HomeMy WebLinkAbout80-00060
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RCC.~!1 ,4.13)..
COMMONWEAL TII OF PENNSYLVANIA
DEPARnlENT OF REVENUE
IIURE,\L1 OF COUNTY COLLECTIONS
*'
,_-.2 /- eo ~'L:
RESIDENT DECEOEHT
COUNTY OF
CtlHI'ERLJ\ND
IMPORT AHT,
rhi~ It.'tlIt1\ 1IIl1st he Cllltllllctcd in detail umJ filed in duplicate. wilh all aURched. With the Register of Wills of the
Cuunty \\III'!l' dCCl'dcnt resided; Return is due within nine nltllllhs "her dllte of dcuth. unless an extension is granted
h) till' St'\'u'wry 01 Ite,,:,clltlc. (Scr.:tilll1 iO.1 uf the Inheritance Rml Estate Tux Act uf tQ61.)
-- - -
I~ TilE \I,\'! TEl( OF Till' ESTATE OF
} AFFIOAYIT OF
XXKO'OOOX
A}q~K'~
DENEFICIARY
._.'__..____.GEORGILE~LEP.~
lr,TA'T1'- rul.L. ~M"L OF OF:CEOEf'.;Ti
Lol. of _____Cwnbecland..--.--
County
Stotn 01 ._,_.J'ennsylvania
Counly ol--,--Cwnber.lanil
} ."
ltXllOICGr
_---n- .TOHN-D LEll:S, L'anQUeiary
XOCl~O[I)eK 01 IhCl elfol., ollho abovo.nomod decedent being duly sworn, depo.. S ond saS
Ot.'ct,'dcnt l1h:d
Janllit):Y 2.
''-'ONTHl IOA.yl
, 19...EL{~iIlHIl:_~X:lW_KYo1!JKAI[-~)'JXMDflllllll'.}
IY EA.RI mfasta'.
-,ome and oddll~~~ (\1 olloT"t'Y or }
other authoriled roptes"rU(llivt! IQ ",110m
all correspondence !ihu"ltl. ..,I.
Georqe M _ Honek, 1\tt""T"n<>y-"t-T,,,W
N"i-i....n"l !,\,,"V Bnildin9- Mp.ch,mic!'lhnT"g. P".. 170<;<;
That as slu;h_.B,ene.ficiaJ:..y-#-dcponclll is familiar with the affairs of said estate and the properlY constituting
, XXXXX'XiKX:XlllXX<<lOI-X
(ht.: assets Ihl.:rCllf ~II\J their fair market \'alue.
That 011 Ihe time of death there was no safe deposit hox registered in decedent's individual name, or jointly with. or
as agcnt or ,leput)" of ,nolhcr. or in deccdent's individualnamc, wilh right of acccSS by another as agenl or deputy, with Ihe
CXCC111iul1 uf the roll(Jwill~: -
NAME AND ADDRESS OF BANK OR OTHER ltJST1TUTlON
IN WHICH DECEDENT. RENTED A S~FE DEPOSIT BOX
THIS SAFE oEP031T BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
.---N
Thin the contents of said safe deposit box or boxes arc itemized under Schedules
with the exception-of the following, for the reasons hereinafter set forth:
of this return,
Tint Schedule A allachcd hereto and made part hereor sets rorlh roily and in detail all the real properly
in the Commonwcalth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mOrlgage encnmbrances upon each parcel or real propert)' at Ihe date of death, giving Ihe amoonl slill doc al
death, nllmc of mortgagee, date, ratc of interest, and hook and page of record Ihereof. It also scts forth in the
columns providcd thercfmc the asscs!>ed valuation of each of said parcels, the estimated markct value thereof
as of date of death uf decedcnt.
That Sch.edulc B attached hereto and made part hereuf sets forth fully and in detail all personal property
whcresovcr silllilled owned hy the decedent at the time of death: all moncys left by the decedent at the time of
death. whelher in decedent's immediatc possessiun, stanc.ling to decedent's crcdit in banks of deposit, savings
banks, trust (~nmpanies, or othcr institutions, whether individually, or in trust for llny other person or persons
glVlIlg al,o separately the accrued interest thereon, if any, down 10 the last interesl day prior In decedcnt's
death in the case of savings banks, and to the date of decedenl's death in all othcr cases; all bonds, postal
savings, treasury certificates ur notes amI other evidencc of indebtedness of the United States to the de-
cedent: all nhligaliol1s, whether hy statute or agreement they ;Ire designated as tax free, of the United Slates,
or any ~tate. or political suhdivision thereof. or of any foreign country, which arc owned at the time of death;
.il: .....Hill!: 'lp\hlL"ci. jl.:\H.:il), :.iln.:I\\.Hc, l'iclUrcs. hooks, wmks of art, household furniture, horses, carriages,
i1utomohiks. hoats. and ,lilY ilnt! all otlu.:r Ilcrsn1\al chattels of whatsocvcr. kind or nature. left by decedent,
together with the fairly estimated market valnc thcrcof: all honds and mortgages held by deccdcnl and nf all
cli\ims dlle ami owing deccdcnt at the time of lIcalh. and all promissory noteS or other instruments in writing
fur the paymt:nt (If 1111111C)' of whkh dcccdetll died possesscd, of whaISUC\'Cr nature. with interest thereon, if
any. gi\ill~ the face valllc and estimated fair market value therenf, and if such estimated fair market value be
less than thc face value. it sets forth hriefly Ihe reasons for such deflreciation as to each item; all moneys
payable to thc estate from life insurance polil"ics carried hy decedent; al1 annuity and endowment contracts
lhe pruceeds of whit.:h WlH .1ayahle upon the death of the decedent: all and the corporate stocks and dividends
due lhcrcon anti unpaill a.., fir lh~ dale Ilf dealh. honds and accrued interest thereon to the date of decedent's
death .\lulnther illH'stml'nt ~;;,(<O ::i,"; emned hy the decedent at the time of death. with the market \'alue thcre-
of at slIt.:h lilllt.:.
-c::SJ~-,..t/ ./~/1.~ ~'J, /''/:ic
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In tho (lt18C of securities of close or frunll)' cOfl'oflltlons, lhp VAluos roported are itS t'ar as
pos~lhlu subsLflntlntcd b~' financial statements of' the corporations, sho'i'iln~ the ussels nod ltah1l1t1cs
thereof as of the dftte of death. The schedule also solS forth the lnlerost of' ctoct!dcnt at the time of
death In an~' co-partnorship or business, und In support of the \'nluo of stich tnterp.sl thert'! Is annexed to
said schedule, financial statements showing thcassets Rnd Ihhllittns of' sl\llI co-partnership or huslness.
A eop~' of th~ co-partnership agreement, (if ofal, 8 stRtl~menl setting forth the ntllllf(> of tlie rlgreement)
together with 8 statemont settln~ forth the Chllrrlcter of Uw bllslnp.ss, tts lOCAtion, nlld such other fuets
;'lertl\ining to the business 88 ma~' be pertinent to t\ f,dr nnd just npprulsltl of tll~ decedent's interest
therein mnstbesubmtttp.d. It should nlso set forth in Itemized form, to~ether .....ith the fair market value
thereof, an)' other property owned or bequeathed b~' the declJdent at the time of oOllth.
The Schedule C attached hereto and mnde 118rt hereof sets forth 1I true nnswer to each inquiry
contained therein and in the case of transfers of property, real or personal, within two ~'enrs 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 ann value of such propert~', to whom trnnsferred, the
relationship of the transferees to tho decedent, the proportionate share received by ench transferee and
all other facts of a pertinent nature regarding said transfers. In the case of trnnsfers intended to
take effect in possession or enjo)'lTIcnt at or after death, there is also nttachert to the schedule a COllY
of the deed, trust agreement or other instrument creating the trust. Therl~ is also set fort.h In said
schedule a list of all propert~., real and personal, with its value, which pa!-;ses at rlec~dentts death by
virtue of the exercise by decedent, either indlvidu8Il~', orjoinLly with another, or any power of nppoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrument. of another,
with a copy of the instrum.ent creating such power attached to the schedule.
That Schedule 0 attached hereto and made pnrt hereof sets forth the nfl.mes Rno. addresses of Rll
persons beneficially interested in this estate at the time of decedent's death, the nflture of their res-
pective interests, their relationship, if any, to the decedent, together wit.h the ages at the time of
decedent's death of dl minors, annuitants and beneficiaries for life unoer rleccdent's W111. It also
contains a statement showing which of the benefic18ries nomed in tho rtecedent's will, if any, died prior
to decedent, the dates of their death, their issue, lUld the relationship of such issue to the beneficiary.
That Sc/'ledule E attached hereto and made a pRrt hereof sets forth all propl.!rty, real nnd per-
sonal, owned by the decedent jointly with another or others, including intangible, stnndinJ; in the name
of the decedent and others, plus the date and place of record of Instrlooents effecting the vestiture of
real estate and the date of ecqulsition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Scf1edule F attached hereto and made a part hereof sets forth rull~' and in detail all debts
and deductions claimed for and on behalf of this decedentt s estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees nnd rurllciary' 5
comissions paid or to be paid; cost expended for burial trusts, tombstones or gravemnrkers, and reli-
gious services, in consequence of the death of the decedent; debts and cl alms owing a",\ unpaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those ullov.'ed under Section
651 of the Inheritance and Estate Tax Act); together with n statement of collatoral pledgeft for obliga-
tions, if any. It is agreed that the fiduciary will present proof of suid claimed obl1gntions upon re-
quest, that 11 the amount actually pnid in settlement of /lny fee, commission or debt Is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of W11ls, and that
the amount of tax assessed cnn be reassessed in accordllnce therewi tho
That the totals of the appropriate columns In Schertules "A", "B", "e", "E", nnd "F" uS directed therein,
have been carried forward and properly registered in the Summflry.
Subscribed and sworn to before me this .................................
..................$.&1.... day of .~:O./...:T.'...... 19...!l..9.
.......................~t~~1'{'~' .,.. "....'"........
My Commiss~on Expires: ,!?y,"~1 /~ dJ'.?
: ," /.
,..,..'.'..(i;>.t~~~.efIclaiy
~j /-
.... ..,.108.,..\.loodland....Dxi:lle................................._.
(Street Number)
,Mechanicsbur,g: I ...12 a',I ....1.70,5,5...........
(City M Town and State)
SOTE: Before sig,ninS!; flff'idnvit make sure n1l hlank spnces In the ,tf'fldR\'lt /II1f1 schellllles nnnexed nre
filled In with detulls or the word "Sane", and In cnse the nsset.s include rure ttl1d unllst.ecl securities,
securities of close or family corporlltlons or Il.tl inU~rl!st In nn).' co_pllrtnershlp or huslness, thnt the
nata Rnd stRtements required under the llRruArllph ul)o\'o rf'!lnttnp; tn Schedule "n" llrl~ nt.tnch~d. ,\lso make
certu1n that column #1 in the "Sunvnnr)'" hILS he en prtlperl~' compl'~t.ed us Ilho\'e-fllrf'!ct.efl.
RC C-U H.-HI
tOMMONWEAL TH OF PENNSYLVANIA
DEP'ARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITAIICE TAX
RESIDENT DEr:I!Df:NT
SCHEDULE "A"
REAL PROPERTY
*
Real property in Pennsylvania, with statement of mortgoge encumbronces upon eacb parcel at d~ath of dece-
dent. Property held by the decedent os tenant in common with another or ather, should be identified
os to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held os joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvonla should bo (1) (2) (3\
ducrlbed bV lot and block number, str.ot and stroot numb.r, together with OEPARTMENT
o general description of the property, with a ref.rence to the record of the ASSESSEO VALUE VALUATION
conveyann by which tlte decedent tnok Iltlo; If a farm stato number of o. FOR YEAR OF ESTIMATED CAUTION
crel; aha statement of mortgage encumbrances upon each parcel at death OECEOENT'S MARKET VALUE (Do not wrlto
of decedent. Tax.s, aueuments, accrued Intore.t on mortgoges, otc.,ar. OEATH In thl. apaco)
to be II.ted an SchedulellF" and mUlt not be deducted from thl. schedule.
NONE NONE
Insert this total opposite "real propc>ly", Schedule" A" in the X X X X X
"As Reported" column on the lost poge of this return.
NONE
N6 .....u
-&vfC
~cc'~;<;;
~.~~.
.~..
.TI1. t\
J:;'.:%!:!.;;
r.0l1\10NWK\I.1'1I GI' PENN5YI,VWIA
TIIANSl,l,1l IN1I1':I\lT.\NCE T.I"
SCIIEIll'IY "H"
l'EllSII~:,\I. IlllllllElnr
ISSTllUCTIOSS: This Schc,llll" mllst dlsclos', 1111 "Ul~II.I" 1llIlIIuu.u,\lhl" 1"'rs,,,,"1 I'rol'"rl, nw,,,.,1 'u,lIvl<lolIll,
h)' tho IIocedeut, lit th" U"," or hIs d,,,,th. I'rnl'"rt, nwu",1 '" th" ,1,'c,',I"u\. .Iolutl)' wI Ih IIlto\.h"r or o\.h'",s
mltst he lIstClIIlItlI"" Sche,lol" "1'". Intlln~lhl" l'"rson,,1 I'rol,,"'tl', lI\.lc,1 In Ih,' Itll"'" or U", ""c,,,I,,,,", III.l
I'")'"hl" lit .Io,"th \.0 IInnther or nth"rs, Incl",Un~ loll\. Ilo\. Ilml \.,,<1 \.0 1'.0.11. \1. S. SlIvlu~s n..."ls IIn,J \."U\.II-
tlve trlls\. uccoon\.s, must he Ilste<l. "')Sl'lt" th" 1'11"1. U'"\. 1.\".l' cr" uot. nt. \.h" 1I,lmlnlst".."II "st"..".
Tlln~lhle I'ersonlll I'rol'"rty sh"ltl>! h" lIst"" nr<;t. ("'~' .I,....lry, wCllrln~ "1'1"",,,1, holtsehol.1
I~Ol)(ls, 111111 furnishl n~s, hooks, I'll tnt tugs, Ul1tomnhll f'S, holt l5, etc.)
Ilttlln~lhl" I'ersonnl I'rol'"rty, sitch liS ho,uls, trcIISIlt.l' cel.tll"lcnl"s, cllsh ou hunll unll In hllnk,
st.ockS, mor\.guges, notos. t.oget.holl' wIth IIccrued Int.erest or ,lIvlllends, slllllrles or wIIges, InsllClutCe pal'-
nhle Lo Lho eS\.IILe or fl.lltelllry In 5111<1 ell'"cHl', l'"rLnerShll' lnL<!reSIS, InLerest In IInyun<llst.rlbut.ell
estllt.e or or Income rro'" IIny prol'ert.). helll In trust. lII11l"r \.h" will or ,,~rcemeut. 01' IInot.her, even t.hou~h
located out.sl.le 01' 1.1", St.llt.e, lit. t.he \.Ime 01' ,Iellt.h, should I'" 11sLo..1 In thIs sehellule.
HESllIENT IlECEIlENT
-
DEP,\1\TME~"T V AI.UATIOK
(Do not write In
t.his space)
item
NO,
ITlill
l.ist. nnll descrlhe t'1I11~'
!INIT
rAt.U~
ESTIll.\TrJl
.IlAIlKh'r V,\LUI,
NONE
NONE
\
Insert this totul oppo5it~ "Personal Property", Schedule "B" in
the "As l\cpnrtcd" column on the last page of this return.
x X
NONE
lilJnU
.-llp1(
'.
RCC-3b
COMMOSWEALTII OF I'ESNSYINANIA
TIlANSEEII INIIEI\ITANCE TAX
SClWIlI'I.I': "r"
Tn \~o..:FEHS
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.&~. ~
I;",~/
~~.t~JJrf;l)
I\ESIIlEST IlECEIlEXT
(1) Old dt~C(Hhmt, wit.hl" t.\\'O ~'I!nrS ul'clf'ut.h, Ill/lk.' 1111)' t."/lIIsl'('I' III' /IllY 1lI111.(~rllll purl nf his ,'stllll', ",'Illlnllt
reech'ing II \'ullluhlc 1II111 mlcllulltc ctlnsl(h~rllt.lult thl'rld'ur" (i\ns""I!r )'es ur 111)) Yes
(2) IIld docoolenl., wi I.hln Iwo y'''''rs 01' .1""lh, I.rnnsf','r I,rol",rl.)" f'rom hlms,,1 r 1.0 hlms..1 r "n,1 "not.h"r or
others (lnclllcttnp; II spouse) In .10Inl. nWlll!rsldp? L\nsvil'r y"s Of TlU) Nn
(3) It' the nnswer to (1) or (:.!) nhove Is III lilt! Ill'f'lrlllnt.t\'f~ slut.l!:
(n) A~c of ctecC!llcnt ltt Ume nf lrlll1sl'l!r 82
(b) St.ule or decedent's hClllth Ill. time ul' muklnJ; Ull~ lrllllsl'er. (~ntl! 1).
(el CUlIse of' IIccp.cltmtl s df!Uth. (SolI! O.
(4) Did decedent, in his 11 retlme, muke lln~' tr8T1sf'f~r of' Jlrollf~rt.~' without recl!lvln~ It vlllullhll! (II' ufh'lIl1ut.n
considernllon therel'or which was t.o t.ukc et'feet In possession ur en.loymt!nt III or uf'tcr his death"
(Answer yes or no) Yp.~
(n) Wus there /loy Jlossibillty thllt the property tr/lnSl'l!rred might return to lrnnsfl!rer or his
estate or he suhJect to his pOIll'(!r of tliSllosltlon? (AnSWI!r ~'es or no) V(:j~
(h) WIUlt wns tile trul\sfereel s UgH ut UmH nf' tll!Cellentls clcllth? R4
(5) Did decedent In his lifetime mak(! /lny trllnsf'er without. receiving 11 vlllunllle Imd {ute'lllute constderntlon
therefor under which t.rllnsferor ex-pressly or Impliedly reserves for his Jlfe or nny l'(!rJOIl which docs
not In fuct end before his denth:
(a) 'l'he possession or enJoyment of or the right to income from thl' property transferred?
(Answer ~'I!S or no) Yes
(b) The right. to designnte the persons WllO 5hl11 J possess or en.1oy the property transferrell or
income t.herefrom? (Answer yes or no) Vt3Q
(0) If the answer to (5) (Ii) ubove is in the affirmativc, stnte whether t.he right was reservert In decedent
alone or others np~pn,:lni- ~, nnp
(7) Did decertent in his lifetime make a transfer, the consideration for which WllS transfereet s promise to
pay income to or for thc benefit of care of trllnsferor? (Answer yes or no) Nn
(8) Did decedent, at any time, trnnsfer property, the beneficial en.loyment of which was sub.lect to change,
because of Il reservelt power to al ter, nmend, or revoke, or which c01l1d revert to decedent under terms
of transfer or by operatIon of law? (Answer yes or no) y~s
(9) If the anSwer to (8) above is in the afrtrmntlve, was the power to Idt.er, nmend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent nnd others?
(Answer yes or no) Yp,!=;
NOTE 1: The anSwers to these questions should be sUJlPorterl by affidavit by the nttenlllng llhysJclnn as
well as n copy of the rlenth certificate.
NOTE 2: If answer to any of the above questions Is yes, set forth below n description of the property
transferred, it's fair mllrket value at dnte of death, dotes of trnl1sfers nnd to whom transferred, wlth
relationship of transferees to decedent, if nny. Submlt copy of Iln~' trust deed or instrumcnt, Lt' trans-
fers are claimed to be non-tnxnble, also submit detuilerl st.atement of facts on which sllid cla1m 1s bllsed.
NOTE 3: List applicable property below In manner in which provided in Schedules 1\, il, or E.
ITEII
DESCRIPTION
IWlKET VALUE
(Estimated)
IIF..l'T. VAI.lJATION
(Dept. Only)
1.
certificate of Deposit *14-2750r
Commonwealth National Bank, dated
March 7, 1978, in the sum of $12,000.00,
in the name of George E. Leesr in Trust
for John D. Lees:
12,000.00
Accrued interest thereon to date of
death:
62.99
Insert this t.otal opposite "Trul1sfers", Schedule "C" in t.he
"As Ileported" column on the lnst. pfl~C of this return.
12,062.99
II/~ 0(,:<, J1
..{/fYL
'RCC.- 3'7 (~2-6 3)
rOmlll:-;WEAI.TII OF I'E:\:\S\"\"I.A:\IA
TIIANSFEH II<'IIEIlITA:\CE TA:\
H~:SIlJENT llECEllE:\T
SCIII.:nn.l': 'W'
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t~'1(~, ~
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111111' ~,
ll",/':~;-~"',:;J
.):..........;V..'~.,<~4
IIE:\EFICIAl\IES
BE 'E~ICl \RIES \"D \111111'S'L'S f HEI.ATlONSIIII'
.N l' I. I I' I l '.. ~r. Of st('p.d1l1drell llr I
lSlRt~ t utI mLl':H':i anti ulldn.:;;ses 01 IlIl \\110 illc~itl1tmtc childrt~n ~
hll\'l~ nn intC'rest. \'CSll'd. contint:enl. or other Me ill\'uln'd, set :
wise. in c!itall') I forth this facl.l ~
SUIIVIVED I
DECEIlI'XI' I
STAn: YES I
UII:\O I
II.IT!':
OF
IIlllTII
I:\TEHEST OF
BENEFICIAllY
I" ESTATE
Estate
,Tnhn D. Le
108 Woodland Drive.
Mp.chanicsburg.
7055
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Bp.l'oncnt rurlhcr SIlYS that ul) the uhove-TluJne(\ hencficillrles Ilre ] ivln.l; III t.hts time except helow:
I DATE OF DEATII
I
I
I
NA~tE
HESIDENCE
..
o .
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.. ..
..
u:;: c
'c cu E
"s ~.E
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a:. o.
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-...~
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i: ::l 0
"eo.
I>l "
~ 0:
SUMMARY
(Seh. "A")
...(Seh. "B")
.. (Seh. "C")
.. (S.ch . .~'.E .'.')
Heal Property . .. ...... ......
Personal Properl)" ......
Transfers
J:o;intly QWMtll'roperty.
Gross Taxable Estate.
l- ""
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oS ... ..l
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t.l ," Ii '"
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- <
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~ t>. ~. .Q 't) 'S ""
p.., 0 Ul ~ '" ""
"" 0 ..::
!:! -< !:! u:l ..-1 M ,.. <
;:: u:l ;:: ~ I'l l': \.I S Q
0 ~ :I: "- III Q) ::; Z
0 ~. .r: 11 <
Z t- O '"
t>. u:l Q) :3 ~ I-
~ 0 0 :a: u 0 CII:
c ~ r.< - 0
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b 0 S
~ -< ~
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'is ..... ~
.- - c U
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...-<:
(I)
(As Hcpnrlcd)
$ . None
$ ....None.
$12,062.9.9
$. Hone
$.. .
$..1::1. ,06 2. 99.
(2)
(As Determhl<'d)
$
$
$
$
$
$
R~C.lll. ..
*
COMMONWEALTII OF I'E~NSYLV^NI,\
TRANSFER INIIERITANCE TAX
SCIIEIlIJLE .. E"
JOINTLY O\\'NEllI'IWI'ERT\"
RESIDENT DECEDENT
lNSTIUJCT10NS: Tll I s sc:tll'llllll.' mils l. disc I (lse nil urupl.'rl.)', n.nl IUl11 1"!I'SlJll:ll, oWII.~cl hy the 11(!1~1!llent. .loIn 11 y
with Illlother or uthers, 1111:1 till IliA Int.llIl~lhlf!s, stllndlng III till! II/WI" Ill' the ctl~CClt.Hlt ullet othnrs. List
rl.'al ('stilI(' first. us elltlrl'ttcs, or Joint tl!llltnt.s, AlYIIlJ; hrlct' cll:serlpt.lon, us 11Idlcutl~11 lUlltf!r SClll!dule
"A", 11lus Uw clul.c ulld Illncc Clt' rOI~ortl nl' inst.rtunl'nt. ~I'f'!l:tlllg; vcstll.lll'f!, hut ,In not Include entireties
or tH':. 01' slatl~ rl~1l1 l!st.nte yuille In eslllt.o yn)uutlon cul"mn. p.!rsonnl llrollcrty ~hClUlll he liste,1 itS in
Schclllllc "U", pIttS dIll.. 0(' ncclulsltlon, 11I111 the lllun'~, ,ulclrc'ss 1t",1 rf!111tlotlsh1ll (I (' UIIY) of' co-owners to
the dcccch'nt
Description of' Prnllor t)', nntt~ of' Acquisition, Slime 1.:l1it pI! rct!n tll~e l~st.ItU~ DrJ'AlITI.IENT VAWATlOS
Address rout Hcllltlonshlp of C()~O\'illCrS, /lllcl PI nee Vulue Shnrn V nl HI1 t Ion CAUTION-Do not Write
of Hecofli of Instrument, where Henl Est.nte. In This Spncl.!.
<> , M ~. IW ~ ~ .?I
~ 0 0 0< '/. .. Vnluo of Value of
M xs: N<: ~0 .. . EnUre Decede" t' s
M/. >00 proJlorty Interest
NONE NONE
Insert this Lotul opposite ".Jotntly Olnlcd Propert~'", SetlcliuIc "E" N.&->1.U
NONE
III the ".\5 He lflrt.ell" coiurDl on the lust 11I1~,f~ of thl s return.
~.f'<j11t
REV-U.4 la-781
County, Number and Nome 21
21-80-0060
01/02/80
- Cumberland
SUMMARY
File Number
Do Ie of Death
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIOENT OECEDENT
Estate Name
LEES,
(LAST NAME)
Geo r ge
(FIRST NAME)
E.
tlNlllALI
REPORT OF INHERIT ANCE TAX APPRAISER
Cumberland
I, the unda"igned duly appointed Inheritonce Tax Apprai.er in ond for the County of
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 lIA", ItB", "Cu, and IIE".
Doted:
March 6, 1980
/&I;~-'r/J I /Plflft,.,J )
INHERITA.NCE TAX APPRAISER
REPORT OF THE REGISTER OF WillS
I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respoct-
fully report that I have allowed deducfion!lo 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.
Daled:
REGISTER OF WILLS
INVENTORV
Re:sl Property ISchedule A)
Personal Property (Schedule B)
Joint-Held Property (Schedule E)
Transfers (Schedule C)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE FI
CLEAR VALUE OF ESTATE
VALUE AS APPRAISED
S None
None
None
12 062 99
12 062 99
.\DJUSTMENTS
ODE (HARRISBURG USE ONL VI
00+
10+
20+
30+
REMAINDER APPRAISEMENT CODE
92+
40-
Valuation of life estates or ...
annultles.....................== $
PRINCIPLE
FACTOR
VALUE
ESTATE TAX ASSESSMENTS _ S
1=
~
FOR USE OF REGISTER ONL.Y
Tax on $
Tax an $
Tax on $
Tax on S
Tax on $
Exemptions
Total Estate
~
COMPUTATiON OF TAX
2%
6%
$
$
$
$
S
15%
.
(-) As evldenc~d by Charitable
Exemption Certificates Issued
by the Secretary of Rovenuo.
TOTAL TAX
s
Less tax previously paid
BALANCE
Less 5% of lax if paid within
3 months ofter doath
$
S
t=
s
BALANCE OF INHERITANCE TAX DUE
Add Interest at rate of 6% from
10
AMOUNT OF ESTATE TAX ASSESSEO
Estate tax paid
s I-
S
$
$
$
$
s
s
c
BALANCE OUE
Add interest at rate of 6% from
10
TOTAL TAX BALANCE
PAlO
Supplemento\ Code., (FOR USE IN HARRISBURG ONl Y)
48-Ad;uslment
49+Adfustment
56-Annuity
6O-lile Edote
92+Remoinder Appraisol
93-Remoinder Deduction
93C-Charity
94-Remainder Re.iduo
96-Successive
Life Estate
FOR USE OF REGISTER ONLY
ADJUSTMENTS
HOTE: Where subsequent adiustments are made to the above computation of tax by the Register of Wills, for proper reason
same should be noted below, with short explanaHon. '
93-
~
~
I E- ...l
Z ." <:
~ tol u !!l
.
" ::E . <:
" .
.... tol u "
.
ell '" ~
I < Cl.
" " <:
~ u. 'c 0
~ "
0 .. z
!!! <: !!! - <:
tol ...
1= !:!:l 1= E- '" E-
O '"
~ ... '" <: '" "
Z E- O E- CJ 0
U. ell ~ Cl.
0 tol .... tol
~ 0 "
" ..c:
.~ tol -
- E- ;;
OS E- CJ
~ .... '"
- <: 0
'" :2 .... c
'c 0 ... g
-
.- CJ '"
=E - ;> E
'--0 " 0 0
==<: ...l U U
-REV-457 (8.78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
~larch 6, 1980
Cumberland
21-8U-UlJbO
OATE
COUNTY
FILE NO.
Whereas, George E. Lees late of Hechanicsburg
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 2nd day of Jaauary 19~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Gloria J. Richard . 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 aanuities and life estates growing out of said estate, hereby file the following appraisement:
I n tho event that any future InteroU in Illls ost..to is 1f.JlIsferrod In posses..lon Of enjoyment to colllllor.11 heirs of the decedent ,lftcr tho explratlon
01 af'lY estate for life or for yeals, the Commonwealth hereby expressly reselves Ihl! rlglll to appraise and ,luess transfor Inheritance to1lt.CS 011 tho lawful ',Il.lter.ll
rate on any such futUle Int.uest
DESCRIPTION OF ASSET UNIT APpr.,lsement
VAl.UES Mo1de 101 Inllclitance
Tal': Purposes
Real Prooertv s None
Personal Property None
Joint-Held Property None
Transfers 12,062 9
GROSS ASSETS 12,062 99
,
Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity
with the law on this 6th day of March 19 80 .
P//~.'f:llJ II?Pt'JUJ"II)
APpraiser
(Number and Street)
Harrisburg
(Post OHicel
. Penna.
.. . . ..
0:
00:
0-
"t:l N: ....
'"
:>, I- ~ \D~ W
- Z .....: :l
5 w <.l 0: \0: 2:
:E Q) .....:
(3 Q 00: M~ W .:
w "': >
'" M: 0: N~ .: a;
<i w e:
.. ~: a: "ti Q) ~
a: N~ ~ l
0.. ",: OIl, ~ u.. Q) '"
0.. <<l: ": ~~ 0 > '" .~
<t <<l: ": ~ Q)' ~ 'iij
X Hj .0: Ill: t.J vi I- a Q. '"
I ; ~ '0 '0 "': ": !;:: 2: ~ ii
~~ u: <=: (3 Q)' w '" Q.
(J""" Q) ....: - '" "t:l
Q) Ill: Q) :iE E
~~1 w - <<l; - c:: ~, -'< ,'" ::l "t:l e:
c..> ~ '" Ill: U'\: "t:l l- e: 0 '"
z ~ '-'; >-l .c: 8 ... '" ::l
.....: 0\: Q) ~ a: 0 <l:: 1l
I '" ~ ~, u: Q N~ ;;; ~ <l: "t:l .0
OJ: .... ~
Ql. <<l: :>::; 's, a.. "ti Q) '" ill
'- ~j ..... e:
a: '-'1 .<:: e: Q) 0 w ~ 's Q) 2:
w - Q) a::: 0 0 til
'" ~ .. .~
'1 u~ :I: Q) .S e: '" ~ '"
. . z Q ::l ill
.!Q 0 <ll
I- '0 '" ~ 1l ~ a:::
z Q) a G:
w - ~ ~
c is
iii
w
a:
INFORMATION
To insure proper credit to your account. the name of tho estate and file number should be clearly print.
ed on the check or money order.
This assessment is made in accordance with Section 708 of the Inheritance and Estate Tax Act of
1961 (72 P.S. ~ 2485.708).
To the extent that inheritance tax is paid within three (3) months aher tho death of the decedent. a
discount of five (5) percent is ellowed (72 P.S. \ 2485-716).
Inherilance Tax, other than tax on a future interest. is due at the date of the decedent's death and becomes
delinquent 8t the expiration of nine (9) months after the decedent's death (72 P.S. 9 2485.711). Inheritance
Tax on 8 future interest is payable within three (3) months after the transfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. ~ 2485.712). Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using tho following interest table:
------------ --------- ---------- ------- --------- - - --- - ------------- -- -- - -- --
1 month .005 4 months .020 7 months .035 10 months .050
2 months .010 5 months .025 8 months .040 11 months .055
3 months .015 6 months .030 9 months .045 12 months .060
1 days .000 17 11 days .00186 21 days .00352
2 deys .00034 12 days .00203 22 days .00369
3 days .00051 13 days .00220 23 days .00386
4 deys .00088 14 days .00237 24 days .00403
5 deys .00085 15 days .00250 25 days .00420
6 days .00101 16 days .00267 26 days .00437
7 days .00'18 17 days .00284 27 days .00454
8 deys .00135 18 days .00301 28 days .00471
9 deys .00152 19 days .00318 29 days .00488
10 deys .00169 20 days .00335 30 days .00500
Any party in interest. including the Commonwealth and tho personal representative. not satisfied with
the assessment may object thereto within sixly (GOI days alter receipt of this N01ice 85 provided by Section
1001 of the Inheritance and Estate Tax Act of 1961172 P.S. ~ 2485.1001).
Make check or money order payable to:
"Register of Wills. Agent"
Mail 10 Ihe address listed below:
,<~ / 'u .S .::>,.,~
DEDUCTIDNS ALLDWED IN
REV-U& u-n)
THESUMO~ s...:L.191 00
,D~Tf APPfO~EO"'-\)l 0-, I~
tJ.J(f.,1 ~,q 1<, ro>h....\J..
i...(' .--..... Rl!GISTEP Of" WILLS, '.UtNT
1-0,.C "
OFFICE DF THE
REGISTER DF WILLS
STATEMENT OF DEBTS
AND DEDUCTIONS
OF Cumberland COUNTY
AND AGENT OF THE COMMONWEALTH
.f .
,.1. I L f
(j >,',')
ESTA TE OF GEORGE E. LEES
LA TE OF --lmCIl]l;HCRBTlRG. PE;!NSYLVAHIA
DATE OF FILING APPRAISEMENT MlIR('H (; 1ClRO DATE OF DEATH
Jl'.imllRY 2 19 RO
. nu .
, I
NO. OF NAME OF PAYEE nEMARKS AMOUNT
DATE VOUCHER
Reaister of I-rills T."'" ('nc:rc: ,; nn
M ... .~, llnmp E.uneri11 P'xneIillec: 7<17 00
J'u:al~1 ~pn;o"'" r;i.i'7.(,:l.l"'l~t -
Pnm~ ,,~, , __ n.._ ann 00
U~~~;~h..~" u_~_;..~, n_' "n-- ';-~" ..-, ". .- ,nn Inn
-
- Mo"o~~ M. n P.:1'''"-- "p_'; -~, TC'~--~-~ ,;n nn
I.' ~ ,,~"..;-- .~ ,~ 1>00 ?nn' nn
. . .
Pennsvlvania Deoart~o" j-
of R 1979 I""'om" 'I':1X '8 00
1'_-" -." >----, .'--- Iv_" .- ?,n Inn
-
-
- .
.. . -
. J
COMMONWEAL TH OP PENNSYLVANIA \
5S:
COU N TY 0 F --.Clll!lb.eJ:lanlL-
I, .J..QIJ~l D. LEES, HEREBY CERTIFY, THAT TOTHEBESTOF
MY KNOWLEDGE AND BELIEF, THE FOREGOING IS A JUST ANO TRUE STATEMENT OF OEBTS, FUNERAL EXPENSES AND
EXPENSES OF ADMINISTRATION SUBMlnEO TO THE ESTATE OF r."p.rmr.p P T.TCTC<::,
DECEASED, AS DEDUCTIONS FOR INHERITANCE TAX PURPOSES, f". . t 1)., !
___-~ ~ -=';:-\"'0"'_'
"
SWORN ANO SUBSCRIBED BEFORE ME THIS 12th DAY OF
.Mar('h.. ;' 19...B.lL
oj'), :;,~: ;~~ic
My Commission Expires Auqust 11, 1983
(L.S.)
-
=uJl
;~!fi~]i~\:~t;:':','COpjIMONWEAL"H OF PENNSYLVANIA .'
Oal'I'28:V':<'::~";'> '. ."', DEPARTMENTOFREVENUE . . ,
: }~~~~,\~:~:,:if~~:I~IAL~ECEI~T. PENNSYLV~N~~~NHE~I~~_NCEAND ESTATE TAX
I
; RECEIVED
II
; From,
~ ;ddre..
U
~ File No.
_____________PTUR U1~Dwn
A I'lM'V -TWt" 51
70/100_____________________.Hllors
rep;csenting Pennsylvania Inheritance or
Estate Tax due from the following estate:
G.O~. M.. HOuak, B.q "-
(John Lee.)
Second National Bank Bldq.
2~ 10, on
s
s
17055
6% Tax on
s
s
Mechanic.burg, Pa.
s
Dole of Death 1-2-1980
s
15'jt, Tax on
21-80-60
I
s
M.u""h 1 2 , 1 9BO
% 10. on S
Estate 1mc, Act of
Moy 7, 1927
s
Dole of Payment
Name of Decedent
GEORGE E" LF.RS
County Cumberland
s
'iQ2_~2
TOTAL TAX CREDIT
less five percentum of tax if
paid wilhln three months afler
dole of death
Plus interest at the rote of
_9'Clfrom
to
Remarks:
29.62
S
.PAID IN PULL"
s
IYOO~[P[L~@&IY~ 5 E A l
562,,70
TOTAL AMOUNT PAID
s
NOTE: Thi, Tripl:cal' Receipt to be retained for audit purpo....
't4_J".,: ;~~~; j("I~
Haro ~\J,!~r eLane, D ut.y
Reqi.~.r of Willa
(Tille)
t
Received by
NOTE: In occepllng the Iron"., inherilance lOll on fulure I!"tal.'. prior 10 the death ollne lile
'enonl or lenanl for years. as IIvldenced by this rllceipt, iI Is understood Ihal Ihe Commonwealth sholl
not b. precluded or preyented hom he'lIoltef auening addillonal Inh.rllance lOll ollne dealh ollhe
III. tenont or 'enont for yean wheneyer II appears thol luch oddiliono!tall moy be legally due and
collectible for any reolon whol$ollver.
"
------------- -- ------- -- -- - - _._-~ -- - ------------ ---.--