HomeMy WebLinkAboutOC1971-0446 - ESTATE OF SULLIVANr "..
IN THE COMMON PLEAS COURT OF,WASHINGTON COUNTY,PENNSYLVANIA
ORPHAN'S COURT DIVISION
IN RE:
No.'I-If ~of 1971 ~
ESTATE OF AGNES M.SULLIVAN
PETITION FOR SETTLEMENT OF ESTATE
UNDER SECTION 202 OF THE FIDUCIARIES ACT OF
1949,AS AMENDED
TO THE HONORABLE P.V.MARINO,PRESIDENT JUDGE OF SAID COURT:
AND NOW comes MARY L.PANCOAST,Petitioner,and
represents to your Honorable Court as follows:
1.Mary L.Pancoast is an adult individual who resides
at 687 Elmhurst Drive,Boro~gh of East Washington,Washington
County,Pennsylvania.
2.On February 27,1971 Agnes Mary Sullivan died
testate domiciled at 687 Elmhurst Drive,Borough of East Washing-
ton,Washington County,Pennsylvania.A copy of the Last Will
and Testament of decedent is attached hereto as Exhibit "A".
A copy of the death certificate of decedent is attached hereto
as Exhibit "B".No Letters Testamentary have been applied for
or granted,although the Last Will and Testament referred to has
been duly probated.
3.The gross value of decedent's estate,exclusive of
real estate,and wages,salaries,or accrued pensions payable
under Section 201 of the Fiduciaries Act of 1949,as amended,
does not exceed $5,000.00.The items of personal property in
the estate are as follows:
(a)26 shares of Standard Oil of New Jersey
valued at $1,924.00
..........'.
(b)Joint account #I-1685 held in
First Federal Savings and Loan
Association of Washington,
valued at $3,000.00
(c)Li'fe Insurance policy payable
to estate and its gross value
(d)Mellon Bank Savings Account
#178-09-0400.01 valued at
(e)Mellon Bank checking Account
#556-8375 valued at
(f)Mellon Bank joint checking Account
#556-6290 valued at $83.71
TOTAL ASSETS
$1,500.00
318.88
214.54
123.84
41.85
$4,123.11
4.The following expenses and debts of the estate are
admitted and are entitled to preference.
(a)Funeral bill,Abel Funeral Home
(b)Kurtz Monument Company,marker
(c)Frank A.Conte,Attorney Fees
(d)Pennsylvania Inheritance Tax
(Estimated)
(e)Expenses of last illness
TOTAL LIABILITIES
NET ESTATE
5.Decedent diad unmarried.
$1,707.00
135.00
250.00
787.50
2,252.70
$5,132.20
-$1,009.09
".J .~
WHEREBY,petitioner prays your Honorable Court to
distribute the assets of the estate according to decedent's Will.
Frank A.Conte,
Attorney for Petitioner
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF WASHINGTON
:Pi)-#::-day ofOnthis __~~~~~,1971,persona11
appeared before me MARY L.PANCOAST,who,having been duly sworn
according to law,deposes and says that the facts set forth in
the foregoing Petition are ture and correct to the best of her
knowledge,information and belief.
~Mary .Pancoast
Sworn to and subscribed
~?6bbeforemethis.day
of ~~,1971.
~u>r-!J?&#-_otary Public
My Commission Expires:
J 0 I N D E R
Agent for the Commonwealth
of Pennsylvania,do hereby join in and consent to the within
Petition and the prayer thereof.
;Q~~2z~
Agent for the Commonwealth of
Pennsylvania for the collecti'n
of inheritance taxes.
I
a'-'OJ
..,
I,AGNES SULLIVAN,of 685 Elmhurst Drive,Washington,
Pennsylvania,being of sound and disposing mind and memory,do
-I hereby make,publish and declare this to be my Last Will and
I Testament,hereby revoking and making void any and all other Wills
I
heretofore by me at any time made.
I
I direct that my Executor hereinafter named pay all my
just debts and funeral expenses as soon after my death as may be
convenient.
II
All the rest,residue and remainder of my estate,real,
personal and mixed of whatsoever kind and wheresoever the same
I may be situate,I give,devise and bequeath to my niece,MARY L.
PANCOAST.
III•
In the event that my niece,MARY L•.PANCOAST,predeceases
me,dies simultaneously with me or fails to survive me for a period
of thirty (30)days,then,and in that event,I give,devise and
bequeath my estate as follows:
(a)I bequeath the sum of $500.00 to my
niece,SISTER M.CECELIA SULLIVAN:
(b)I bequeath the sum of $500.00 to my
niece,SISTER M.BERNADETTE SULLIVAN:
(c)I beaueath the sum of $500.00 to
THOMAS DOUGLASS GLADDEN:
(d)I bequeath the sum of $500.00 to
LAURA LOUISE GLADDEN:
(e)All the rest,residue and remainder of
my estate of whatsoever kind and where-
soever ~he same may be situate,I give,
devise and bequeath to my following
nieces and nephews in equal shares,
:I
share and share alike:MRS.MARY CURRY,
MRS.CLARA PETRINI,MR.JOHN P.SULLIVAN,
MR.EDWARD SULLIVAN,MR.WILLIAM SULLIVAN,
MR.TIMOTHY SULLIVAN,MRS.CECELIA BRACKEN
and MRS.ALMA WAGNER.
I nominate,constitute and appoint my niece,MARY L.'
PANCOAST,to be the Executrix of this my Last Will and Testament,
to serve without bond,but in the event that she is unable to
serve,I then nominate,constitute and appoint THOMAS D.GLADDEN
to be the Executor of this my Last will and Testament to serve
without bond.
seal this
IN WITNESS WHEREOF,I have hereunto set my hand and
:;<3 day 0 f )-t-l>'-v'£-"'~,1968 .
4 AGNES SULLIVAN
Signed,sealed,published and declared by the above,
AGNES SULLIVAN,to be her Last Will and Testament,in our presence,
who,at her reauest and in her presence and in the presence of
each other,we believing her to be of sound and disposing mind
and memory,have hereunto subscribed our names as witnesses this
..,~f.)-1'.<.:.::><.~cf day of"I ;/tr-r<-n<-h="'-~,1968.
Address
Address '/7
'J
t
\
II
\
Wnntl1tnltllt~altl1 ot tlC11U!i!J1UUlt-r,t
1tht!Jllttt9tuu QiUUtlty,lill;..
•e '.'./I ~LAYlJ
BE IT REMEMBERED,That upon this ......:rc.::.f.'.day of _·.7:'..~.~..~__ _.
19 ~,before me ~.~..~.~.~..+.J ~.~!...+..;?;g.._Register for the probate of
Wills and granting Letters of Administration within and for said county,came ..
Thomas B.~.JtB·rieIr!and M.Catherine:.O'Brien........................................................................~-.
.........................................................................................................,..the subscribing witnesses to the foregoing attached Will of
....................................................h.g,n~..::l §.y..l.l~.y.!?:.n ..
deceased,who,after being duly qualified according to law,depos~and say:That they were present at the
execution of said vVill-saw the testat..r.i.x sign the same-heard Ji~.r.publish it as and for
He r I W'll d T . h .th He r ..He rd'th..............................ast 1 an estament,t at ey at.request,m presence,an m e
presence of each other,subscribed their names thereto as witnesses;and at the time of the doing thereof said
testat.r.l~was of sound,disposing mind,memory and understanding,to the best of the affiants'
knowledge and belief.
c~-d~/:J~~/r·;..··..!5..····:··:~··..·..·:·~·..·..·..··.JL.~..~
.'.f )--1:[I ~j,''.~I ')f I -',+'..:')-I !11../7
I
:late of /../...C:~~y...C)~..1iJCl..s.~~1'l9i:():rl ,\Y/a~hington County,
Pennsylvania deceased,and (Grunt of ·i!Jttrr~~.for Probate Only
.,
i\pplirutiou fOl-ilrnbat~of mill iif ~~l-J.E.~~.~?~~~~y.~~.
REGISTER'S OFFICE,
\Y/ASHINGTON COUNTY,55,:
Before the Register of Wills of Washington
C~unty,personally appeared :.}1~B.X L.~J;~NCOAST ::who being
duly sworn saysthat 1igP.~9 11.!S.~lliv.a.n .late resident of
q~Jy q.~..~~~.1:l~:ng:t,q1}\Y/ashington County,Pennsylvania,a citizen of....~.~~!-!.~.~.~died
testate at....~.~~?~.t:~~.'~~.~n.<!l:.·on the ~7:l::h..day of..f.~b.,,A.D.19 ..7.J...
I
I',
at o'clock.m.,age leaving an estate of the estimated value of $..
•I
personality,and $realty,said real estate being located in :t.l,l~..G.i.'!::y C?:f:..
Washington,at 687 Elmhurst Drive.'",........................................................................................................................................................................
•••••.•••••••••.•••••••••••••••••••••••••••••.•••<!,.
The decedent'~legatees and devisees are as follows:
NAMG I RELATIONSHIP RESIDENCE
687 Elmhurst DriveMaryL.Pancoast Neice Washington,Penns¥-1Y.
.
----
-
ania
Testator has I1C>:t married and !l.9.children have been born since the
execution of the'will offered for probate.
Petitioner prays that the paper writing filed herewith dated :N.C?v~~ep;..4~.,l~.~.e .
may be admitted to probate as the last Will and Testament of said'decedent,and to grant ~
te J?~C?~~.t;~9.~W~~J..C?A~y.~: .
whose postoffice address is ::.
,
Sworn to and subscribed before ~e this..d t..
r~.IY::~~A.D.197/
G ..~~J.JLJrG:~M .
Register
1fI0S.1i2 400M 2·70 '
(100 Cert.per.bookI
,Fee for this Uf:;
Certificate.~)
WARNING:It is illegal to duplicate this copy by photosta~orphC)tograph.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF-HEALTH
VITAL STATISTICS N2 253721
SULLIVANMARY
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
'!>.;,~",',178 c
Registered No....
~,,:-~
.'·..·..··..···..·..····:·:·;·j:i~·i..······..·······:··..········..::·..··Midd·I~···················..·•·············..··········L~;i·······..·..····..···.
685 Elm H1irstDrfv8 Washington Washington Pennsylvania···..··,..·..........··N~-;;;;;i"......·........····s;;;i··..·..···....·..........·..:·::·ciiY··~;..i~;-,;···..··..··..·..··..·......····....·c~-;;;i~....·........···•....·····....·si~·i;··..·..........··..···..·
Usual
Address
Placet of ,'.,',Washington.,.'.'...\vashington,..'.Death".:::,,_T Pennsylvama
'-.K ~City.Borough or Township -...-..""..County"':;~•-
.February 27.1971 . .178-09-0400 Whi teDateof:Death SOclal SecurIty No Race ....,
'~"...·:s./".N~ver,r~rr1-ed .".'..'Female ;.....May 28,1895 . ,;JYlarttal~~t~tus :;;.,".;,:..::.:'::.Sex.'.;.::;;;...•Date of .Blrth..::;..
......,"Retired'Bookkeeper,.'..'.,.Tiffin"Ohio .'.'Occupation :::':~.,".::,::.:.•;::.:::::.:..::,Blrthplace ~.::..;::'...............,
if,V eteran~-wh~ch'W a;.:~.:.:.:;.,~.:.:.::::::..:::.:..:.~:.::~:.::;:..:;"':.::..-•..:Vete~an·s"Serial N~..:,~:..
MEDICAL.CERTIFICATE~.'Interval Between"~'...·Part I.Death '~as caWed-by:OnSet·and Death
';~;;;in~~i;t~.Caus~(a).g~.~~~~?~:::..,,::;:.;:::~,..,~:':;..~._::,.,~..,.~.~~~.::~..~,~.~,::~::~.:.:..::,:::~:.,:.:,.::.~..:.~~Z~,C ..
D~e f;.·(·~):'QE.~.t~!.~.~..·..9..!?i~i~~~.~~~.~ij ..~:~i~~.~.~r.~~::..~.".~,,,,::::.::.:.:..:;.7..~:..7.:.•'g...~.Y.:~:.~..:
(c')g~i9.t~Q§.~t..£9.~::j?.i~:!!.~~g.r~.$.:.:.~.:..:.~.:'::~~~·."..:L.:.~.::..:~:.~.:;..9.~Q.p.~bi.:..
'.'PartiL OTHERSIGNIFICANJ:CONDlTIONS:contributing to death .butnot related to thej,mmediate ,cause given in;.Part I (a)..'.•.'.,
-"!\c~ide6t,."Suicide'or'.Homicide··:::::::..:.~.:.;;L~:;;.:::::::,.;.~:•.:.How '.did irij~ry'occur .:..~.:".::.;:..,~.";.:::::
...,-
IN THE ORPHAN'S COURT OF WASHINGTON COUNTY,PENNSYLVANIA
upon consideration of the within Petition,it is
,-1971,
IN RE:
ESTATE OF AGNES M.SULLIVAN,
Deceased
DEC R E E
AND NOW,this
)
)No.If tf G of 1971
that all sums which now are payable or which shall become payable
in the future as set forth in the within Petition are hereby
ordered to be paid to MARY L.PANCOAST.
BY THE
_.~
"
J
Form RCC-33
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
COUNTY OF Wa..s.hi.ngtQn ..
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 one year after
date of death,unless an extension is granted by the Secretary of Revenue.(Section 703 of
the Inheritance and Estate Tax Act of 1961.)..........J~G.~;.s.~:~;:~:Z:.I;:N~:~~~~~F }:::uA
;;:OF
(State full name of decedent)
Late of YJashi~lgton County ADMINISTRATOR
Administrator
::.:o::::::::::~~_::::=:~_~}'"
....M9.,:I::y~~..:p.g,.nGQ~s.t..
of the estate of the above-named decedent being duly sworn,depose and say
........Executor
...........,19 7J ,5 testate leaving a last will,copy of which is hereto attached.}'c'.
(lIay)(Year)Lintestate
....Frank..A..Conte.,Esq.............................
.231..Washington Trust Bldg,Washington,Pa ·
Decedent dJed :f~p..;:U(;i]::'Y )]
(Month)
Name and address of attorney or}
other authorized representative to
whom all correspondence should be
mailed.
That as such deponent is familiar with the affairs of said estate and the property con-
(1';nclIlor·Adminislralor)
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
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 Schedule A attached hereto and made part hereof sets forth full v 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 of decedent.
That Schedule B 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 thereo~or of
any foreign country,which are owned at the time of death;all wearing apparel,jewelry,silverware,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 mortgBl,!:es held by decedent and of all claims due and owing decedent
at the tlme 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 to each item;all moneys payable
to the estate from life insurance polici'es carried by decedent;all annuity and endowment contracts the
proceeds of which were payable upon the death of the decedent;and all the corporate stockS and dividends
due 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.
In the case of securities of close or family corporations,the values reported.are as far as
possible substantiated 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 decedent 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 business 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 persoilal,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 transferee 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 CORY
of the deed,trust agreement or other instrument creating the trust.Ther,~is also set forth in said
schedule a list of all property,real and personal,with its value,which passes 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 joi!1t1y,by':~he will,deed,or other instrument of another,
with a copy of the instrument 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 relationship,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,and the 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 anli unpaid at time of
death;taxes accrued chargeable for period prior to decedent's death (except 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.
~~.
..6...S..7 E.lmh.ur.s.t Dr.i:v:e _..
(Street Number)
............:v.?~§.hJ.P..gj:.9..P...I.p..e.n..na .
(City (Yf'Town and State)
That the totals of the appropriate columns in Schedules "A","B",
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ..cf!!.tJ..~
........r)day of .~19.'21
.j~~~.
"e","E",and "F"as directed therein,
NOTE:Before signing affidavit make sure all blank spaces in the affidavit and scheliules annexed are
filled in with details or the word "None",anli in case the assets include rare and unlisted securities,
securities of close or family corporations or an interest in any co-partnership or business,that the
data and statements requireli 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.
.
RCO-34 0\64)
COMMONWfALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE uA"
REAL PROPERTY G·
Real property in Pennsylvania,with statement ~f mortgage encumbrances upon each parcel at death of dece-
dent.Where property held as joint tenant or tenancy by entireties,report on Schedule "E".Property held by
the decedent as tenant in common with another or others,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 Commonwealth of Pennsylvania should be
described by lot and block number,street and street number,together wi th
a general description of the property,with a reference to the record of the
conveyance by which the decedent took title;If a farm 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.
(1)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
(2)
ESTIMATED
MARKET VALUE
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
lot
House and/located at 687 Elmhurst Driv.~X¥XXXXX~__~
Wanngton,Pennsylvania.pl?ar fit"t;OO.
.. b d'. .·N·-'(deslgnated as Lot N-.52 ln Su -lV1Sl n
No.2 of the "Sheraton Manor"Plan of t//;;:;-:-T-:-.....:t?0 00,-
Lots,situate in Borough of East Washingt:C ~-~-j;)~l--
Deed Book 841,page 299)v~_~".vu
1/2 interest as tenant in common (16,000)0.»-,-S;1 7 6'~
d~Yi1~~
Insert thi statal opposite ureal property",Schedule"A"in the X X X X X
uAs Reported"column on the last page of this return.
•RCC-35'....'~
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS:This Schedule must disclose all tangible and intangible personal property owned individually
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,notes,together with accrued interest or dividends,salaries or wages,insurance pay-
able to the estate or fiduciary 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)
a.}26 shares of stock -Standard Oil Company 07(4~/,9:2'1.00
of New Jersey $1,924.00
(2 )Savings Account #178-09-0400.01 at 61rft V c:2/1.5"'1-/
Mellon Bank 214.54
0;10-:)
I :1-3.f''1{3}Checking Account #556-8375 at Meiliilibn Ban 123.84
(4)Prudential Life Insurance Policy 191(/1';).3/f y-r#27-293-801 318.88
Insert this total opposite "Personal Property",Schedule "B"in X X
the "As Reported"column on the last page of this return.
RCG.-36
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "c"
TR...~NSFERS
(1)Did decedent,within two years ofdeath,make any transfer of any material part of his estate,without
receiVing a valuable and adequate consideration therefor?(Answer yes or no)No
(2)Did decedent,wi thin two years of death,tra.nsfer property from himself to himself and another or
others (including a spouse)in joint ownership?(Answer yes or no)_N",-,uOo _
(3)If the answer to (1)or (2)above is in the affirmative stat~:.
(a)Age of decedent at time of transfer !\lOt appl1.cable
(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 enj oyment at or after his death?
(Answer yes or no)~N~o~__
(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)Not applicable
(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 aaequate 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 Not applicable
(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)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 c01l1d revert to decedent under terms
of transfer or by operation of law?(Answer yes or no)No
(9)If the 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)Not applicable
NOTE 1:The answers to these questions should be suppo~ted 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
NONE
DESCRIPTION MAlUCET VALUE
(Estimated)DEPT.VALUATION
(Dept.Only)
Insert this total opposite "Transfers",Schedule "e"in the
"As Reported"column on the last page of this return.
,.,",'.'
ReC-3a
CQMMONWEALTH OV PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
INSTRFCTIOl\S:This schedule must disclose all property,real and personal,owned by the decedent jointly
with another or others,including intangibles,standing in the name of the decedent and others.List
real estate first,as entireties,or joint tenants,giving brief description,as indicated under Schedule
"A",plus the date and place of record of instrument effecting vestiture,but do not include entireties
or out of state real estate value in estate valuation column.Personal.property should be listed as in
Schedule "B",plus date of acquisition,and the name,address and relationship (if any)of co-owners to
the decedent.
Description of Property,Date of Acquisition,Name I Unit
Address and Relationship of Co-Owners,and Place I Value
of Record of Instrument,where Real Estate.!
percentage Estate
Share Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
Savings Account #I-1685 in First
Federal Savings and Loan Association
jointly owned by decedent and
Mary L.Pancoast,neice,of
687 Elmhurst Drive,Washington,Pa.3,00C.00
Mellon Bank checking account
#556-6290,jointly owned by deceden
and Mary L.Pancoast,neice,of
687 Elmhurst Drive,Washington,pa.83.7
1,500.00
$41.85
/5"00.00~
Insert this total opposite "Jointly Owned Property",Schedule"E"
in the "As Reported"column on the last page of this return.
~....
RCC-31 :-(12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED(If step-children or DATE INTEREST OFStatefullnamesandaddressesofallwhoillegitimatechildrenDECEDENTOFBENEFICIARY
ave an interest,vested,contingent or other-are involved,set STATE YES IN ESTATE
wise,in estate)forth this fact.)OR NO BIRTH
M\.RY L.PANCOAST Neice Yes
687 Elmhurst Drive
TAl;:,ch .'lvania
(
h
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
OF THE
ESTATE OF
~IATTER OF THE APPRAISEMENT
AGNES MARY SULLIVAN
Deceased
(Executor-Administrator
must complete "As
Reported"column #1.)
C1 ...,'"1:1 ~........~~0 Il:>....e:...til ::s til
til til 0...,....,::s '"1:1~e:...........
Il:>;~til 0><'0Il:>:0 '"1:1 ~C'"........
CD ;1-'-0 ~:~'0
t%:I ~:rt ....
til ........to '<Il:>....~;Ii:0
':0:CD;Ii:rt!<:
DO THE
!No.t!l/{Yea<!9?/O.c..Will
Administration
Late of BC?rou<J.hC):l::E:.:l13~~'is.1:li.J:l<J.~Op ..
County ofWClShi:r'lgt()l'l
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
"Vd"O INDJ..:n 1/sr';:1
S1J:,;~,.J.!8 ,}I::.~--;I;)3;,]
CJ)c:
~~:>~
W CJ)CJ)~
n n?"?"?"
r:i ~>::::::........................
~~-(h ~~~
'(J):>r-':~til
:tV :tv 00 ~..'"~....(D-"-':lTl 'lTl b '0 ~
:tv :~:00 b Q........:w :~:~0 ..... .ro..'0 '.•f""'o,~:00 tvo::::
~lTl 0'10
ttJI~:;I~t 1/.1 :,1"j
..,...."...·'\lie,'.~!,il ."~L r;I~.i~...._...J
~~-(h~~~
#l~dJ ~'!1
;..,~:::".,nl:/'j I J.,J ~,nJi:t~~,{.~~,~
~,~
~.".
-.:."'-:t('
:~
.~
..-..0.':>N ';'\\;r.
'\'.'-Ju(A :C)ro ..-..~"8"t-:l'Y .'-.)3~'":\:)_..'.::I~-~~:\j\,.~
,'
..
ESTATE OF _A=G:..:N;;:E:::.;S=-.:.;M::...;.:......;S=U.=L:..:L=.:I=.V.:..A::=.N:...·__LATE OF Washington,County,Pennsylvania
Form RC C·lO
OFFICE OF THE
REGISTER OF WILLS
OF _~W~a:.:s~h~i~n~g::1.t=o~n~_COUNTY
AND AGENT OF THE COMMONWIiALTH
STATEMENT OF DEBTS
AND DEDUCTIONS
DEDUCTIONS ALLOWED IN J
THE SUM OF 4h..~..!?:i.i.l].~
om OV!:.~~\'\,l\
\LL~
DATE OF FILING APPRAISEMENT DATs:OF DEATH _---'FLliiie""bl!..=rlo..u.!CJiiial.:!r...y~..Ei2w7L.Lr....;:!1...9!..7.t....=.1 _
DATE NO.OF NAM&:OF PAYEE REMARKS AMOUNTVOUCH""
Abel Funeral Home Funeral Bill 1,707 00
Kurtz Monument Company Grave marker 135 00
Frank A.Conte,Esq.Attorney Fees 250 00
~~ttJ.---~.O'-.."'99-1-50-.,c",,:Vdil:l:a-iI,nne'.....~......,..............."......"".../
~~,
w~~hinaton Hosnital 16]50
I,
W~~h;~Nron Hosnital Extended Care Facilitv 950 00
Dr.D.McCarrell Dunbar 341 00
nr ~lev 65 20
Mrs.James Lechie Nurses care 350 00
Mr~M "Rowlriod Nurse 245 00
M..-Q .T Watson Nurse 35 00
Mrs.Patricia Sorice Nurse 105 00
i
---
-
If 3LJy 76
TOTAL DEDUCTIONS ~......"
COMMONWEALTH OF PENNSYLVANIA
HEREBY CERTIFY,THAT.TO THE BE8r OF
DEBTS.FUNERAL EXPENSES AND EXPENSES 01'
DECEASED.AS DEDUCTIONS FOR
dL/4 ~-::~~~!6~:::.-..Jt:.z..J...,~~tl::::----:--_(L.$.).-r----~~EML..--
nH
.)':-1L-DAV OF ~tv -'1 ~~)p,~
~RENM.-_
"WASHiNGT •WASHINGTON COUNTY
MY COMMISSION EXPIRES APRIL 14.1975
Member,PennsylvaniaAssociation ofNotaries
COUNTY OF Washington
I,Frank A.Conte
IIolY KNOWL!:DGE AND BELIEF.TH!:FOREGOING IS A JUST AND TRU E srATE"lENT OF
ADMINISTRATION SUBMITTED TO THE EST"'TE OF A nes M.Sull~v
INHERITANCE TAX PURPOSES.
en
."
0 t.P
U_J l''
~,
:c-'---..-.-l .t_...
o (J)..:(
.-l G-
.-l::::::0:.:-C)
·,
RC C-el (2-64)
COMMONWEALTH OF PENNSYLVAN IA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
NOTICE OF FILING OF APPRAISEMENT
Mary L.Pancoast
IN YOUR REPLY PLEA8E
REFER TO
38-166-1
In Re:Estate of A~gc.=.:n:...::e:..::s:-.-=~..:..f=-._S:::.u=lc::::l:.::i:....:v~a~n~_
_____....l\.uvao!<;sliLhu.r..i..un.e;g~to.l.ou..nL-.---County - F He No.63-71-446
Dear Miss Pancoast ,
You are hereby notified that the original
appraisement in the estate of Agnes M•Sullivan
has been filed in the office of the Register of Wills qf Washingon
County on May 28 ,19..1l.Said appraisement reflects the
following valuations:
Jt.Hd.
Real Est ate _-'-_----'9~,O:::.O=O.L.~O~O~_
Personal Property __~2~,5~8~1~.~2~6~_
:lfn~ft 1L..,,...5.L:;,41:,J1 8......sL--_
Tota1 ---------.....]~3.....,...1...231-.161,1,,------
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 __~_fa-,y<--2_8:::...J-'.-.;1;;;:..9=-.:...;71=--_
Title
DATE OF DEATH:February 27,1971
Note:This is not a bill.
RCC-39 (5-68)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUMMARY
Estate of Sullivan
(Last Name)
Agnes
(First Name)
l;f.
(Initial)
DATE OF DEATH 2-27-71 FILE NO.63-71-446
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,May 28,1971 ~
ERITANCE TAX APPRAIS R
REPORT OF THE REGISTER OF WILLS
t
VALUE AS REAPPRAISED
$-------+--
EGISTER OF WILLS
INVENTORY
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)
Dated:}_fa....::y_2_8....,,--1_9_7_1 _
I,the undersigned duly elected Register of Wills in and for Washington County,Pennsylvania,do respect-
fully report that I have allowed deductions in the amounts claimed by deponent ~as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule",which greater or sser amount represents the sum
allowed as a deduction.
CLEAR VALUE OF ESTATE 7 778 41 8 778 4
Valuation of life estates or
FOR USE OF REGISTER ONLY
Tax on $.-.__
Tax on $.-.__
Tax on $---------t--
Tax on $.....,...__.-...,..",.._
Tax on $-----........+-J-....L.lo.'-f....-f-
Exemptions========I==Total Estate -I-__
TOTAL TAX
COMPUTATION OF TAX
$--------+---
$--------+---
$-------1--
$-------4---$__---I14-'-l~'_I.1.l..L..4~__'-7Jw..7.:1_
$-----_--1._-
(*)As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previously paid
BALANCE
Less 5%of tax if paid within
3 months after death
BALANCE OF INHERITANCE TAX DUE $L
Add interest at rate of 6%from_____to $--.J <
AMOUNT OF ESTATE TAX ASSESSED $----~L-
Estate tax paid $--JL-
BALANCE DUE $----IL-
Add interest at rate of 6%from t=
------tto-----$-------1<
TOTAL TAX BALANCE $------.1
PAID $-J
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE:Where subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason,
same should be noted below,with short explanation.
Will (...No.AdmInIstration
IN THE
Year .
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
AGNES H.SULLIVAN
Deceased
Late of WASLUNG:'l'QN.
County of \'1ASHINGTON.............,.
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
f·
*
,
Form RCC-2
JDEPARTMENT OF,B~ENUE.'
BUREAU OF COUNTY COLLECTIONS
HARRISBURG,PENNA.J7 J27
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE .N~y ~.~..,1..Q.?.1 .
COUNTY Jy.a..s..h~i.ngt..Q..n .
FILE NO §..~.::..f~..:.4.4..?.
Whereas..A.gn.e..~N.L S..1J.l.l:t.Y.~n late of J1~.§.h.:t.l}gt..9..l}.
in the County of Jia.shingm Commonwealth of Pennsylvania.having died on
the ~.?~.~day of ~.~?E?.~.9!19.?.~.•seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore.I..A.L.F.:R~P.r..9.$...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 intel'est 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 AppraisementDescriptionofAssetValuesMadeforInharltance
Tax Purpoles
$
REALTY:
See copy attached to appraisement (schedule nAfT)9.000 00
PERSONAl :
See copy attached to appraisement (scheduleTl Bn)2,581 26
IJT.HELD:
I See copy attached to appraisemnent (schedule nc n)1,541 85
II
I ----
I total 13.123 11
("
Having been duly sworn according to law,I do hereby certify that the above appraisement is made in con-
formity with law on thls..........&.£'..."'AJ...day of .......................~.\2i',........19~..................................................................................ht0......~...
ppra'ser
................................................................................................................................................................"
_(Number and Street>.
...............................................&.Ja.Llu.~..............,Penna.
(Poet Oflle
\vASHINGTON.................................,.County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
AGNES 1-1.SULLIVAN
Deceased.
Late of
."WASH.INGTQ.N ...
Date of Death,~.~..~.7.~.?~_ .
Appraiseme/!t Docket Vol.,J.S .
Page,J.§.§.~.1 No..§}.:.7.J.:.4.4..9..
Filed in Register's Office,.....}f.~y.....~.?........19...?..!.
Amount of tax due,$.
DEPARTMENT OF REVENUE
Received,
Examined and Approved,..
Wrote abo.ut Appra.isement,..
Appeal f"om Appraisement,.
Entered and charged,.
,'
;
4,
"'
RCC-43 (4-71)
~d -7/-e,[<,L (,j
COMMONWEALTH OF PENNSYL~ANIA·~"eZECf1yt
DEPARTMENT OF REVENUE "OUNTy Rt4U ~
BUREAU OF COUNTY COLLECTIONS COL(t~:-"
HARRISBURG Sff rONs
17127 Y </
,?o f/1 '11
NOTE:TO BE SUBMI TTED IN TRIPLI CATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
PittaburRh National Bank
6 S.141rl.n StreEtt
Washington.Pe..1,301
ZIP CODE -----
September 5,1972
Pennsylvania Department of Revenue
Bureau of County Collections
Gable Building,3rd,Floor
411 S.Second Street
Harrisburg,Pennsylvania 17127
Pursuant to Section 742,Pennsylvania Inheritance and Estate Tax Act
of 1961,we herewith submit the follOWing report:
ACCOUNT NO.OF JOINT,TRUST OR
INVESTMENT DEPOSIT 083 20S8214--~~'-'-"----"-~----------------
NAMES ON ACCOUNT OR
INVESTMENT Mnea M.Sullivan or Mary L.Pancoaet
DATE OF DEATH _----.;;;,F...::.Gb,;:..";:....•.....::2:;..:,7..0&.,....;:1:;.:.9....:,71=-_
DECEASED JOINT DEPOSITOR,TRUSTEE
OR INVESTOR .Agnes M.Sullivan
ADDRESS 685 Elmhurst Drive COUNTY Washington
_W=sS,..h"""i"",n;..:.::p,,,,,,t=.:ono:.,",iL--=P.....a.....ZIP CODE 11:;301---
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR Miss Marry L.Pancoast
ADDRESS 685 Elmhurst Drive.\fashington,PalO 15.301
RELATIONSHIP TO DECEDENT ~Auw~n~t~___
DATE DEPOSIT OR INVESTMENT*WAS ESTABLISHED _~Au:::JR~".~"~31=-"IL'.....::1~9-=61=--_
BALANCE,INCLUDING INTEREST
DUE,AT DATE OF DEATH $583.77:::..-..:::...:....:....:..-_-------------'-------
4uL~~.
TITLE
*Subm1tted to correct date of oriainal deposit account established.'
Or1ginal eubmitted with wrona date depoe1t nceol':nt established.'
•....J
-\-.,."
~-......
~p •s,..
RCC-4!(S-ell)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
HARRISBURG.
llarala 4 1911·
NOTE:TO BE SUBMITTED IN TRIPLICATE//"'J
/~.~"1/
Pennsylvania Deportment of Reven e \"
Bureau of County Collections //_.
26 S.4th Street '
/
f 0
Harrisburg,Pennsyl~ania\(l.:/
Dear Sir:
Pursuant to Section 742,Pennsylvania Inheritance and Estate Tax Act of 1961
we herewith submit the following report:0 ,
NAME OF REPORTINGFINANCIALINSTITUTION P1000:---t_t.ab_ur_fJ1~_Na_t_1_0I1_u_8ank _
6 .joat.b K&1D Jt.re"
ADDRESS lIll~ab1niton,?a.15301ACCOUNT-:-N7':O:-.-::'OF=-=-JO:-:I-:'N=-T,..-:==:=.::!!.::::L.:.=~:.::..::=___
TRUST OR INVESTMENT DEPOSIT 8~J_20_5821__J._
NAMES ON ACCOUNT JU••Mary L ~encoa.t.01"
OR INVESTMENT ..::tU.=.:.:.s=-.:.:A~rJ1~~::;::s:..:M~~:.:'u~11=1:.:v~an::-_
DECEASED JOINT DEPOSITOR,
TRUSTEE OR INVESTOR K1_S_._A....:~-.-_M_;)t_'1_1_1v_8il_·_---_
"'~:-,,-~"',..
ADDRESS b'l_5_F._"lmh_·u_
o r_._t_O_r_.~,~a:::a;;;a;;[h:.-P-a_._1_5_30_1_
DATE OF DEATH P'~ry 17,°1~
SURVIVING DEPOSITOR,BENEFICIARY OR INVESTOR ·l!tn"~-.1[i-art-··_L_P_M_o.e1:J_!_it _
685 ilahurat Drive
ADDRESS -:-:,'i__I\....:.hing..:..::....:::::t_o:....n~,....:p:...:&:..:.__.:lS:..:J:.:..J....::..l _
TITLE
...
Signature
~l~ttorm A~91.t~nt
RELATIONSHIP TO DECEDENT Me1ce
DATE DEPOSIT OR INVESTMEN·-=T---7-.:i-:::~5-:-:-·0 ":':'70-···-......---------
WAS ESTABLISHED ....~-~.,;
BALANCE,INCLUDING INTEREST ~S83.T1
DUE,AT DATE OF DEATH $----~--~'----_I_..J_...:__-_:___-
ISJ.i ",-,i'3:J?.;f;7·J O,?...",/':;f?-.~-;,{¥r~~brv fJ-...,.,
~et;,;r-J.7J /If 1 ").
II
OFFICIAL NOTICE OF INHERITANCE
TAX APPRAISEMENT AND ASSESSMENT
OF ASSETS NOT SUBJECT
TO ADMINISTRATION
\";ASHH:GTON,PA.15301
Date:SEPTEMBER 1,1972
County WASHINGTON
County File No._
Bureau File No..::......,;,._
W~~¥tDAR'fi~7~notice tLyr,as a resul!of the deat~of AG~S M.SUlJ..IVAN (~ASHmGTO~).
on .19__,you came Into ownership of certain property through right of survivorshIp,which
was formerly owned by the decedent.
TO:MARY L.PANCOAST
681~~Elmhurst Drive
RSf"34 (9-71)
CCfMMONWEALTH OF~P.ENNSYLVANIA
DEP.<\RTMENT OF'REVENUE
BURf-AU OF COUNTY COLLECTIONS
"INHERITANCE TAX DIVISION
Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable
and the liability for the payment of the inheritance tax due is imposed upon you,as transferee..
The Jlroperty on which tax is hereby assessed consists of:JT.ACCOUNT 83 2058214 HELD IN TIE
PITTSBURGH NATIONAL BANK WASfiING'l'ON OFFICE,v.[ASHINGTON,pENNA.IN tHE NARES OF AGNES M.
$~5:...:8:::..3.:..:.77....:....-._
appraised by the Commonwealth,as of the date of death,at $_58_3_._7_'1 _
100 %of this amount is taxable at the rate of 15 %
.!50 /5"ORIGINAL ASSESSMENT
DATE OF ASSESSMENT
TAXABLE AMOUNT
LESS:ALLOWED DEBTS
NET TAXABLE AMOUNT
AMENDED ASSESSMENT
$eZ9/-.99
AMOUNT OF TAX DUE
87.57
If you pay the above amount withinthree (3)months of the
date of death of the decedent,or on or before :---_
______19__,you may deduct a discount of
5%of the amount of tax due,or
This tax became delinquent nine (9)months after death
(one year if death occurred prior to December 22,1965
and fifteen months if death occurred on or after
December 22,1965 but prior to June 17,1971)and,in
addition to the tax,statutory interes,t 1tthe r~te of 6%ol
the tax per annum is also due as of I()~Offiilll 27,19 72~~i~the ~6uA6h~fSi:jJl --
*If the tax is not paid by the above date additional
interest is due at the rate of 6%per annum until paid
/.°9
,~
____,d/,L __
d/15f
$TOTAL AMOUNT DUE
/
APPRAISEDBY~?"~(/C.v/:';;;;J..,.o~C ""ASSESSED BY:RtlS~SEb.IoL.....t_EMD.JA:u;RwINII.IOJ_____,_,-----
./(Inheritance Tax Appraiser)(Agent for the Commonwealt~i
INSTRUCTIONS TO TAXPAYERS
15301
Make checks or money orders payable to:To insure proper credit to your account/i)II this Official Notic.e must.acc.ompany1\~Jtl,{~aym.nt.Ma"a'bung ,11a:
AGENT FOR THE COiVlMoN~...:'r....
COURT HOUSE
WASHINGTON,PENNA.
(over)
If you have already paid this tax to an executor,administrator,attorney or other personal representative of tbe...
decedent for forwarding to the Commonwealth,list below the date paid,name and address of th~persc.n to whom
you made payment,the ir officia I titIe 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 ca~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)
I,hereby certify that the foregoing is a just and true statement ot
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 $•
Date of Approval:_
Register of Wills