............................................................................................. , an appraiser du y appointed accordmg 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 Deacrlptlon of Asset Values Made for 1 n herl lance Tax Purpoua $ JT HELD: S.ee copy of schedule "E" attached to appraisement 465 76 I Having been duly sworn according to law, I do h~reby certify that the a~e appraisement is made in con- forrnity with law on this .............. ~---········day of ....... _._·_·_· __ ·_·_·_·_·_·_·_·_·.·.·.·_·_:·.::·.·_·_·_·_·_·_::::::·.·_:::·:::~~;_:. .. ::::···-~·:·_;·····_·_··¥a·.·.-.. -.:~~- Appraiser .............................................................................................................. .................................................... ~~. Penna. (Post Office) I I WASHINGTON ...... County RESIDENT INHERITANCE TAX APPRAISEMENT .. Estate of .... ANNA.. ... B.RE.HL .... CAMPB.E.LL .................................... . Deceased. Late of ..... JIX ... WAS.HI.IDTON ......................................... . Date of Death, ............... l~??~7l ...................................... . Appraisemel!t Docket Vol., ...... ~ .. ~ ........................... . Page, /1.:-Z~.z ............... No .... ...f:{J..~7l-::?.3..7 ........ . Filed in Register's Office, ........ J::u.n~ .... lO. ........ J9 .. 7l .. Amount of tax due, $ .................................................................... . DEPARTMENT OF REVENUE Received, Examined and Approved, Wrote abo.ut Appra-isement, Appeal f,.om Appraisement, Entered and charged, 15 day notice ~STATEMENT PENNSYLVANIA TRANSFER INHERITANCE TAX - - - l J Date ...... J.uo.e .... B .... l9..7.6 .................................. . To ...................... ~.lJ.i?!.9.Q§t.h ... ~.;r.eb.l. .... 7.5. .... W.l..ls.Qn ... h.;v.enu.e ....... W.ashin.gt.Qn .. J?.enna ........ l5.30.l ..................................... . ........................... At.t¥ •. F . .r.ank ... c ....... Ca...t;.r;:o.;u ...... 33 .... w ....... Beau .... S.t .•... Jxashin.g:t.on.,J?.eon ....... l5.3.0.1 .......................... . ESTATE DATE OF OF ........................ ~P.:P.:~ .... ~ .. ~ ..... S:.~l?.Q.§:J:.J: ............................................... DEA TH ...................... +.-.:::.?..?..:::.7~ .................................................................... . Date County ate Appraised ...... §::::J:.Q.:::.7..± ............................................................... File........................................................... ...... . ile ........ ~-~::.?..~::.?.} .. 7. .............................. . Real Estate Personal Property Joint Accounts .......... .46.5 .•. '1..6 ..................... . Less Exemptions Less Debts and !\.d . . . E .. " ministration xpenses .......................................................... " ............................................................................................................................................................ . TAXABLE AMOUNT ............... 46.5 .•. 7..6 ..................... .. TAX on .......................................... @ ........................ ro .................................................... . TAX on ........ ~.?..~ .. ~ .. ?..?. ............ @ ......... ~.~ ......... 7c ......................................................................................................................................... ~~--~--~~ ....................... . Amount Previously Paid TAX BALANCE 69.86 ............................................................ Interest from ......... 1:.::-.~.~.:::-.:Z.~ ............................................. to .......... 9..:::-.~.~ . .:::-.7..§ .................................................... . 6 69.86 .................. ro on ............................................................................. . 17.47 BALANCE DUE COMMONWEALTH ................... 6..7 ..... 3..3 ...................... .. DISCOUNT (57o) IF PAID WITHIN THREE MONTHS FROM DATE OF DEATH. Address __ 3_3_W_._B_ea_u_S_t_r_e_e_t _____ -----l 2% Tax on $ $ Waahington,Peama. 15301 6%Tox on $ $ 15% Tax on $ 465.76 $ 69.86 File No. _6_3_•_n_._2_3.:..._?_Dote of Deoth_l_•_2_2-_'1_1_-j June 10.1916 Dote of Payment ----------------------1 %Tax on $ $ Estate T ox, Act of May 7, 1927 $ Atme B. Campbell Nome of Decedent --------------------1 TOTAL TAX CREDIT $ Waahinston ! CountY----------------------4 69.86 Remarks: Less five percentum of tax if paid within three months after . , _ dote of death ... . \ .\' &Plus interest4J.tz-flof ·· .. , -\-% fro'aat....,e.,---------to ____________ _ ., j' $ ________________ _ 1?.4? ,; $ ________________ _ ,. .. TOTAL AMOUNT PAl