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Home My WebLink AboutOC1971-0244 - ESTATE OF FOLTIN! I Fonn RCC-2 . ' DEPARTMENT OF REVENUE . BUREAU OF COUNTY COLLECTIONS /~ARRISBURG, PENNA. 77 12 7 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE .. ~.C:.h-.... 9.'-..... 1.97.! ........................................... . COUNTY .~~~.~~~~.?.?. ............................................... . FILE NO. ..?.J:::..?J.:::?.4!:t .................................................. . Whereas, ........................................... ~~¥.~~~ .. X.9.~~P:~ ................................................................... late of ............ Y.!.~.!.~~~~ ................................................................ .. in the County of .......................................... .'W:AS.HJ.NGTON .......................................................... Commonwealth of Pennsylvania, having died on the ........................................... 9.~.v~.nt.h .......................... day of ............. P..f?..G.~P.E3..r. ..................................... 19 .... 7.+.., seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, .......................... X~~g~ .... ~ .................................................................... , 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. Savings Account #TB 050118 held in the FIRST NATIONAL BANK & TRUST COMPANY. FREDERICKTOVVN OFFICE, FREDERICKTOWN1_ PENNSYLVANIA In the names of MiillY FOLTIN OR MARGARET TOPOR GER. O_Qened 11-10-69 BARANCE AS OF DATE OF DEATH, $826.91 826 91 form~~V:fhbl:: ::~~sw<>rJl~:· ~.~ o~~ .. ~~=7:~;2::::;=d~l~~ftv Appruser .................................................................................................................................................................... (Number and Street) ....................................................... dd.~ .... Penna. (Post Oftlee) I ' I I I . WA$H:r:NG'I.'ON. . County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of H •• •• •• ••• •• • ••••• MARX F.OL.T.J..N. .. Deceased. Late of .VES.TABURG ................................................ . Date of Death, ................................. l2-7-?0 ....................... . AppraisemeHt Docket Vol., Page, No. ... ?.?..-:?..~~?44 ............. . ---Filed in Register's Office, ......... ~.C!:!.'.~:b.: .... 9. ..... 19 .. 7.~ .. Amount of tax due, $ .................................................................... . DEPARTMENT OF REVENUE Received, • Exa.mined and Approved, Wrote abo.ut Appra.isement, Appeal f,.om Appraisement, Entered and charged, /' 03-7/~~fLcf J COMMONWEALTH OF PENNSYLVANIA stEC£tVEo .. DEPARTMENT OF REVENUE ·couNTy ~gAu OF HARRISBURG t.. LLE~CTfONs DEc }4 4 RCC•43 (5-65) · 24 fH 'lO 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 First National. Bank & Trust Co. FINANCIAL INSTITUTION ___,Wita~s~h~i:::n~gt~oatl~a=P!!ak. ~~--------Frede~icktown·Offioe ADDRESS FrederiCktown, Pa. 15333 ACCOUNT~N~O~.O~F~J~O~IN~T~,~~~~~~~~6~,~~~~---------- TRUST OR INVESTMENT DEPOSIT ____ 0___:.. _________ _ NAMES ON ACCOUNT OR INVESTMENT Mary Foltin Or Frances Slusarez)'k DECEASED JOINT DEPOSITOR, :::::;"' TRUSTEE OR INVESTOR ___ M_a...:..ry~F....;;o:...::l...:..ti::::n:::.__. __ l---/..::::_ ______ r, ADDRESS Box 43~, Vestaburg, P~. 15368 ~~ DATE OF DEATH Deoember 71 1970 / SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR Mrs. ·Frances Slusarczyk ADDRESS __ V_i_n_e_la_n_d....:;.,_N_e_w_J_er_s_e....:y_OS.....:.3:...6_0 __________ •.. RELATIONSHIP TO DECEDENT.=-...;;D;._a=u-g=ht=e:;.:::r-:------------ DATE DEPOSIT OR INVESTMENT . WAS ESTABLISHED February 9, 1970 BALANCE, INCLUDING INTEREST~ 6 ":1·6 .. DUE, AT DATE OF DEATH $ __ o_l_._·.;~_. ______ ....:....._ _____ _ Signatur/ TITLE )' ..,.._,. • C.· _ .1' ~ ... ~C-,411-69) , COMMONWE_e.L TH OF PENNW L VAN!:<\ DEPARTMENtt'QF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION OFFICIAL NOTICE OF INHERITANCE TAX APPRAISEMENT AND ASSESSMENT OF ASSETS NOT SUBJECT TO ADMINISTRATION TO: ____ ~M~r~s~·-fwrwP~.n~c~e~F,~S~l~uwS·~nruc~~~rk~------Date: --4DJEe~a>eeE!3:!SS-~e:Hr~l~gT, ..... l~::-~97ff!t:.01------- VII'Ifi:"UND, EE\·J Jl::lWEY l 08360 County \'iashington County File No. _________ ~- B urea u F i I e No. _ _;:;c;_;;;_y.;;;__,_:~;_:.V_-2~0,.......:....~--_ We have received notice that, ~IDif~{V,A{rXYXT1XXXXXXXXXXXXXXX'ZXXXXY.XXXXXXXXXXXXXXXXXX:XX' on December 7 . 19....2Q., you came into ownership of certain property throughmb~:zri"~~~ IDiUlifme~6Wded'{lf.y::>tltiDnet:ed~1lK. transfer from l!:ARY FOLTIH, 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. Sayings Accol.Ult //867 held in the F'IllST NATIONAL BANK & TRUST CO., FJiED1~RICTOVJI'J OFFICE, l"REDERICKTO\'iN, P.:;NNSYLVANJA. In the namen of t~tARY FOI.'l'UJ OR FRANCES SLUSARCZYK. Qpened 2-9-70 BaJ a.nce as of date of death, ~1516. '36 appraised by the Commonwealth, as of the date of death, at $ SJ.e.3a 100 % of this amount is taxable at the rate of 6 % 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 l·l;;rch 7 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 a~d, in addition to the tax, statutory interest at the rate of 6% of the tax per annum is also due as of *------ l9 __ in the amount of *If the tax is not paid by the above date additional interest is due at the rate of 6% per annum unti I paid $ ORIGINAL ASSESSMENT AMENDED ASSESSMENT $---~8~1~6 •• J~(~1------- ---_g_.};i4_ ___ _ -~-------- 48.98 $ -================ TOTAL AMOUNT DUE APPRAISED By: _/&_-'.....t.)?-~_/_;:C:::_1 :._L_, __ ·,,_.t.~-~-;-/!:...,__ __ (Inheritance Tax· Appraiser) ASSESSED BY: _____________ _ (Agent for the Commonwealth) INSTRUCTIONS TO TAXPAYERS Make checks or money orders payable to: '''1:, \ :\>~· ,,.. . ... • -.4· .. ~ ' ·: ·' ... To insure proper credit to your account th1s Official Notice must accompany your payment. Mail or bring it to: If you have already p_aid this tax to an executor, administrator-, atto~ney or other personal representative of t~ ~·--1 decedent for forVIf!lrdi~g· to the Commonwealth, list below the date paid, name and add.ress of·the p~_r~on·tp whom ·, you made payment, their of.ficial title and the amount. "" · Date Paid Name and Address of Payee Official Title Amount Paid Under certain cir~,umstances, 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 required) COMMONWEALTH OF PENNSYLVANIA) SS: COUNTY Of _______ _ I, hereby certify that the foregoing is a just a_nd 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 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$--------.. Date of Approva I:-----------',..,___ ____ _ Register of Wills POST OFFICE DEPARTMENT OFFICIAL. BUSINESS" PO!;TMARK OF' DEL.IVERif.!~ OFF'lCE -·-· · dd ·below If you want to Print your name and a_ ress the address of delivery restrict deliv~ry, or. to. ~ave~~me! otheside. ~ shown on this receipt, c dec t to ack of . Moisten gummed ends an a • .. article. · · ttorney at law: Washington Trust Building."'~: ·~ ' .z~~~~ Washin?toq, J}~Q:Q"§MN3JJLia ~ I '. "'' ··"'"~' - { ~'~''$/[.'/ r;.,, !~.tdt.:,:ii~:l.Kt.lfJijfd~\. ~:.' ~;,;;',;,l3.g~Z&f~~ Deliver ONLY to addressee If you have afr~~d~. ~aid this tax to an executor~ administrator, attorney or other p_erson~l repr~~n)qt,ive of the·., decedent for•·forwa,~dmg t,o the Commonwealth, I 1st below the dote po1d, nome and address of the person to whom you mode payment, their official title and the amount. Data P~ ~1 11 19/~ Nome and Addre~s of Payee ';!J";j#r, \£~ ~UtA/Hc:t?r(( Officio I Ti tie 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 to)( 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 osses$ment of tax. · · THE THREE TESTS WHICH MUST BE MET ARE THAT: 1 • You were personally legally responsible for these debts, and 2-You actually paid these debts out of the account or property described above and can furnish proof of such payment, if required, and 3-These same debts ore not also claimed, for tax purposes, by on executor, administrator or other p~rsonal representative of the deced~nt handling the administration of the general estate of the decedent or any other transferee. · SCHEDULE DF DEBTS Date Paid ~arne of Pay_ee De~sription of Oblig_ation Amount Paid ..1 . ./L-J~) L' Z:,.,J _.,...,. . .._-:£ .£-• .1. / ./( dh~J d ,':;7!_/. ' ·-A./ /~'!.A! x...L~ i'L'L . .JL /' / . TOTAL s t/i ;It . . .. '- ( att.ach separate sheet if required) COMMONWEALTH OF PENNSYLVANIA) . SS: ~~2.::.~..:::1'.) '·•••t' S'"'''l-, lh9t th• foi nv,.i,• a i••• and •••• •tatement of funeral expenses and other de~f the decedent, •· ~· · • , fllt wt.;d! I W!ft !egaUy responsible and which I did poy out of the property.. ··rein toucl I further certify, that to the beat of my kno~le-dge and belief, these some debts will not be claimed by any other person, for inheritance tu purposH. ~ S1111$CRIBED BEFORE ME TH.IS s£~AY OF -...z2:2.tta<l~ . 19 .zL. . ~ 6'~ ((, ~~ 1), I? n BERNICE R. m-;r E¥ ~ 11, CoSIABURG, WASIIII;GrJ 1 cou~PORT OF REGISTER OF WILLS ' mm•ssion f.xp · • • >-Ires Match 29, 1971 f,.tt. undersigned, du.ly elected Register of Wills in and for the above county, do respectfully report thqt I heve eUowed deductions listed above in the total amount of $ -------~ .• Date of Approval:~-------------- ' l• . Register of Wills , . Fonn Rrc-2 ~. DEPARTMENT'OF>REVENUE' BUREAU OF COUNTY COLLECTIONS HARRISBURG. PENNA. 17 12 7 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE ......... Ma.r..c.h .... 9., ..... l.~J... .................................. . COUNTY .......... W9..l?..b.inecti.9.P.: ....................................... . FILE NO •........... 9?.::.Ih::.?4.4 ............................................ . Whereas, .................................... M.a.r.y .... f.9.lt.i.n. .......................................................................... late of .................... .Y.~~~.<:t.~~.& ......................................................... . in the County of ............................................ ¥~~!?,,.h;bngt,q_P, ......................................................... Commonwealth of Pennsylvania, having died on the .................................. .s.e.v.ent.h .................................... day of ..................... P..~.9.~ml::>.~.:r. ............................. 19.7.9. .... , seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, ............................ ERAN.CES ... .LEO .................................................................... , 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 Purpoaea $ Jt. Savings Account #867 held in the FIRST NATIONAL BANK & TRUST EMX COMPANY. FREDERICTOI'JN OFFICE, FREDER.ICTOVJN, PENNSYLVANIA. In the names of !v'iARY FOLTIN OR FRANCES SLUSARC2YK. Opened 2-9-70. Balance as of da.te of death. $816.36 816 36 . INSOLVENT I I I \ I I I I i ' ·--!-·-- .. Having been duly sworn according to _law, I do hereby certify that the above appraisement is made in con- fonnity with law on this ........ ~· day of·······················~···········~····· .... 1~ ............................................. ~ ................ pd ...... App iser ...................................................................................................... ....... ............ ,, .................................... (Number and Street) ............................................. U/~ .......................... , Penna. (Post ee) I I I ' I I I I•Jlt.S RING TON County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of MARY ... FOLT.IN ................................................................ . Deceased. Late of v:&?.':l' . .AJR!RG ........................................................... . Date of Death, ...................... l~.~z~7.9 ................................... .. Appraisemel!t Docket Vol., Page, No. .. ......... .63.~7l~244 .... Filed in Register's Office, .... ~~:r..9.~L .. 9 .......... J9 ....... .71 Amount of tax due, $ ................................................................... .. DEPARTMENT OF REVENUE Received, ' ., ··········-·············································································· Examined and Approved, Wrote abo.ut Appra.isement, \ ············································································· ' I Appeal j1'om Appraisement, -------········ I ···························································································································· Entered and charged, .• # COMMONWEALTH OF PENNSYLVANIA lfC£1V£o DEPARTMENT OF REVENUE CouNryU~£Au OF HARRISBURG t-OLL£CTJONs Dec 1 t/ RCC•43 (5-65) NOTE: TO BE SUBMITTED IN TRIPLICATE Pennsylvania Department of Revenue Bureau of County Collections 26 S. 4th Street Harrisburg, Pennsylvania Dear Sir: 4 2S FH '10 Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act of 1961, we herewith submit the following report: NAME OF REPORTING First National. Bank & Trust Co. FINANCIAL INSTITUTION tvashington • Pa. -Fr;-e-d~e-r~i~ek~t-o_wn __ ·~o~r£~1-c_e ________________ __ ADDRESS Fredericktown, Pa. 153)3 ACCOUNT NO. OF JOINT, TRUST OR INVESTMENT DEPOSIT __ ____:T:.::B:.....::.:05:::__:::0:.:1:18:::..· ------- J NAMES ON ACCOUNT. . • OR INVESTMENT Mary Folt1n or Margaret Toporcer t (o --- DECEASED JOINT DEPOSITOR, -~ C: TRUSTEE OR INVESTOR ____ Mar_...::y_Fo.;;;.;;l;;;_;t::.;;::;i=n-----=\......-/:...._ ______ , ~,- ADDRESS Box 435, Vestaburg, Pa. 15364 ~,D J" DATE OF DEATH December 7, 1970 SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR Margaret Toporcer --~~----~--~----------------- ADDRESS ____ Ve_s_t_a_bur~g~,_Pa_._l~53~6_8 ________ ____ RELATIONSHIP TO DECEDENT Daughter DATE DEPOSIT OR INVESTMEN=T-------------- WAS ESTABLISHED November 101 1969 BALANCE, INCLUDING INTERESTd _ 6 DUE, AT DATE OF DEATH $ __ 0_2_·..;..•.;:;.;;91:...._ __________ _ <f. ~ ~ 1 /:lt, Cfl-: t.!(f.&,/ 3f0 ~---~.'/1 \ RCC-134 ( 1-69) .... . ' ~ COMMONWEh TH OF PENNSY L VANIA• DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS !')INHERITANCE TAX DIVISION ·~OFFICIAL NOTICE OF INHERITANCE TAX APPRAISEMENT AND ASSESSMENT OF ASSETS NOT SUBJECT TO ADMINISTRATION TO: ___ l~~-~_iG_-M_'lli_(_T __ TO_!_.lO_P_.C_ER ____________ ___ Date: December J 8, J 970 V"'~Tii.BUltG, P~:l\iN3YLVANIA 15368 County __ ___.:Uwrt.liO!s.l.lh"'"':i nu;gt!;O.!.· ~o.u..ni------------ County File No. ______________ _ Bureau File No. W ~ 2/-~ Yj/ We have received notice that, ~~W.d'Er~'<XXXXXXx:xxxxxx.Y ..... XXXX...XXXX)"',,X.XXXXXXX.UXX.i\XX..'{XX]{XXX on De cemb.er 7. .1~70 ou came into ownership of certain property through .r.v;t:~tt.'tc\iXY"J.Y'.OISlJ.:Ll.Y'.~illX YVY_"l'TY_V'Y.Yif.Y:YVVY>f\IIV.Yt'IY.J ~ l"'i"-' 'wes'-l'effTfe'r-•yl.ow·~a-''9r...,.11e · transfer from HAnY FOLTIN, 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. ~:av:i.ngs Acct.//TB 050118 held in the FITIST NATIONAL BANK & TRUST CO., FH~DE:UCKTO';JN OFFICE, FHEDERICKTO';'JN, PENNSYLVAHIA In the names of HARY FOLTIN 011 N:ARG.i·.W.:.T TOPOIWEH.. Opened ll-10-69. Bcl.ance as of date of death $826.91. appraised by the Commonwealth, as of the date of death, at $ _...;82;;;.;;...;;6..:::.•~9;;;;1 ______ _ 100 % of this amount is taxable at the rate of 6 % 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 Harch 7 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 *------ l9 __ 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 $ _ __;:;,;82..;;,.:6;,.:,. 9=1=----- 49.61 ---_2.!.~----- 49.61 $ ================= TOTAL AMOUNT DUE APPRAISED BY: _--Y_U:.!...<!/:....:...· ~li-~~(,....:;:/ ~::....::'"c..a-~~7-=uzy=¥-- (lnheritance Tax Appra1ser) ASSESSED BY=-------------------- (Agent for the Commonwealth) INSTRUCTIONS TO TAXPAYERS Make checks or money orders payable to: To insure proper credit to your account thjs Official Notice must accompany your payment. Mai I or bring it to: .. ---....) •• i . ..; -l '-'··· If you have already paid thi' tax td an executor, administrator, attorney or other personal representative of tht>• decedent for forwarding to the Commonwealth, list below the date paid, name-and aollress of the person .Yo 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 required) 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 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 ? ' ' ' "" ~-.. "*· •--• tL ea. :asp,~ , -· -' . J If you have plready paid..:Jh-is '?ax to on executor, administrator, attorney or other personal representative of the ... "·/: decedettt.for forwarding to the Commonwealth, list below the dote paid, nanw and address of the person to whom L- you rr.ade payment, their official title and the amount. Nome and Addre5s of Payee Official Title Amount Paid W~~!~-n >J"A-Lan~~~J~~------4. .$126,11 Under certain circumstances, if, after the dote 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 on amended assessment of tax. THE THREE TESTS WHICH MUST BE MET ARE THAT: 1 -You were per~onolly legally responsible for these debts, and 2-You actually paid these debts out of the account or property described above and can furnish proof of such payment, if required, and 3-These some debts are not also claimed, for tax purposes, by on executor, administrator or other 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 ! la:.. II ;9 Ji. Go..< L')o.J 0.fJ_H !J.J/ :;:'./ & j:L d I Jl<L41.L . <:"J IL?f 0~-h A//,/,\)/ c: _y./J/NU'< %....1~ 9/ I . ' ·- TOTAL $ J ol_(_ .y[ (attach separate sheet if required) COMMONWEALTH OF PENNSYLVANIA) ss:~ .. :.l::&~fi/J~~~~~~z::!::~~---hereby certify that the fore ing · a· stand true statement of enses and other debts of the decedent, . · • , f()( which I ... t.,.!tr , • .,_-.iW• onJ •*'•"h ! 1 .<[ p-o1 o\1• of th• ptoperf) lt '" to:ud. I futtt.e• cc-ttlf,, that tc -dte best of my knowledge and belief, these same debts will not be claimed by any other person, for inheritance tax ,.rposes. 71: y-DAY OF //'-..; f ~1'..LC~-1fxak-U:V Ll Signature of axpayer iy Comm~slon EXplres.Mfi~~rliWf 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.cri1~pproval: --~----------Register of Wills ·~·