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Home My WebLink AboutOC1971-0475 - ESTATE OF SAMPSONl3_71 J25 J l\ffi~uutt (@f 1Exrrutnr (1)r l\~mtut5trutnr ~tatt of 'tuullylttauia l arounty of lllItall~ington )ss: .Personally before me,the undersigned authority,a BQ~t~r.'y Py..b.li~in and for said County and State,appeared .M~.~g~J..:~~A.·...J?~!!l:P..~9.~who,being duly sworn according to law,deposes and says that She is the executor or administrator of the es- tate of L.:wY-l.i~.sa.mp-s.Qn.}__._deceased,that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of ..L.!.W.Yll~...S..~ro..P..$.9JL, deceased,except real estate outside the Commonwealth of Pennsylvania;that the figures opposite each item of real and personal 'estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date of the decedent's death,based upon a just appraisement of each item made by the above named Executor Aa.l'R~Mer. Sworn d subscribed belf90re7~e.this 2.~.~.}~~/~.,f a~.f~.~_~.J.~. ............"7/r~I·············.,..,.r·>O'··~itl'1/E;ecutor_kd;;~;;;~~..v::..;{,~~.~~r.'....'~~I'.,t3 ADDITIONAL INSTRUCTIONS A inventory must be filed within three months after appointment of personal representative. A supplemental inventory must be filed within thirty days of discovery of additional assets. 1 Original and 2 Copies and 2 RCRI-34,Under $10,000;1 Original and 2 Oopies and 2 RCRI-33, Over $10,000,including Copy of Will;1 Original and 3 Copies and 2 RCRI-33,Over $50,000,in- cluding Copy Of Will and copy of Federal Estate Tax Return. REFERENCE FOR ADDITIONAL COpy Act of 1947 P.L.513 Sec.5.2,72 P.S.4844.2 ~ntttutory aub .Appraistmtnt of the goods and chattels,rights and credits which were of L..!....w.y),.J.~S~mp~9.P.:.J late of ..GJ~Y$.v~),..l~.,. Washington County,Pa.,taken and made in conformity with the above affidavit. PERSONALTY: Checking Account No.357-3584,Mellon National Bank and Trust Company,Claysville Office,in the DOLLARS CENTS name of L.W.Sampson REAL ESTATE: None. $3,901 32 None '"r:l~'"~t'4 ''Vd "Or)~;'J \"'NI'r\S'Ji,\ ....... '....,,\...........'"'" ;:l Sll\,'.'.J I)\1::lS\~31~ :is .......~ ~Z '";:l ,.~..~;~'.;:;~~i iJ t'4 .... OHi/.' I-l ~<::>~ f. ~tz::l tr.I ;,.w ltI.l tr.I ;:l >~1 -\~f \L, c;n p.G\\~\1 l)L a=..,~"-J ~ 'I "C ~"<:l-..,"<:l-........ tI.l ~~ .0 tr.I ;,., 1...\ <;:. \-'~ z ~~~ -' ,.,.-.-'"'-.1:-.0 ;:l.... "\ \,-...:. r-'--------~--------------~--~--------'"""'------------------J Q!ommuulUtttlt4 of 'tuuliyluttuitt.~ IlIttli4iugtou Q!ouuty.~lili: KNOW ALL MEN BY THESE PRESENTS:Whereas,at Washington,in the County aforesaid on the 7 day of May A.D.19 71,before me, Russell Marino ,Register for ,the Probate of Wills and Granting Letters of Administration in and for the County of Washington,in the Commonwealth of Pennsylvania, the last Will and Testament of L.W;ylie Sampson a/k/a L.W.Sampson a/k/~ Libus Wylie Sampson late of Claysville in the County aforesaid,deceased, (a true copy whereof is to these presents annexed),was duly admitted to probate;and Margaret A.Sampson the Executor in said Will and Testament named,having appeared before me and taken and subscribed the oath of office pr,escribed by law; NOW,THEREFORE,I,Russell Marino ,Register as aforesaid,do grant these LETTERS TESTAMENTARY,unto the said Margaret A.Sampson committing unto her the administration of all and singular the goods and chattels,rights and credits,which were of said deceased,and requiring her to exhibit a true and perfect inventory thereof into the Register's Office,at Washington,within ninety days from the date hereof,and to r,ender a just and true account of said administration at the expiration of six months from 'the date hereof,and to regard and comply with the provisions of the laws of this Commonwealth relating to inheritance taxes. IN TESTIMONY WHEREOF,I have hereunto set my hand and the seal of said Office at Washington,this 7 day of May in the year of our Lord one thousand nine hundred and seventy-one ..............~....~ Register "'OM 14"Wi ".4 ..- t"'lti ,~.....~.r0's::1:E i=s ~m i·~~:f-I~lCfJ }.Ie :::'1\:1 F ~I-'1;3 +'1.....!'d kn trt(),co ~In10aC/)GtttilI~'P -I StI i:IJ ~~s 0 -I trt111'In ....N "0 rco~0 fa 0 ,~"'II a~ r ~~:=~....r fa+'1(J:: STATE OF PENNSYLVANIA, WASHINGTON COUNTY,}55: The within named Accountant being duly sworn according to law,depose s and says that the above account as stated is true and correct as Sn.e.veri Iy bel ieveS • Sworn ~nd l~l,.Ibscribed before me this ...L7~.. ~./ day f ..~.:::-:.........19.]~...(1.. . ~.--_....................................-,.--. vs c.MARSIIAll.IIGI'AI't PUBLIC ASHINGTON.WASHING'IOfI COUNTY MY COMMISSION EXPIRES APa It 191' Memblr,PeMlyMaIa A......"""" Washington County,ss:I do certify that I have given legal notice to all persons concerned of the filing of 'the within account in the manner prescribed by Statu'te and Rule of Court,as evidence by proofs thereof filed to No b-3.~-2:;.-:-::J _._._.. Witness my hand and official seal thiS.__&.__~.__. . day of~~__19~~ -.Register of Wills .\ i~:~i~.::i:0:'":'"1<:~:0:....:>,!'O) tIl~~! ~=i~'i~~ Q o .....'0)+-':", 'biJ0) .~ ••.1111["0;-'~i.l"72 Ji"~1 1 0.I".r I t.l ,l oz --.-~-----------=--~- ,. J --------------------------------, ·a~D~sa S!U!uoqnq!J~S!P JadoJd au!wJa~ap o~pa~sanbaJ Alln~padsaJ S!~JnoJ a41. tl'~t ti..:l:::'".W:':·--1 -.,...'."--;:,-;...'-------------------11',-:-.~l~.--i,l.t::::~:·"fl,.,,:' Cda.~tJ 1!:';:x..~.A.~'...''.' ......,'.." ,, ••$' FIRST AND FINAL ACCOUNT OF MARGARET A. SAMPSON,EXECUTRIX OF THE LAST WILL AND TESTAMENT OF L.WYLIE SAMPSON a/k/a L.W. SAMPSON a/k/a LIBUS WYLIE SAMPSON,LATE OF THE BOROUGH OF CLAYSVILLE,WASHINGTON COUNTY,PENNSYLVANIA. Accountant is charged as follows: To Inventory and Appraisement filed: Personal Property Real Estate TOTAL, To Gain over Inventory and Appraisement filed: Accounts receivable Blue Cross Refund F.I.C.A.Survivors Benefit ~.. GROSS ESTATE $3,901.32 None 93.00 10.20 255.00 $3,901.32 358.20 $4,259.52 Acc?untant claims following credits: Dettra Flag Co.Inc.-Flags 5-17-71 Brownlee Funeral Home -Funeral expenses 5-17-71 Jean F.Howard -Witness fee 5-17-71 Dr.Fred D.Large -Last illness 54.47 1,583.50 10.00 85.00 5-17-71 Claysville Cemetery Assoc.-Opening and closinggrave 85.00 5-17-71 Washington County Reports -Adv.Letters 14.00 5-17-71 The Claysville Recorder -Adv.Letters 12.00 5-28-71 S.White's Sons -Grave Marker 19.35 6-14-71 Ashmore's Flower Shop -Flowers 37.10 John J.Hughes,Attorney,Advances: R.Marino,Register -Letters and 3 S.C.16.00 R.Marino,Register -Filing Inv.&App.3.00 19.00 ;1 .:.. Margaret A.Sampson -Executrix Compensation John J.Hughes -Attorney for Accountant Russell Marino,Register -Filing First and Final Account, TOTAL CREDITS, R E CAP I T U L A T ION 200.00 200.00 16.00 $2,335.42 TOTAL ASSETS LESS CREDITS BALANCE FOR DISTRIBUTION, $4,259.52 2,335.42 $1,924.10 • ,~ I The Claysville Recorder Claysville,Pennsylvania PROOF OF PUBLICATION In qompliance with the Newspaper Advertisdng Act of May 16,1929, P.L.1784,Paragraph 3,Sub-paralgra ~5. Commonwealth of Pennsylv.:fifa),ounty ofashington,5S:per:~on~pearedb fore ~~otar.PU-!>!iC in and for said County and sta~~~~~~~~.__~bein~~,~n according to law .pooes and s.ays that he is the !x.:::'~~ O'f the Clay,svil1 R.epf ,er,and its agent in this behalf;that the abovenamedpensonistliepublit,her of The Cla.ysville Recorder,estalblished~une 15,188i8,weekly newspaper of general circulation,printed and pub- '.l-l,shoo a,nd having its plaice of busJineslS at Claysville,WalS1hing1;on County, PenIlis'Y!lv,arua,where it has been es:tablhshed and pUiblilSihed continuously for more than six months prior to the publication of the notice heretoa,ttached;that the printed notice or advertis,ement hereto attached is a copy of an official advertis:ement,official notice,legal not~ce or legal adver- tiSement eXiao1;ly a·s pr:inted or publi'shed in The ClaysV!ille Recorder in its EXECUTRIX'S NOTICE Estate ofL.Wylie Sampson ca/k/a L.W.~amps()ria/k/a Libus Wylie Sampson deceased late"of Borough of,Claysville, Washington County,Pa, Letters Testamentary upon the .above estate having 'been"grant~ eo to the undersigned,notice is hereby given to those i~debte~l thereto to make immediate pay- ment and to those having claims or demands to present for settle-ment.' John J.Hughes, Attorney ,Claysville.Pa.,15323 50-3t Margaret A.Sampson 216 Wayne Street Claysville~Pa.15323 " Washington County Reports Washington#Pennsylvania (PUBLISHED BY WASHINGTON COUNTY BAR ASSOCIATION) PROOF OF PUBLICATION In compliance with the Newspaper Advertising Act of May 16,1929, P.L.1784 Sec.5,paragraphs (5)and (25). COUNTY OF WASHINGTON}SS. STATE OF PENNSYLVANIA Personally appeared before me,a Notary Public in and for said County and Commonwealth,CHARLES C.KELLER,who,being duly sworn,deposes and says:that he is the Editor of the WASHINGTON COUNTY REPORTS, the official legal periodical for said Washington County,published weekly having its place of business at Washington,Washington County,Pennsylvania, and is acting as its agent in this behalf;that the said WASHINGTON COUNTY REPORTS.was established on March 51,1920,and was designated as the official legal publication for Washington County,Pennsylvania,by order of the several courts of said County,dated November 11,1920;that the printed notice or advertisement attached hereto is a copy of a notice or advertisement, exactly as printed or published,which appeared in the said legal periodical in its regular issues on the following dates: ..................Ma.y ;aQ.,..·..27..;l·9·7-l · · ·..· · ·. ...................~.~.~~~.'"~..~.z.~. Estate Notices The Register of WiHs has granted letters,testamentary or of administration, in the following estates.Notice is hereby given to all persons indebted thereto to make payment without delay and to those having claims or demands to present them for settlement to the Executors or Administrators or their Attorneys. • • •••••••• •••• • •• SAMPSON.L.WYLIE,a/k/a L.W.SAMPSON.a/k/a LIBUS WYLIE SAMPSON,Dec'd. Late of Cia y s ville,WashingtonCounty.Penna.Executrix:Margaret A.Sampson,216 Wayne Street.Claysville,Penna.15323Attorney:John J.Hughes,Claysville. Penna.15323 that the affiant or the corporation in behalf of which he is acting is not interested in the subject matter of said notice or advertising and that all of the allegations of this affidavit as to the t~'pJ1te and character (!;!PUlibli~ittv are true.1/r Sr ,IJ.,/e;P'LO'JlI!:tJ .~~ ,h ~.=,_=~~<;:"_ .~--'-Sworn to and subscribed before m .•----- .9 day of ~.!:!.n~,191 Z-I..!. ..__..:.J..__~,<'- JOSEPHINE T.SCIAMANNA Notary Public,Washington,Wachlngton Co, My Commission Expires July 1,1974 ~lt t4:r Qtuurt uf O!umutuu '1:run uf lIunijiugtnn Qtnunty (@rp4unn'O!uurt minininu In the matter of the Audit of Account in J Estate of L.WYLIE SAMPSON a/k/a L.W.SAMPSON a/k/a LIBUS WYLIE SAMPSON, Deceased. TO THE AUDITLNG JUDGE: No.475 of 1971 Enter__----'m""yJ.-,appearance for_--=A'-"C~c=o:..:::U:..:n:...t=.;a=n:....:t=-----_ N.B.-Counsel shall,by separa:te paper,present a concise statement of each claim,wHh supporting calculation of any interest claimed.Objections to an account as filed,shall be concisely stated in a separate paper. Council suggesting proper distribution shall file a separate concise state- ment in that regard. r:-r:r.:f)t •1...L .....JI '72 APJ(F.P:4 3 24 RUSSF~_t_1/~~.:{:r~0 nEGISi E.r~(1/-WILLS WASHJNC,TO/,'CO ..P/~. No.475 of 1971 In ra Audit of Account in EstaJta of L.WYLIE SAMPSON a/k/a L.W.SAMPSON a/k/a LIBUSWYLIESAMPSON, Deceased. AUDIT 'ra~rip~fnr 1\pp~araur~ FOR A~countanL. r \. John J.Hughes, Attorney ~2 """ \..;PETITION SUR AUDIT IN'THE ORPHANS'COURT OF WASHINGTON COUNTY..- .. Estate of k.·VJ.X1.J.}j:~AMJ?~Q.:N ..~j~l~~w..~.No 11.~...9J...!~.?!. .SAMP.s.QN..al..~/..~Lla..U.S W.YLIE ..SAM.eSON".. Deceased Fiduciaiy .Ma.:r.g~.r.~.t...A s.aJll.P.~.9.n.l . ..~~~.c.y.t.r..:i.:K .. ~~~~~~ Decedent's death~Ap;ril 2~+..~9.1.1;Grant of Letters May 1.,l9.1.1 . This is the F.t.r.§.t...~.:ng FJ.:na.l.account filed in.this estClte If there have been 'fo~mer accounts f'iied in'this estate,list file number or number and term NQ~.E?..J~!.E?..~.~.,,,,,.. ..........._--~-.,-_..__- ---_. Election to take l Under or Against will.(cross out one) !-- Date Election Place of; Filed NQne....filed Record . Name'of surviving spouse N.o ~-'.u::.v.j,:vj..ng ..~.P.Qll.$.~:. List issue,where material:Not rna teria1 Did decedent marry after execution of will?<indicate)~.No.Any children born after execution of will?<indicate) ~e£;.No.If answer yes,name them..............•.................................................................................................................. --.._..__----_-_ _--_.._--_.._- -- - - -_---_-_--__~_~.. Legatees Relationship Interest Fiduciary,if deceased or not sui juris Margaret A.Sampson Gladys M.Danley Leah S.Driehorst Daughter Daughter Daughter 1/3 .1/3· 1/3 Sui Juris Sui Juris Sui Juris " List,if exceptions to above:Adeemed:Revoked:Lapsed:Abated:.Give Cause: No exception. If partial in.testacy,give facts: No partial intestacy Notice to interested parties.Have all parties,having either vested or contingent interests and all crediors entitled to notice (Court Rule No.9 paragraph C:Section 6:Subdivision c)received written notice of the filing of the account and of call of audit?.Yes.~ If any exception give cause:,NQ ~~.c.~.P.ti.9.n . File copy of Notice and date of mailing..C.Q.p.y...Q.f...~Q:tJ.Q~...~.t.t~.c.h.~.g.~...g..~:t.~..9.:f...maJ.li.:ng...F.~.p.r.1l.~ry....~.~.I •••J..~.7.~.•.......... Is estate subject to the filing of a Federal Estate Tax Return?NQ :. Actual payment made on Pennsylvania Transfer Inheritance Tax.Amount $:Ng~.~Q!!th.~..J~.~.:t~.t~. If the Will makes any portion of es!ate subject to a life-estate,gi;.re name and birth date of life tenant . ....NQ J.J.f..~t~X\~lJ..t..•.............:,. Give Names and addresses of all unpaid creditors who are legally entitled to notice,together with the amounts of such claims;state whether they are admitted to be correct;and whether the claim is denied. All creditors of whose claims the Executrix has received notice have been paid in full. 0"'.1 Give reference to such parts of the will as require interpretation by the Court;a reference to all questions re- quiring adjudication,and a statement of any other facts deemed necessary for the preparation of the adjudication: None. Balance for distribution per account, Itemize any additional debits not shown by account:$l~.~.~~.•.lQ . -':-otal additional debits (Add)$NQ.ue . Itemize any additional credits not shown by account: Affidavit to this petition 1.00 It J:.11 Balance for distribution in cash. If balance for distribution is not in cash,list each item held in kind,giving appraised Value (or distribution Value>; Totol additional credits (Subtract) Balance for distribution $1.•.00 . $1.,.923.•.10 . lI,. t!I! ·If ~r ~ I -''.;•~I I If Family Exemption claimed by Petition,give place of Record:,. If Family Exemption is claimed at audit,give name,relationship and basis for Claim:.Ma.:r.ga.:r..~.t...JL . Sampson,daughter,was a member of decedent's household at time of death and claims $1500.00 as her Family Exemption. List any advancement or distribution on account that has been made,and nature and amount of same: None. .",. L Suggested distribution of balance shown,both as t~principal and income,attaching signed and itemized elections to take in kind if balance is not in cosh:residuary shares being stated in proportions: Margaret A.Sampson,daughter,Family Exemption Margaret A.Sampson,daughter,1/3 residue Gladys M.Danley,daughter,1/3 residue Leah S.Driehorst,daughter,1/3 residue ··..-::·~>·1n~.f'~.Y\~.:.•t<t~·,~,.:J~~.-......~-~-r-----::-.-.-~.' l:l C ~.. COUNTY OF WASHINGTON,SS: COMMONWEALTH OF PENNSYLVANIA. The above named Fiduciary or representative thereof, $1500.00 I~!r being duly _.~w.Q:rn doth depose and':say that the facts set forth in the foregoing petition are true And yaur petitioner will ever pray,etc. to the best of he.r.knowledge and belief. Sworn.t d b 'b d b f ,',::.~~;.:.,;:~~~~~..~;:.:~~r.0~~~,:~.:c~.~..~..19~;'~~'.__.:..~j!.o.~. Signature of Officer~..C~ Tille of Office,:~..:~-•.."mlff'POliiiC'".;. .,MY COMMI::::'~WASHINGTON Courm Office explres···············MtMbfj·Pi·········~l8E.S·AARll..}2;.,!""'.:I'.r.ennsylvanl.Association of Nota;i:~•••••.•••••••••.••••••••••••••••.•••••.•••••••.•••.••••••••••••••••••••.••••••...•.••.•.•• .-.-;~·~lJ" _....--- No..1.7.Q 9.;{.•.}.~.7.1 . Estate of....L.•...W.YL.1E...8AMP.SON..a/..k./.a.• L.W.SAMPSON a/k/a LIBUS WYLIE SAMPSON, Deceased Fiducia ry MaJ:gar.e.t..A Samps..on.,. ••.•••..••........•..~~.~~~.~~.~.~.!""""'" UII: I j j J ! II ....."1 .t""'-~......~1 .......I"~t ..."_-4.•......'): '72 r.PR F,Pr~3 Zl1 ~:JS~~:-~.i;l~~'tlNO ~:::CIS TU<0F \'/1 LLS ~Ii ~(:r:I'\1 "::-~'(\'I',"0 PAJ'JI.Uiui.1'1:1 I.,.,I -I Of • ,~,I,' I; ,. ;~ fi't'ii~jr •1 , ) 'Ir,•?' j \: .'~I ..:.'":: ~ ~~8 ..-<;.--.."'"0R~:.:: i.~~S 3'0 ~~...:c~a·6 ~~~~uz-::::O~;,;;~....~0~Bi:(::~;S to'~. .~ PETITION SUR AUDIT FROM WHERE DECEDENT LEFT A WILL Counsel of Fiduciary will submit herewith the following,in conformity with Court Rules adopted effective December 3,1951,being rule No.9:parag ra ph b-c;and divisions thereof:shown on pages 23-24. 1.Written praecipes of all Counsel in the case. 2.Copy of order appointing Guardian ad litem,if pertinent. 3.Copy of Order appointing Trustee ad litem,if pertinent. 4.Proof of service of above. 3.Letters Testamentary or Administration C.T.A.or an attest copy of Will. 6,Copy of inventory and appraisement. 7.Proof of advertisement of grant of letters if not filed with account. 8.Certificate of liens in case any of the funds for distribution are from judicial sale of real estate. 9.Signed and itemized elections if any distribution in kind. 10.Copy of Federal Estate Tax return if .es- tote is subject thereto. •....{o_1?:.!!eI ~Hg.h~.~J ~~.<i . ,Attorney r,,, :.;0...1"/ \',J..I "r," Ii I \,<11 ~")., 1 ., 1,/ , \J : ,J i it:I, Ii;] "~:' ii :1"I. . I~~ tjI~; t ~~I •,1'1 ):' To: Mr.Donald W.Hodgens R.D.#2 Claysville.Pa.15323 FROM JOHN J.HUGHES AlTORNEY AT LAW 203 MAIN STREET CLAYSVILLE,PA.15323 (412)663-7788 SUWECT:A.'Marguerite Blayney a/k/a Marguerite Blayney, deceased -N6.290 of 1971 IDATE Feb.22,]972 'I You are hereby notified that Donald W.Hodgens,Executor of Estate of A.Marguerite Blayney.a/k/a Marguerite Blayney, deceased,has filed his First and Final Account at the above number and term of the Orphans'Court of Washington County,Pennsylvania, which account has been placed on the Audit List and will be taken up before the said Court on TUESDAY,MARCH 21,1972,at 10 o'clock, A.M.,at which tiae you may present yourself at the Court House in Washington,Pennsylvania,should you so desire. Rectey:¥~~_~/HUghesq Attorney for Accountant ENCLOSURES:Copy of Will Copy of Account NO INSURANCE COVERAGE PROVIDED-(5••oth.r sid.) NOT FOR INTERNATIONAL MAIL '"GPO,1'700.•'7.4•• D RECEIPT FOR CERTIFIED MAIL-30~1 (pius Ipostage) , Qtauuty. ESTATE OF Qtaurt af Qtamman Jlrns af lIusl1iugtnu Jruusyluuuiu.®rpl1uus·Qtaurt Biuiswu 63-71-475No..__--=---:.._...!..:..:=..-_ J L.Wylie Sampson a/k/a L.W. Sampson,a/k/a Lihus Wylie SRmpson,deceased In the matter of the First and Final Account of·__:.:M~a.:::..r..og.:::a.:::..r~e~t:.....:::A~.__.::;,S_=i~m~p~s~o~n'__ Exe cutrix ADJUDICATION AND DECREE And now April ,19 72 ,this matter came on for hearing, audit and distribution at this session and testimony ta en;and thereupon,upon due consideration thereof t'f b.~.Q~O for distribution in ,the hands of the Ac.countant.is detern;it;ed to be $t 9 ).and the account is accordingly confirmed;and It IS ordered, adjudged and decreed that the said balance be paid out by the Accountant in accordance with .the schedule of distribution hereto attached and made a part hereof,unless eX,ceptions hereto be flied sec.reg.or an appeal be taken herefrom sec.leg. SCHEDULE OF DISTRIBUTION Margaret A.Sampson,daughter,Family Exemption, as requested in cash at the audit,1500.00 Balance per account._ Additional credit asked at audit Balance'_ Deduct Clerk's Costs &Receipt::;..s _ Attorney John J.Hughes Ru~sell Marino,Agent,transfer inheritance tax, Margaret A.Sampson,daughter,1/3 residue, Gladys M.Danley,daughter,1/3 residue, Leah S.Driehorst,daughter,1/3 residue, 1 00 13.00 135.65 135.64 13$.64 $1,924.10 $1,923.10 $410.10 $406.93 ~1;/1'7 ~ ~~#~,17 I ~~ ~C/ No balance .,I ,,I r -:INo._ In the matter of the ,'"7',.po{L Il /I '- '- h r~~1 .Zl.t RCGIS -I ~I ••~I'\,'ILLS \'!ASill N'·1 0 Ii ~;0"PI\. '- Account of L '- of Estoteof I.Rl.J~~L;:~\r'l n '-... Abjubitatinn aub ittrrr -I ~a ~~ '- " '- '- r ·1 L .i I ~. J IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNA ORPHANS I COURT DNISION L.WYLIE SAMPSON,a/k/a L.W.SAMPSON,a/k/a LIBUS WYLIE SAMPSON, INRE: Estate of ~Deceased. z<>..I>-IIIZZIIIII. io~BEFORE:ziIII~ ( ) ( ) (No.475 of 1971 ) ( ) ( HEARING ON AUDIT The Honorable P.VINCENT MARINO,Judge of the said Court. Tuesday,March 21,1972,at 10:00 A.M.,EST JOHN J.HUGHES,Esquire,of Claysville,Pa., representing the Accountant. " .,:u~~APPEARANCES: Q ..I<U QJ"l XI-~TIME: iiiII:IIIt-Il:oII.~THE COURT:Number 475 of 1971.the estate of L.Wylie t-Il:8 Sampson.deceased.The Executrix is Margaret A.Sampson and tbe ~~attorney is John J.Hughes.Mr.Hughes;?...o MR.HUGHES:If the Court please.I have the necessary papen in this estate;the signed Audit Petition and appearance.and also (ther papers have been filed.There are no outstanding claims that remain unpaid.AU interested parties have received notice.And the balance for distribution is in cash.There were•.in addition. certain joint accounts which we didn't inventory.but were returnee 2 for inhe ritance tax pu rpos es . j THE COURT: decedent's estate? THE G:r®.iURT: Court. Is there anyone else in Court interested in this (NO RESPONSE) The audit of this account is ordered closed by t e (A UDIT CLOSED) ff ~z~...I>-(/)z Z 11/II. ie~z iIII0( ,3: tiii:l-(/) ii ...I0(Q I hereby certify tha.t the proceedings a.nd evidence are o:J.,. ~contained fully and accurately tn the notes taken by me on the hearing of N ~the above cause~and that this copy is a correct.transcript of the same., :!a::oII.11/a:: I-a:::JoU ...I0( Uii:II.o .The foreqotnq record of the proceedings upon the hearing of the above cause is hereby approved and directed to be fUed. ourt~i I J. -, j l .:,.J j 1 ....,-.~.' " " 1 .', ,~.,J ,. J •.-'- ~7J :;n~.-;".rnr..n (,")c ::.:(.' 'J) --;. " -.,:,:~-'.ro -"-.r-0 1 C-);po r;..l) i '~ ,,'1 ",::I ..... .--..." " ., ,1'"\,j.."-, .. f ....''.' ~o 7 ~3~7/~~7-!J ESTATE OF L.WYLIE SAMPSON a/k/a L.w.SA~IPSON,a/k/a LIBUS WYLIE SAMPSON, Deceased .m TRANSCRIPT ~... I l:1'r,l i ...,-.....-~:-..., --ril .-Y(f)(C")e-X -.().z:~.~.>( ,r..~"",-; ~. ,- '-.). ilt":.-,,-(~) -...' ::::: :-'__:.l - "J -...J , ;1 ~ JOHN J.HUGHES ATTORNEY AT LAW 203 MAIN STREET CLAYSVILLE,PENNA.15323 (412)663,7768 ~ IN THE COURT OF COMMON PLEAS OF WAffilliGTON COUNTY,PENNSYLVANIA ORPHANS I COURT DIVISION ESTATE OF L•WYLIE SAMPSON a/k/a L.W. SAMPSON,a/k/a LIBUS \iYLIE SAMPSON,deceased. )NO.63-71-475 ) )In the matter of the First and )Final Account of Margaret A. )Sampson,Executrix ) ) !!!_TRA~N_S_C_R_I_P...T We,the undersigned distributees under the Last Will and Testament of·L.Wylie Sampson a/k./a L.W.sampson a/k/a L1bus Wylie Sampson,deceased,do hereby acknowledge receipt o~al1 the residue hereinafter set forth according to Adjudication and Decree of April 6,1972 in the above estate,and do further release and discharge the said Margaret A.sampson,Executri.,from all further obligation therefor in her administration of the above estate. $1,500.00 )~L/lf22 Margaret A.Sampson,daughter,Family Exemption,as requested in cash at the audit, Ytta~d{J.~ residue,135.64 ~1?t.{'1J. residue,135.64 ~;;/Ok Margaret A.S~pson,daughter,1/3 residue ~«Ja.f...,4U Gladys M.Danley,daughter,1/3 ~V7~ Leah S.Driehorst,daughter,1/3 ~d&;;L~ 135.65 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE HARRISBURG RCC-43 (4-69) NOTE:TO BE SUBMITTED IN TRIPLICATE j Pennsylvania Department of Revenue Bureau of County Collections 26 S.4th Street Harrisburg,Pennsylvania Dear Sir: Pursuant to Section 742,Pennsylvania Inheritance and Estate Tax Act of 1961, we herewith submit the following report: NAME OF REPORTING FINANCIAL INSTITUTION First Federal Savings and Loan Assoc.of tJeah. or Marp;sret A.Sampson Washington.Fa.15301ADDRESS77SouthNainStreet ACCOUNT NO.OF JOINT, TRUST OR INVESTMENT DEPOSIT_~S---=1.;..;91::.;:6;,.=..O _ NAMES ON ACCOUN~OR INVESTMENT .....tv.Sampson DECEASED JOINT DEPOSITOR,L.W"SampsonTRUSTEEORINVESTOR _ ADDRESSANDCOUNTY ClsysvUle.PS, DATE OF DEATH April 24.1971 SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR Mare.oret A.Samp$on ADDRESS __....:q).;..:ox:.:.:....4..:..4.:..:3:-....:C:..:l:..=a:LyS=-v:..:i::.:l:.:l~eL•...:;P~a..&.._ _.'TITLE /i "Signature RELATIONSHIP TO DECEDENT -..::::d~a\W=-h:.::.;te:=.=r:...-_ DATE DEPOSIT OR INVESTMENT WAS ESTABLISHED ~Npwrlr.!ll~i.t.lh""--J....9u.6~5 _ BALANCE,INCLUDING INTEREST DUE,AT DATE OF DEATH $....;l:..1I..::.0~03::.zt~lO=--_ ~~-.r' -f..-I Cl (J 3 /0 -=S 0 /.!;)-./})tr X).S=J e ".sol r a 'd'~c2 .5"",{}f'__ orJyo r>{y COl-~r--=.3 0·0 I S'7d ~/so RCC-134 (1-69)' COMMONWE~bTHOF PENNSYLVANIA DEPARTMENT OF REVENUEBUR~U OF COUNT1'COLLECTIONS INHERITANCE TAX DIVISION OFFICIAL NOTICE OF INHERITANCE TAX APPRAISEMENT AND ASSESSMENT OF ASSETS NOT SU BJ ECT TO ADMINISTRATION CI.AYSYILLE,PENNSYLYANl\15323 TO:XXIX MARGARET A.SAMPSON BOX 443 Dote:July 14,1971 County WASHINGTON County File No._ Bureau File No.{J-'?/-r""7S- We have received notice that,~~~¥£XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX on April 24 19 71,you come into ownership of certain property throug~~~~X ~X&~~~transfer from L.W.SAJfPSON,DECEASED (CLAYSVILLE) Under the Inheritance and Estate Tax Lows 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 #19160 held in the FIRST FEDERAL SAYINGS AND LOAN ASSOCIATION,WASHINGTON OFFICE,WASHINGTON, PENNSYLVANIA.In the names of L.W.SAMPSON OR ~UffiGARET A.SAJ1PSON.Opened }~rch 1965.Balance as of date of death,$1,003.10 appraised by the Commonwealth,as of the dote of death,at $1,003.10 50 %of this amount is taxable at the rate of 6 % ORIGINAL ASSESSMENT AMENDED ASSESSMENT DATE OF ASSESSMENT TAXABLE AMOUNT LESS:ALLOWED DEBTS NET TAXABLE AMOUNT AMOUNT OF TAX DUE o If you pay the above amount within three (3)months of the dote of death of the decedent,or on or ' before July 24 19 7L you may deduct a discount of 5%of the amount of tax due,or o This tax become delinquent,fifteen (15)months after the dote 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 dote additional interest is due at the rate of6%per annum until paid TOTAL AMOUNT DU E $ $_:';;501.55,-- 30.09 1.50----------- 30.09 $--------- $================= APPRAISED BY:~,-,.'d <L,iL'-f"'l ASSESSED BY:_ (Inheritance Tax Appraiser)(Agent for the Commonwealth) INSTRUCTIONS TO TAXPAYERS To insure proper credit to your account this Official Notice must accompany your payment.Mai I or bring it to: Make checks or money orders payable to: ~4',,!/s"yH/£/77/ /Z/4//~o, ~,.,''''"ro""f ,ffI\';.£~t .;'~' AGl "~.$;.,;......i If you have already paid this tax to an executor,administrator,attorney or other personal representative of the decedent for forwarding to the Commonwealth,list below the date paid,name and address of the perso..~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 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 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 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 Dote Paid Nome of Payee Description of Obligation Amount Paid TOTAL $ (attach separate sheet if requ ired) COMMONWEALTH OF PENNSYLVANIA) COUNTY Of _ SS: I,hereby certify that the foregoing is a just and true statement of funeral expenses and other debts of the decedent,,for which I was legally responsible and which I did payout of the property herein taxed.I further certify,that to the best of my knowledge and belief,these some debts will not be claimed by any other person,for inheritance tax purposes. SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF____________19__. 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 Wi lis RC C-43 (4-69) COMMONWEALTH OF 'PENNSYLVANIA DEPARTMENT OF REVENUE HARRISBURG J NOTE:TO BE SUBMITTED IN TRIPLICATE Pennsylvania Department of Revenue Bureau of County Collections 26 S.4th Street Harri sburg,PennsyIvan ia 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 Firat P~dcl'al S.vin,sf~end 'Loan J'SSociDtion of t1oohf.ngton ADDRESS 71 G1uth ~·1utn Street Uanhinr,ton.l'&*15~f>l ACCOUNT NO.OF JOINT, TRUST OR INVESTMENT DEPOSIT__9_..._1_,9_15_1 -- NAMES ON ACCOUNT OR INVESTMENT L.;....._W..;;.._S_BlD-=-Pl_Oft_,_Ol'~_O.;;;.;lad~y,;;;..s...;.M_=•...;.Da;....;;;.;.n;;,.:;;l.:.::.eylt..__ DECEASED JOINT DEPOSITOR,TRUSTEE OR INVESTOR L_._'W_._t'i_"G_tD_P_IO_'U _ ~~8Rl6aNTY Claysville.,'£>9. DATE OF DEATH "l>rU 24,1911 SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR Gttd;,,;M.J).tnl~y----.;;..-----..,;;---------- ADDRESS CliJysvUle,Pa. TITLESi'gnature RELATIONSH IP TO DECEDENT d3_t:_~u_ht_e_f'_ DATE DEPOSIT OR INVESTMENTWASESTABLISHED M_ar_e_h_8..;;._1_'_65 _ BALANCE,INCLUDING INTEREST $6966,67DUE,AT DATE OF DEATH $_ IP-If 'A ~I 9t t,~'1-:-3,L/t 5.3 t/ (P10 .."'13,L/t3.3t1 -;..1 tM'1.0 a rr <:P6/6 ¥;"0 9,0 ()::/(),t(,J TO:GI.ADVS M.DANI.EY CLAYSVILLE,PENNSYI.VANIA 15323 RCC-134 (\-69) COMMONWEALTH OF PENNSYLV'ANIA' l),EPARTMENT OF REVENUE •BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION OFFICIAL NOTICE OF INHERITANCE TAX APPRAISEMENT AND ASSESSMENT OF ASSETS NOT SUBJECT TO ADMINISTRATION Date:--..JJJ4u,J,.,l1~y~l:"l4.....,-:l-1.y97:j.,1~--- County ~W~ASl..;1l1:lHL.LI~N~C*T.u04l+N------ County File No._ Bureau File No.CJ -7/~7J We have received notice that,~XKd{ltilXXecXIXXXXXX.XXXXXlXXXXXXX..Y.....\JCx..'!J.XXXXXXXLXXXX on .I April...24-19-ZJr,you came into ownership of certain property through .2t1!X.Et~.xxX I ~RX~transfer from L.W.SAMPSON,DECEASED (CLAYSVILLE) 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.Held SaviDgs Account #19161 he1a in the FIRST FEDERAL.SAVINGS AND LOAN ASSOCIATION,\iASHINGTON OFFIcE t WASHINGTOl PENNSYLVANIA.In the names of L.W.SAMPSON OR GLADYS M.DANLEY.Opened 3-8-65.Balance as of date of death,$6,966.67. appraised by the Commonwealth,as of the date of death,at $6,966.67 50 %of this amount is taxable at the rate of 6 % ORIGINAL ASSE~SMENT AMENDED ASSESSMENT DATE OF ASSESSMENT TAXABLE AMOUNT LESS:ALLOWED DEBTS NET TAXABLE AMOUNT AMOUNT OF TAX DU E o If you pay the above amount within three (3)months of the date of.death of the decedent,or on or before July 24 19 71 ,you may deduct a discount of 5%of the amount of tax due,or o This tax became delinquent,fifteen (lS)months after the date of death and,in addition to the tax,statutory interest at the rate of 6%of the tax per annum is also due as of *_ 19__in the amount of *If the tax is not paid by the above date additional interest is due at the rate of 6%per annum unti I paid TOTAL AMOUNT DUE $ $3",-+-=,4%j8.z..3.z........3,e4t...-__ 209.00 $--------- $================= APPRAISED BY:~A4JGC.O~>9 <b"~~ASSESSED BY:_ (Inheritance Tax ~ppraiser)(Agent for the Commonwealth) INSTRUCTIONS TO TAXPAYERS 15301 Make checks or money orders payable to: ~<f/y,t:0~- ~/,t//;7/ ~'~I~<?2/(;:(I?~ /le.-,I/~///~/ To insure proper credit to your account this Official Notice must accompany your payment.Mai I or bring it to: ~Wi'f!II fIJ)..~ AGEI'4T rO"l!iE.\L.i'~h COURT HOUSE WASHINGTON,PENNA. If you have already paid this tax to an executor,administrator,attorney or other personal re.prese'l'itative of the decedent for forwarding to the Commonwealth,list below the date paid,name and addre-ss of the person to whom you made payment,their official title and the amount. Date Paid Name and Address of Payee Official Title Amount Paid Under certain circumstances,if,after the date of death of the decedent,you personally paid funeral expenses or other just debts of the decedent,with funds derived from the property herein taxed,such amounts expended by you may qualify as deductions against the gross value of the property in the computation of tax due.If any such expenditures meet 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-'fou 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) COUNTY O~_ SS: I,hereby certify that the foregoing is a just and true statement of funeral expenses and other debts of the decedent,,for which i was legally responsible and which I did payout of the property herein taxed.I further certify,that to the best of my knowledge and belief,these same debts will not be claimed by any other person,for inheritance tax purposes. SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF____________19__. REPORT OF REGISTER OF WILLS Si gnature of Taxpayer I,the undersigned,duly elected Register of Wills in and for the above county,do respectfully report that I have allowed deductions listed above in the total amount of $--------0 Date of Approval:_ Register of Wills ",,:,. Fonn RCC-2 DEPARTMENT OF REVENUE ..,. ..BUREAU OF COUNTY COLLECTIONS HARRISBURG.PENNA.17727 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE July..20,DU J,'ll+. COUNTY W~~.h~.~. FILE NO.§J..:7.?:.:4.7..?. Whereas,L~.w:~s.AMP.S'ON.late of Q~X~y.~. in the County of WASHINGTON Commonwealth of Pennsylvania,having died on the 24th day of April.19.71 ,seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore,I,f.:MN.Q¥.$~¥.P.,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 Allet Unit Appraisement Values Made for InheritanceTaxPurpOlea $ Jt S~v;nt1S Ac~o\lnt.nlQlhO held in t.ne FIRST FEDERAL SAVINGS AND LOAN ASSOCIATION.WASHINGTON OFFICE.WASHINGTON.PENNSYLVANIA.In the names of L.W.SAMPSON OR MARGARET A.SAMPSON.Opened March 1965.Balance as of date of death.1,003 10 Jt.Held Savings Account #19161 held in the FffiST FEDERAL SAVINGS AND TJ)AN ASSOCIATION WASHINGTON OFFICE,WASHINGTON,PENNSYLVANIA.In the names of L.W.SAMPSON OR GLADYS M.DANLEY.Opened 3-8-65.Balance as of date of death,f 6,966 67 I I I Having been duly swo.rn according to law,I do h~reby certify that the above appraisement is made in con- formity with law on this w.ztJ.u.day of ~~1 CP;,...................19n?(. ............................~~~~~pn.<).. Appraiser .......",,",,",,..",,..........".","...............................................w.~,Penna. ......WASl:l.OOTON...............COUt~ty RESIDENT INHERITANCE TAX APPRAISEMENT Estate of ...................L.•W.•....SAMPS.QN . Deceased. Late of CLAYSVILLE..,-. Date of Death,4~24~7L .. Appraisemel!t Docket Vol.,.. Page,No.63-71-475 Filed in Register's Office,......J:uly....2.Q..........J9....7~ Amount of tax due,$.. DEPARTMENT OF REVENUE Received, Examined and Approved,.. Wrote abo.ut Appra.isement, Appeal f,.om Appraisement,.. Entered and charged,. , , RC C-43 (4-69) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE HARRISBURG / NOTE:TO BE SUBMITTED IN TRIPLICATE tCllh .•Driohorst 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 Firat Fed Save 6tl'ld Loan hs.oe.of Washi.ngtonFINANCIALINSTITUTIONe_ 77 (~o\Jtb.Main Str.e.et l~Bllbf.ngton.Fa.ADDRESS __'_ ACCOUNT NO.OF JOINT,3_l!)lS~'TRUST OR INVESTMENT DEPOSIT _ NAMES ON ACCOUNT L \1.SIl1<lJ,i6on Q'l:'Leah S.DriehoretORINVESTMENT-_ DECEASED JOINT DEPOSITOR,1..tJ.:~~rt';i'tJcnTRUSTEEORINVESTOR _ ADDRESS Cl"sHill'""'aANDCOUNTY....'1".....- April ;(\4 t HllDATEOFDEATH ~-_ SURVIVING DEPOSITOR,BENEFICIARY OR INVESTOR _ Signature TITLE RCC-134 (1-69). COMMONWEALTH OF PENNSYLVANIA \0DE~ARTMEN'1 OF RE~ENUE ~UREAU OF COUtlTY COLLECTIONS INHERITANCE TAX DIVISION OFFICIAL NOTICE OF INHERITANCE TAX APPRAISEMENT AND ASSESSMENT OF ASSETS NOT SU BJ ECT TO ADMINISTRA TION TO:I.J!~AH S.DRIEHORST 55 ACHESON AVENUE Date:-.-vJ\l\l:l:l:=)iVot-:Jll.t;4h,t'"""""::I:l~9::j-7±-1---- County _.IlW'-.cJAlWS:.uH....I~NJ.!G.J,..T1oL0aN _ WASHINQTON,PENNSYLVANIA 15301 County File No....:.-_ Bureau File No.~-3 -7/-r7S- We have received notice that,~IlH~DBt106.tXXXXXXXXXXXXXXXXXXXXXXnXXX¥.J{XXXX)£XXXX on~19-1L,you came into ownership of certain property throughxr»Ktx~lXXx x~~transfer from L.W.SAMPSON,DECEASED (CLAYSVILLE) 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.II Savj ngs Account III 9)59 held in the FIRST FEDERL SAVINGS &LOAN ASSOCIATION,WASHINGTON OFFICE,WASHINGTQN PENNSYLVANIA.In .the names Of L.\'1.SAMPSON QR LEAH S.DRIEHORST.Opened ~arch 1965.Balance as of date of death,$6,966.87 appraised by the Commonwealth,as of the date of death,at $6,966.67 50 %of this amount is taxable at the rate of 6 % ORIGINAL ASSESSMENT AMENDED ASSESSMENT DATE OF ASSESSMENT TAXABLE AMOUNT LESS:ALLOWED DEBTS NET TAXABLE AMOUNT AMOUNT OF TAX DUE o If you pay the above amount within three (3)months of the date of death of the decedent,or on or before July 24 19~.....you may deduct a discount of 5%of the amount of tax due,or o This tax became delinquent,fifteen (15)months after the dote 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 dote additional interest is due at the rate of 6%per annum until paid TOTAL AMOUNT DUE $ $_~3..L'4~8=3:..=:..=34-=--_ 209.00 209.00 $-------- $============== APPRAISED BY:~fIn '-,&,/)/21 £:Lro..ASSESSED BY:_ (Inheritance Tax Appraiser)(Agent for the Commonwealth) INSTRUCTIONS TO TAXPAYERS Make checks or money orders payable to: ~/ycf:S-~I 011 /77/ To insure proper credit to your account this Official Notice must accompany your payment.Mai I or bring it to: COURT HOUSE WASHINGTON,PENNA.15301 If you have already paid this tax to an executor,administrator,attorney or other personal representative of the decedent for forwarding to the Commonwealth,list below the date paid,name and '.7ddress 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 req~ired) COMMONWEALTH OF PENNSYLVANIA) COUNTY Of _ SS: I,hereby certify that the foregoing is a just and true statement of funeral expenses and other debts of the decedent,,for which I was legally responsible and which I did payout of the property herein taxed.I further certify,that to the best of my knowledge and belief,these same debts will not be claimed by any other person,for inheritance tax purposes. SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF____________19 __. REPORT OF REGISTER OF WILLS Signature of Taxpayer I,the undersigned,duly elected Register of Wills in and for the above county,do respectfully report that I have allowed deductions listed above in the total amount of $0 Date of Approval:_ Register of Wi lis Fonn RCC-2 DEPARTMENT"OF BE-VENUE # BUREAU OF COUNTY COLLECTIONS HARRISBURG.PENNA.17 127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE July.23.,l.97~. COUNTY ..WAS.m.NG'ION .. FILE NO 63.~7~~4.75.. Whereas,L W S.AM.rs.QN late of G.M.X9..Y.AJ.$. in the County of WASHINGTON Commonwealth of Pennsylvania,having died on the ·24th day of April..19 7;J",seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore,I,f.RANC.~~,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 Jt.SavingS Account n,o,1:;0 held in the FIRST FEDERAL SAVINGS &LOAN \sSOCIATION.WASHINGTON OFFlr.F.WASH 11\1'."111\1 .V llT\TT A In t.he na.me!'; of L.W.SAMPSON OR LEAH S.SRIEHORST.Ooened 3-65.Balance as of date of death. Unit Values $ Appraisement Made for InheritanceTaxPurpoles 6.q66 167 Olumbe1'and Street)........................................W ..~)j"d ,Penna. ...............WASHINGTON .County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of L ..W..····SAMPSON······················Deceased. Late of .CL.J\.X$V;I:W$.. Date of Death,..·J.v.,.24~71 . Appraisemcl!t Docket Vol.,21..-:.. Page,./..1R...9-:.:z,No §?:.?~:4.?.?.. Filed in Register's Office,J..ulY.Z3 19..71.. Amount of tax due,$,. DEPARTMENT OF REVENUE Received, Examined and Approved,, Wrote abo.ut Appraisement,. Appeal f"om Appraisement,.. Entered and charged,.. # J. " , Form RCC-33 RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS COUNTY OF ..WASa..lNQ':l'O'N .. 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 Inh~ritance and Estate Tax Act of 1961.) State of PENN.s.YLVAN.lA } ss: County of WASHINGTON . ......................MAR.GARET.A SAMPSON.,..:.............. i\dftritristnKiIT of the estate of the above-named decedent being duly sworn,depose S and sayS .Eueutor ...........,19..7.J......J testate leaving a last will,copy of which is hereto attached.} (lillY)(V""r)Lintestate Decedent dJed ...Ap:r;.:i..l .....~4.L. (Month) Name and address of attorney or}.J.ohn ..J ..Hugh.es,203 Main ..Str.e.e.t..,...Claysville,.....Pa..&........... other authorized representative to whom all correspondence should be .. mailed. That as such E~~.c.ut.r..ix.deponent is familiar with the affairs of said estate and the property con- (Exl~r.\ltor·Adminishator) 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 None None 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 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 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 mortga~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 to each item;all moneys payable to the estate from life insurance policl'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 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 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 co~y 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 jointly,by the 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,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 and 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. That the totals of the appropriate eolumns in Schedules "A","B","en,"E",and "F"as directed therein, have been carried forward and properly registered in the Summary. Subscribed and sworn to before me this .-~~-da~of Yr--1971...----.-f!7;f~- ~a....~.er."//;-r-.C;117.4 (Street Number) ..........G..:l,.~.Y~.Y...~..:t.J.~.J p..~.~P~.y.)...y..~.~.:i..~. (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 securities, securities of close or family corporations or an interest in any co-partnership or business,that the data and statements required 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. 'RC~-34 (i-.s•.) COMMONWEALTH OF.PENNSYLVANIA DEPKRTMENT OF REVENUE ,BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDUL.:E "A" REAL PROPERTY Real property in Pennsylvania,with statement of 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. NON E. (1) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH (2) ESTIMATED MARKET VALUE (3) DEPARTMENT VALUATION CAUTION (Do not write In thl.space) Insert this total opposite "real property",Schedule "A"in the X X X X X "As Reported"column on the last page of this return. .RCC-35.-" CO~mONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "n" 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,ti.t1ed 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 cHv Idends,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 No. ITEM List and describe fUlly UNIT VALUE ESTIMATED MARKEl'VALUE DEPARTMENT VALUATION (Do not write in this space) 1.Checking Account No.357-3584,Mellon National Bank and Trust Company, Claysville Office,in the name of L.W.Sampson Insert this total opposite "Personal Property",Schedule "B"in the "As Reported"column on the last page of this return. x X $3,901.32 $3,901.32 3 90 (..3 .2 I .3 9()f.3:L I r:cc-36....• . cmmON'\K\LTH OF PENNSYLVANIA TIUNSFER INHERITAN('~TAX ~~SIDENT DECEDENT SCHEDULE "c" TRAN SFERS (1)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)-ANuO~_ (2)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 (3)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 enjoyment at or after his death? (Answer yes or no)No (a)Was there any possibility that the property transferred might return to transferer o·r his estate or be subject to his power of disposition?(Answer yes or no)_ (b)What was the transferee's age at time of decedent's death?-----(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)_N~OL-_ (b)The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?(Answer yes or no)~N~OL-_ (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)_.Nuo'-_ (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)No NOrE 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 NON E MARKET VALVE (Estimated)DEPT.VALUATION (Dept.·Only) Insert this total opposite "Transfers",Schedule "C"in the "As Reported"column on the last page of this return.None. ...... COMMONWEALTH OF PENNSYLVANIA THANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY INSTRFCTIONS:This schedule must disclose all property,real and personal,owned by the decedent jointly wi th 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,Namel unit Address and Relationship of Co-Owners,and Place Value of Record of Instrument,where Rea!Estate.! Account No.19161 in First Federal Savings and Loan Association of Washington,in the name of L.W. Sampson and Gladys M.Danley, Account opened 3/8/65 -$6,966.67 Account No.19160 in First Federal Savings and Loan Association of Washington,in the name of L.W. Sampson and Margaret A.Sampson, Account opened 3/8/65 -$1,003.10 Account No.19159 in First Federal Savings and Loan Association of Washington,in the name of L.W. Sampson and Leah S.Driehorst, Account opened 3/8/65 -$6,966.67 percentage Estate Share Valuation ()1'<'~ 50%~3483.34 ~50%/ffI,.,501.55 (}{L50%.ir~3483.34 DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's Property Interest I I_______________________--L__----'-'---,-+-+-~ Insert this total opposite "Jointly Owned Property",Schedule"E"n /..It !"-;;L3 in the "As Reported"colwrm on the last page of this return.$7468.23L..,".l.4-lt_1_J ~ RCC-37 r (12-63)..."i .- COMM()~WEALTH OF"PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES ( h ""RELATIONSHIPBENEFICIARIESANDADDRESSES(If step-children or SURVIVED DATE INTEREST OFStatefullnamesandaddressesofallwhoillegitimatechildrenDECEDENTOFBENEFICIARYaveaninterest,vested,contingent or other-are involved,set STATE YES IN ESTATE wise.in estate)forth this fact.)OR NO BIRTH M~l"'O'~.l"'Pt.A. Clavsville.Pa,"Daughter Yes One-third ~l~nv!O:M n~nlpv Claysville,Pa,Daughter Yes One-third Leah S.Driehorst 55 A{"h,",~",,,,Avenue Wa~hinO'ton Pa Daughter Yes One-third- Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE 'N'n :inn!O: SUMMARY Real Property (Sch."A") Personal Property (Sch."B") Transfers (Sch."C") Jo.i.n.t.ly Own.e.d P;rop~;t;'.:t.y........................(~~1l,.~.~) Gross Taxable Estate .. (1 ) (As Reported) $...No.ne . $.3.,.901 32.. $None . $.7.,.4.6.~~:z.~ $. •.l.,..3.~.~.•.5.5... (2) (As Determined) $. $~q9/.3~ $$.;16f ,;)3t. $ $··i3b9.S?I.;.... E-<:'0ZClI...W :tilell~:ca ..;lQ)·ClI:>-:Col 0(W 'ClI rJ)c::l ,'-rIJ~....~....".io(i I<:~ell I ,- ~~'2 i,~•....,....,L,.'"; Il..0 ~=.. Il..0 l'J):C ell =.. tol <:tol AI:'"0 ..2:'7 I ~UL s~All In 43~J:W ~, W l-<r-o ~:Q)~:Vl Q ,.J ~:r-f:bll c 0 ~::r:r..~l'J):r-f:C ~Z0r-ozr-o rJ)-1"1:-1"1:Il..< ~W .:>.d .....R~C (',I ',.-...-..0 r:=.til (12 0 ~v ~)r .:.,".I t~0»CIS:..c R~I"'--''.-:1"lllSc~..CIS r:=.::0 Q..Vtl_I\,....i d :c w t4 r-f 0::~V!A~HIH\~T()N CO.,PA.ell r-o c).....;..l:l r-o 0 "Vl c '2 --r:......c,0....0 E'6 ,."..~c E....;:: ~"Cl 0::0 0~....:l U U .:;. Rcc-al (2-64) COMMONWEALTH OF ~ENNSYL VAN IA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION NOTICE OF FILING OF APPRAISEMENT MARGARET A.SAMPSON IN YOUR REPLY PLEA8E REFER TO 38-169-2 J In Re:Estate of L.WYLIE SAMPSON a/k/a•• WASHINGTON County -File No.63-71-475 Dear MrS.Sampson, You are hereby notified that the.~~_o~r~i~g~i~n~a~l~_ appraisement in the estate of L.WYLIE SAMPSON has been filed in the office of the Register of Wills qf WASHINGTON County on August 26 ,19..1)..Said appraisement reflects the following valuations: Jt.Hd .~,--__7.J....f-"4::Ll6OLJ08L.<......2.....3r.-_ Personal Property~3~,9~O~1~.~J~2~-------- Transfe r s =---:~-::--_=_:::-------- Total -=1::01"-1,'-"3....6....9"-'.'-"5....5"--_ 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 (5%)percent per annum is charged. Any party in interest who is aggrieved by an appraisement may appeal therefrom as provided by law. Date __A_u.=g'-u_s_t_2_6.....,_1...;.9_7_1 _Signed ~~~jL, Title MADELINE FINNEY,APPRAISER I DATE OF DEATH:~ April 24,1971 Note:This is not a bill. --..f';j . RCC-39 (5-68) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SUMMARY Estate of SAMPSON (Last Name) L. (First Name) w. (Initial) DATE OF DEATH 4-24-71 FILE NO.63-71-475 Dated:__A-:u=g;z.:u.:..::s:.....:t=---2::...:6:.....;tL-..::1::...:9:....;7;...::1=--_ 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". ~E~~Rft'="'~ 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 11 369 55 NONE 1 11 369 55 VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISED $$$3 901 32 -----+-- 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) CLEAR VALUE OF ESTATE Valuation of life estates or -E FOR USE OF REGISTER ONLY Tax on $-----------i--2% Tax on $('6%) Tax on $'3% Tax on $10% Tax on $15% Exemptions * Total Estate -+-__ TOTAL TAX COMPUTATION OF TAX $--------1--- $--------1--- $--------1--- $--------1--- $-------+-- $...L.....__ (*)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 :::::::::~t=== BALANCE OF INHERITANCE TAX DUE $t= Add interest at rate of 6%from _____to $------ AMOUNT OF ESTATE TAX ASSESSED $--------<L- Estate tax paid $---'l- BALANCE DUE $-----ll- Add interest at rate of 6%from t ------lto-----$--------1. TOTAL TAX BALANCE $-----~ PAID $.....J FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE:Where subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason, same should be noted below,with short explanation. Will (...No.AdminIstration IN THE Year .. MATTER OF THE APPRAISEMENT OF THE ESTATE OF L.~WlI.:I:J~;$~I>~ON Deceased Late of 9:r.A.X$y:rLLE County of WASHINGTON -.., '-' Commonwealth of Pennsylvania REPORT AND APPRAISAL '. -. - ~ ,.. •\' Fonn RCC-2 l'.!"'"..,....DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG.PENNA.17 127 COMMONWEALTH~OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE ~~.~~.~..~~.§..t !.~..?.!.. COUNTY WASHIN.GT.ON .. FILE NO §..~.:.?!..:.~..?..?.. Whereas..L..,:w.xL.I~S.AMPS.9..N a./~la.late of c.t.A.XSy.I.t.t~. in the County of W.AS.H.I.NG..T.Q.N Commonwealth of Pennsylvania.having died on the Z:4.t.A day of Ap.:r..:i::l.19 7..+..•seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore,I,MADELlNE FINNEy ,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 Ufe or for years,the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral rate on any such future interest. Unit AppraisementDescriptionofAssetValuesMadeforInheritanceTaxPurpohs $ PERSONAL: SEE COpy OF SCHEDULE "IX "B"ATTACHED TO APPRAISEMENT 3.901 l32 JT.HELD: SEE COpy OF SCHEDULE "E"ATTACHED TO APPRIASEMENT 7.468 ~3 total 11 ."fiq lCi .Ci -f . I ,.... I -1.-,I.-I ..., ,-l...:, ,'-~. !•,,, ~ form~~V:fh~a~~:I:h~SW('rl'~&Jt;'1~~~·~~o~e~~~~77~~~t~~~;;;~1)E).. App.e,.e• .................................................................................................................................................................. .........................................£Uclzt::;;kr.v..........................Penna. (PoRt effieel - ......................WASHI.NGTON .County " ., ": ..." -, . i RESIDENT INHERITANCE TAX APPRAISEMENT Estate of L.WYLIE SAMPSON Deceased. Late of .......U ...C.l,.AY.§Y.:r.:I:.~~. Date of Death,4..~.~4.~.7.l .. Appraisemellt Docket Vol.,38 . Page,.~E?~.:.~No ~.~.:.?~.:.~.7..? Filed in Register's Office,...A~.g ~.§19.JJ Amount of tax due,$.. DEPARTMENT OF REVENUE Received, Examined and Approved,.. Wrote abo.ut Appmisement, Appeal j,.om Appraisement}. Entered and charged}.. .'-I- ~ -" , .,.. AND AGENT 0 ..THE COMMONWIiALTHra3-71-17~- DEDUCTIONS ALLOWED IN,J THE SUM OF •,~,l!i?J..f!,.~ Y -Cf-l 'l/................................................. '. STATEMENT OF DEBTS AND DEDUCTIONSLJ_7/_~15 ,.,'-'L..o",-,,-,"",@ ''7} COUNTY Form RCC·IO O'-vICE OF THE .f!~".-/I''''REGISTER OF WILLS ~;WASHINGTON ESTATE OF _La.u...--L!W...J.YL~IL,;!E~S~A~M~P..:::S~O~N~__LATS OF --lB~o~r~o..:u:.cg..:.h:..-:o~f~.:o::C...:l;.::;:a:..ly..:::s::...v~1:::.·:::.l.:l..:e~,_ DATE OF FILING APPRAISEMENT DATIi 01"DEATH _ DATI!NO.01'NAME OF PAYEE REMARKS AMOUNTVOUCH"" Dettra Flag Co.,Inc.Flags 54 47 I, I c=./"1 '7 /1 h Brownlee Funeral Home Funeral expenses 1,583 50 I ~/"1 ror /~"1 TOOl"14'......:J Witness fee 10 00 I c:./''7 /17,n,..li',..l:>n n T.~T"D'P.T.a.~t illness 85 00 I Fl /1 7 /171 r.1avsville r.emeterv Assoc.OneninQ'&closinQ'Q'r~Vp.R~100 I 5/17/III Washington County Reports Adv.Letters '1 d,00 II Fl /1 7/171 The r.1avsville Recorder Adv.letters 12 Ino \5/28/~l S.White's Sons Grave Marker 19 35 h /1 L1/t71 11 ,~14'll'wJPT"Shon 1<'1 ~7 Ilo R.Marino ReQ'ister Letters &3 S.C.16 00 R.Marino.Register Filing Inv.&App.3 00 M~T"D'~rp.'t A '"'~~'Xp.('.11t,,,ix It;n"')00 I()o .Tohn .T.Hughes.Attnrnp.v fnr 1I.,..,..n'ln+,-,,,+')no 100 n M,-,,..;"n l1oO';c:tOT'14';1 ;"0'1I.I"',..n11"+lh nn I q;;,~--,/2 (!;f}~~A l~~.~A (~.;I4~LoD../...-//S()(;~"'1 I Q -4 A cluf-fl~d LJ'j_/, /1 ~ I, COMMONWEALTH OF PENNSYLVANIA } COUNTY OF __LU:lu.u~oI.U.O~.LU_____ss:WASHINGTON -------....,.JJ-\,O~H+lN"l_.,JJ--JH~IT.I.;GI.tHl.JEI:.lS~HEREBY CERTiFY.THAT.TO THE BEST OF MY kNOWLEDGE AND BELIEF.THI!FOREGOING IS A JUST ....NO TRUE srATEMENT OF DEBTS.FUNERAL EXPENSES AND EXPENSES O~ ADMINISTR....T10N SUBMITTED TO THE ESTATE OF -:t INHERITANCE TAX PURPOSES. '.' ..·'11-....l-.:::::1 F"'J--:::nJ>fl1 C-.r-(/)G)c:::r::-..:l:(/) '2:(j)(/') F'1"jZ....,rr~:"...(i)~r-0:) CJ -;::0-0 0 '"-"s::::Do ......""'t1 ~[,~~~. 0 Al,:z.-0 r-e, ~J>en <.v IN THE ORPHANS'COURT OF WASHINGTON COUNTY,PENNA. In the matter of ,the Audit of Account filed in the Estate of Sampson,L.wYlie Deceased )Date of death y:_~d_0_..._}__.LI _ \NO.J+1S of 1971 ,Term.19~,A.A. )Docket 38-169-2 TO THE AUDITING JUDGE: Enter my 'appearance for the Commonweal'th of Pennsyhllania,claiming transfer inheritance tax in the above estate,as follows: DR. To appraised Vialue of Estate:Realty_________.......$_ -------.... $-----_.__._. $ TOTAL DEDUCTIONS,$ $-------- $------ $------- $---:------ $-------- ) -----:~,=-_. able (-- 1~)------ --$--L-- ---------------------------------------------$-3--(11-- Interest__yrs.__IDOS.__days @ __%•$ Less amount previously pa,id________________________________________________________________$.._ Balance .------------.--------.---..--------------------.--------.-------$~rt--- Total Tax __ TOTAL TAX AND INTEREST DUE ..$2£-1-:)4----- $------ $------- $------ $------- $ TAX PAID ON ACCOUNT NOTE:credits claimed in the Account arg l'CAL,CULATION ~uctible a'S arinst the tax:_..1-1·1 "?10 j L-- I I lq8'I ~....\-_..7t,Gross v:roue ----r---7""-/::e------ ,z,?J.I -'",Less Deductions -----------------._}i "Cf P'_o I ~lq ~'l")-_...1 Clea'r VaJue __m m__--5[".,-fQ _ --/2-----.1rtt#I Thx.!_S'l--frL _ able at 2% Debts and Expenses per Acco CR. Additionffi ~~l,pe,A'<OU:~'~~~~=~~7di~:-=--f-t-,L-~=---u.·~~·0:-~;-;)--+-- AddrtionallcAssets per Audit,Sub't to 'Dax '._..$---:;;;;::;;===::::==.,,==-_ -GR SS VALUE_____________$(4 J ~;.~~3Cj 01,>V $~~t;~((~_ z0 n [0 3:"1l3::II0»z In =E n In "1l t:l:J»In ~r~"T1 ~t J:"T1 0 0 0 :II '11 :u » 0"1l "1l "%j >-3In"1l (D'"Z In ~Z )-m :u-<» 0-r Z '"~n I rnz W:; (D >ll>~~Q. ... I ;:....,=::~;,~;~;;;",'. ..C-4 (8-68)"-i;-;C()MM8.N~,E~~T~.pfrE~~SY ; ;.,;.•.,•..,....;•.•';;:~••;...•,..".,..;••....•;...•..........••~';;'DiEPA~T~~~T.'()F;RE\J.~.~H·.; 'No.B 4'629 O~~.f,,~'/~~l~;i~fi;~J;~~;~~~:~,~~~9~~·'~;J~~~~:;!;, RECEIVED THREE and 17/100----------------__________________--------------:'tlollars MARGARET A.SAMPSON-EXR.representing Pennsylvania Inheritance or ATTY JOHN J HUGHES Estate Tax due from the following estate:From:·• Address MAIN STREET 2%Tax on $_$---------~ CLAYSVILLE,PENNSYLVANIA 15323 6 %Tax on $.5_2...:-_9_0 _$,__3;:;...::...;1=.7..:.--." File No.63-71-475 Date of Death 4-24-71 15%Tax on $,_$-------_.11I Date of Payment May 9,1972 Name of Decedent _L=-=.~WYL..:...=.=I:..::E::........:S=AMP::.==..::S=-O=N:..:....._=a::L.,;:.=L._=a=__t %Tax on $,_ Estate Tax,Act of May 7,1927 $----------1lIlI $---------1rJ County ....:.W.:,:A.::S=.:H=I=N::..:...=G.::TO...::...:.N:...----l Remarks: JMOd;.-R TOTAL TAX CREDIT Less five percentum of tax if paid within three months after date of death Plus interest at the rate of __%from _ to _ $3.17--------- $--------·01 $,---------1111 3.17 $,========I!TOTAL AMOUNT PAIDSEAL 38-169-2NOTE:To be delivered to taxpayer Received b,.....~dru~~~~;.;;,f-I--¥.n.~:=::=!!!..:--------I NOTE:In accepting the transfer inheritance tax an future estates,prior to the death of the e tenant or tenant for years,as evidenced by this receipt,it is understood that the Commonwealth s all nat be precluded or prevented from hereafter assessing additional inheritance tax at the death of -.:;e;......gc;~twt.~..Il....~~g....,.....!.A.("A...L.oI.ALL-1UI life tenant or tenant for years whenever it appears that such additional tax may be legally due an collectible for any reason whatsoever, PM 4;u;_e....J,.-[f ••CQ.-=""'!'u;e¥'9 ""'~""P"'"........~..,.,...op-"T..............'~ 3 9 0 1 ":z:2-' 3 9 0 1 ":z:2 s-' 3 4 8 3 ":z:4-' r:::0 1 r:;5- 3 4 8 '"Z 3 4J 1 1 3 6 9 5 5 s 1 1 3 6 9 5 5 ,I.',' .1.',' ~•••••....·di».....:"._.S·k ["tOe _"."••,.iletIn,d ._A ~~__•~ ''3 ~7/-47~ 1\ffi~uutt ®f iExrrutnr '®r 1\bmtutatrutnr §tute nf '.ruuayluuuiu } Ql.nuuty nf lIua4iugtnu as: Personally before me,the undersigned authority,aNQt~.rY-..~b_l._~_in and for said County and State,appeared .•~.g~~.~!~.!§~~p'~~~._.._._who,being duly sworn according to law,deposes and says that S he is the executor or administrator of the es- tate ofLA..~".Ylie_..S.amJSo.lh ·deceased,that the foregoing schedules constitute a 1 t ·t'd . t 'f th 1 d"1 t f L.Wvlie Samnsoncompe e mven ory an appralsemen 0 e rea an persona esta e 0 ._~,r..", deceased,except real estate outside the Commonwealth of Pennsylvania;that the figures opposite each item of real and personal 'estate in the foregoing schedules are 'determined and stated by the undersigned to be the fair value of said items as ,of th~date of the decedent's death,based upon a just appraisement of each item made by the above named Executor '~'til!l'l'im~. Sworn,~subscribed'before me this .:.,fa~:},-'YU nhAnA ,";'.n " J'Y/'fJp'~f:di~',,PI<.-rExec~or~..tLJ..~~.:~.~.~. {~6 ~l ADDITIONAL INSTRUCTIONS 1.An inventory must be filed within three months after appointment of personal representative. 2.A supplemental inventory must be filed within thirty days of discovery of additional assets. 3.1 Original and 2 Copies and 2 RCRI-34,Under $10,000;1 Original and 2 Copies and 2 RCRI-33, Over $10,000,including Copy of Will;1 Original and 3 Copies and 2 RCRI-33,Over $50,000,in- cluding Copy of Will and copy of Federal Estate Tax R,eturn. REFERENCE FOR ADDITIONAL COPY Act of 1947 P.L.513 Sec.·5.2,72 P.S.4844.2 3Juueutnry uub .Appruiaemeut of the goods and chattels,rights and credits which were of L.~.J'Yl..~~$."~.P~.9~h .tate of ..~~.~.y.~.,.~.~~~".. Washington County,Pa.,taken and m~de in conformity with the above affidavit. DOLLARS CENTS PERSONALTY; Checking Account Ho.357-3584,le110n National Bank and Trust Company,Claysville Office,in the name of L.".Sampson REAL ESTATB: None. $3;901 32 None -.' 'lj ~~ .....;i 'Vd"O:J .....~"N,)J 'J NIH 5v;,\z '"\;i....511 if~\.:I 0 TilS!~3H ~c"'l'Corlil:'·.1 1"3St1H trl ;:.t I ;itrl~c;n '""i ~I ~i<:Jl Eh Oi ~PJ '1"4 ('""i_...(l It:Ul..!lit trl ;;:. .~~~~"'"U ,_.J ...;:l~.. \Q ......',