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No. 21-80 497
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of
VIOLA K. MOFFITT.
, deceased.
To MARY C.
of Cumberland,
is
Petitioner(S:kme the executn,.
LEWIS
in the Commonwealth
, Register of Wills for the County
of Pennsylvania. (James R. Moffitt died
September 5, 1977)
named in the Last Will and
Testament of Viola A. Moffitt dated Julv 9. 1976
Decedent was a citizen of the United States and a resident of
Township
IiGII~, Cumberland County, Commonwealth
Silver Spring
of Pennsylvania.
Decedent died on Wednesday.
the
16th
day of
Ju1v
A. D. 19 80 , in the County of Cumberland I State of
I''''""''yl V,,"; " at the age of 79 years.
:ha5 RIllS he r
Decedent has not been married and has not had children born to mmc
since the execution of the above described Will.
Decedent was possessed of personal property to the value of
515 .000.00 and of real estate to the value of
540,000.00 as near as can be ascertained; said real
estate situated as follows 824 Nest Trind1e Road, Silver Sorinq
TnwnRh;p, ("nmh~T"l:1nn ~nnnt:y. Pennsylv~niA..
Xl:ppf~
Therefore, your petitionerlt;) respectfully appl ies for the probate
of the said Last Will and Testament and for Letters Testamentary thereon.
Dated Ju1v 23. 1980
Name and address a~~ J. h'f' ~'.d..
of Petitioner(s) /~
Rnh",,.~ ~ Mnrr;~~
?,n ~~~~ Mn~~h ~~~~~~
C",.l;s]." !>.,""sylvania. 17013
COMMONWEALTH OF PENNSYLVANIA f
ss
COUNTY OF CUMBERLAND
ROBF.RT J. MOFFITT.
named in above application, being duly sworn according to law
say(s) that the statements set forth in this petition are true to the
Sworn
h ;" knowledge and belief.
and subscribed before ~Z--;-,;! ::Jl/ td 'pC
-y;
best of
me July 2'L 19 80
,
~(1 /'1- {j. .j~e~~r
00;0
July 23, 1980
Attorney:
GEORGE M. HOUCK.~
LAST WILL AND TESTAMENT OF VIOLA A. MOFFITT
I, VIOLA A. MOFFITT, of the Township of Silver
Spring, county of Cumberland and State of Pennsylvania,
being of sound and disposing mind, memory and understand-
ing, do make, publish and declare this to be my Last Will
and Testament, hereby revoking and making void all former
Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and
funeral expenses as soon as conveniently may be after my
decease.
2.
All the rest, residue and remainder of my Estate,
real, personal and mixed, whatsoever and wheresoever situ-
ate, I give, devise and bequeath unto my beloved husband,
James R. Moffitt, to his own use and benefit absolutely.
3.
In the event, however, that my said husband should
predecease me, or as the result of a disaster common to both
of us, should die at about the same time as I die, I give,
devise and bequeath my Estate to my children, Robert J.
Moffitt, Viola E. Bender and John H. Moffitt.
4.
LASTLY, I nominate, constitute and appoint my hus-
band, James R. Moffitt, to be the Executor of this, my Last
will and Testament. If he should predecease me, or for any
other reason fail to qualify as such Executor, then I nomin-
ate, constitute and appoint my son, Robert J. Moffitt, to
be the Executor in his place and stead.
IN WITNESS WHEREOF, I have hereunto set my hand
and seal this 9th day of July, A. D. 1976.
QC,-,~. fZ. 7tl#';ht; (SEAL)
Signed, sealed, published and declared by the
above-named VIOLA A. MOFFITT, as and for her Last Will and
Testament, in the presence of us who .have hereunto sub-
scribed our names at her request as witnesses thereto, in
the presence of the said Testatrix and of each other.
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OATH OF SUBSCRIBING WITNESS
COMMONWEALTH OF PENNSYLV ANIA I 55:
COUNTY OF CUMBERLAND \
This...........................2.3X"d... ................................ day of ,...... .... ........J.ul~. ~...... ............. ... ........... A.D., 19S'O....,
Mary C. Lewis,
before me ~kZllCkixAmlIXD5HDC, Register for the Probale of Wills and granting letters of Administration
in and for said County of Cumberland, in the Commonwealth of Pennsylvania, personally came ..............
..................................l;l~9.R(1);:...W.,..JI9.U~............and.......... ......MA.RX...s A...ROIUNS.ON.,.................................
the subscribing witnesses to the foregoing instrument of writing purporting to be the last Will and
Testament of ........... .V.X9:t.l\... ..l\.,. .1IlQJ:'.r.;J;T.r...................................... .............. Dated ....Tuly... fJ. ~.. .19. .7.6...... ......
lateof...............::i.i.ll('!:.X"..Sp.r.iXlg...'!:QWI\sb.ip.,........................................ Cumberland County Pa., deceased
who being duly ..........lllotQrn...................... according to law, depose and say, that ...tb.~y...wex:e................
present, and saw and heard the testa:t.J:ix......................, ................Y.;!?.:h~...l.'!.~...t:~9.;.g.t:t:.......................
sign, seal, publish, pronounce and declare the said instrument of writing as and for h.eJ:.......... Testament
and Last Will, and at the time of so doing ................llh~..........................\Vas of sound and disposing mind
memory and understanding, to the best of ...........tb.~.ix:...................... pow ledge, obse~a/and belief.
.....m....m.~.'" ..d ~b=ibol b,f.re:'mm.. ~~'",::::'4""cLm
CJn /7 l' ........~.~J~L"'-=.a..............................
~:~~!...............................mmm....mmm.................m....m
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND \
................. ..................... ........................ BQ~);:.ro:...o7..,.. .~IRJi'.r. X:r.f........ .......... ......... ..... ........ ................ ..being duly
..................lllotQAXI,................. says that as nearly as can be ascertained the said decedent ..........................
..............................................................Y.lQ~JI...l\.,...~RJi'.r.;J;.o:r.J:...................................... ...........................died on
............W.e.dne.sday..,............. the ...............J./ii.tn........day of .................J.P.;!.y.,........................... A.D., 19..e.o..,
at or about ........................~.:.~R......... o'clock, ~.~M.
........................Jiw.QX"Il................and subscribed this
/1 / -d-,4 ~ J ~~'
.k!:.~'!.:~....../"~.......Z.Z~..................
..................~.3X"d.................... day of ..July..,...........
19, ~.Q...., before
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/'/<:, ,....'.....c....:; ..../
Ri~1~~.R~~i;rt~/.'...r......."................
Mary C. Lewis
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA}
COUNTY OF CUMBERLAND S8:
Before me, the Register for the Probate of Wills and granting of LclLers of Administration in and for
the County of Cumberland, personally came .............................m;..!,\!;;.\\T...l1.,...I19.f.fJTI.,...............................
who, being duly .......!'!W9.j:;p..........., do ~!'!...... depose and say that as ........!?~!!.9.':!J;.9.!::.....................................
of the last Will and Testament of ...............Y.lO'~..l'\..,...119.f.f..t:f.?'.....................................................deceased
...........JUL..... will well and truly administer the goods and chattels. rights and credits of said deceased
according to law. And also will diligently comply with the provisions of the law relating to Transfer
Inheritances. .....sw.Qm............ and subscribed
before me.
.......................J.ul:i...2.3.,............... A. D., 19BO........
..~t#:..~~mm....
Mary C. Lewis
-:2~~t:,t....t!(#~.................
..................................................................................
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DECREE
Be it remembered that on the ......23.:c:d......... day of ............J.ul:i.,.......................... A. D., 19 .ao..., there
was probated and recorded the last Will and Testament of ........Y.I9.~...~.~...!19.tf.I~.?;...............................,
late of ......Silvex..SpJ:ing...'!:ow.nsh.ip..................., Cumberland County, Pennsylvania, Deceased. Letters
.......:r~lOt.~~X\!;~~.................... were granted to ...........EQ~!'I.m:..i!.,...I1Qf..:f.*7.':r...........................................
Witness my hand and official seal the day and year aforesaid.
0)~;;tl-"~~
/i :kK I Regtster.
Mary C. Lewis
'*
.-;{ /f'{J-!c;l
RCC-B9
COllllON\\l.:ALTII lW I'ENNSYl.V AN I A
llopnrtmerltot'fievenue
ENTRY INTO SAFE nEPOS IT nox
TO RElIOVE A WILL OR CEMr.:'flmY nEED
;rlll~, .')1.. lCJ80
(nate of Entry)
1. Name of deceden t: ,t -~ t,1 ..
2. Address 'of decedent: :,' .-l~
3. Date of '~.l~l:: lS, 1<;- .'
death: v
.:.....,.."'i..;......:...
, :~sc::.;;Jllc~l)urb,
~.
~ ~~
, : 1'", ~ 1
;x,d
4. Name and address of person who requested the opening of the box: .o:.)-;,rt
;::-::"'i0 --:'~I~~ ~-o....,t:-.
~tI'~-;i~t ..
-., 1. i ~; 1. f).. ~ ':~
1'701:;
5. Name and address of the financlal instltution where the safe deposit box is
17055
i:offi tt
TA 17055
-'he 'lr;'J"~ ~>:_n~-: :.:.Ylcl -i_',~,U:~~;o. T......--.ill ,.,1"..(1 '.-'.:~-:""',--:'.'_t s - nc' 'mlC~')Ur"
'" _,,__ ..~ _ _ __ _ -:t.'., ::.... :1_ . <J: h,
located:
6. Number of box:
11",'0
7. Title under whlch box is registered: 'f; 01" '. . 'of -'1. ti;
8. Was there a will in the box? (Yes or No) '''''5
9. If yes, state date of will, name and address of personal representatJve, If
named in the will, and name and address of attorney, if any: .~',1 :' C'. I 1 C0'7D
....o.~):;:'t .-:. ::0f.fitt, 2.28 .:.ts:; ~'I':)rt~l -:;t~-:-;;,::.:~, ";::!'lisl.:=, :':... 17C13
And now thls :-'1 day of ',-1'
certlfy under penalty of perjury that the
to the best of my knowledge and belief.
J 1~ f"'fl , I hereby
above record is correct and complete
Signature
Prlnt Name and TJtle
~..
K_
a__ _______ ____.__ ____ ___~ -- - -. - u._ - - _. - -- --. - --- ---
...-..... -" --' =--- -.
~", RCC 4 (11/78/ . .
il't,:C,"".' ',.' . ..>COMMONWEALTH OF PENNSYLVANIA .
iIINO;;!.063358' . DEPARTMENT OF REVENUE .
=j;!;A~,\'..."\'" OFFicIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX,
If'.:"""';"" .c.,..,.
; RECE1VE~---------------TDN'l'Y-POtJR HtJNDRBD PORTY-FOUR &. 97/100-----------~s
H representing Pennsylvania Inherilance or
= om, Robert: J. Moffit.t Estole Tax due from Ihe following estate,
~ C/O hoXge M. BOuck, Bsq.
~ ~ress A~t'lnd ..tJnn.l Rank Rut ,t!~"9
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~ Fife No. 21-80-497
i Dote 01 Payment
MechanicabUJ:'Q.
Pa.
17055
Dole of Death 7-16-1980
A.p+~n.~ 2~, 1980
Name of Decedent
VIOLA A. MOrFITT
County ('!.",,"harland
Remarks:
.PAID 011I ACCOUNT"
I
'U'OO~[P[L~@&'U'~ SEAL
NOTE: This T,iplicate Receipt to be retained fo, audit purposes.
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2 'it Tax on
s
6lJcToxon
s
15'lc. Tax on
s
ex, Tax on S
Estate Tax, Act of
May 7, 1927
TOT AL TAX CREDIT
Less five percentum of tax if
paid within three months after
dole 01 death
Plus interest 01 the rote of
_%from
to
TOTAL AMOUNT PAID
v
Received by
NOTE; In accepting Ihe Ironller inherilonce 10l on fulure ellolel. prior 10 Ihe dealh of the lile
l~nonl or lenonl lor yearl. os evidenced by Ihil receipt. it iI undcHslood Ihol the Commonwealth Iholl
not be precluded or pre...enltld from her~alter oueuing additional inherilonCll IllI at the deo.h 01 the
Ill. lenonl or lenanl for yeon whene...er it oppeorl thaI luch additional '0. may be legally due arid
collectible for ony re050n wholloe...er.
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REV-'49 (8-78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
ReSIDEHT IJECEDEln
COUNTY OF _ Cm.lB1>RJ~}ll,m
IMPORT AHT:
__ n_
This rt:lurn "'UbI be complC'lcd in detail nnd rilet! in duphelllc, with allllllllchcd. wilh Ihe Register of Wills (If Ihe
Cuunty where decedent rc"hlcu; Rl.'lurn is dt.c within nine l11ul1lhs after diue of lIcath, unless an CXlcl1!'tiull is granted
by the SeCrelin)' lIf RC\lcnu~. (Sect inn 703 t)l till: Inlu~rilancc Bnd. EM31C Tux Act uf IQ61.)
IN TilE MATTER 01' TilE ESTATE OF
} AFFIDAVIT 01'
EXECUTOR
X\:OJdJNlS1:llXl.'OO
VTOT,n n Mnl""'T'l'')'
eSTATE FULL NAMF. OF DECEOENTl
Lale of
rnmh"'rl;m.d--_____
C.:Junty
Stato of P~nn.c;yl "~ni;'J
I
J os,
Executor
Counlyof Cumberllmil
"lIIHomlfJ{IX
ROEEllT..T MO".".T'l"r ,
of tho cllalo of tho ahoyeonomad decedent being duly sworn, dllpolO S
ond IOY S
Decedent died Jul V
{MONTHI
Hame and addro.. of attorney or }
-"her outhOflzed roproun'otlve '0 whom
all cerruiJondence should bo moiled.
J 6 19 no~ te.tetll loovlng a 10" will, copy of whieh is herelu o'taehed. }
IOkyl ~i'JO>>)O)O
Gp-n'-gp. 1\,' Hnt1~k _ 7H.-t-n,..n,oy-:ti- T'a~"
l'l~i:jt"lT't~' 'P,;:1nk n"ilni't''ll;J'. ~~of"'n:tni("~'h",.f). p~
] 7055
That as such Exe~ntor I-deponcnt is familiar with the affairs of said estate and the property constituting
I EXECUTOR--ACMINISTRATORl
the assets thereof and thdr hir markct value.
That at the time of death tht:re was no safe deposit box registered in deceJcnt9s indh:idual name, or jointly wilh, or
as agent or deputy of another, or in decedent's individual namc9 with right of &ccess by another as agent or deputy. with the
exception of the following: -
NAME AND ADDRES~ OF BANK OR OTHER INZTlTUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
o
~
-
That the contents of said safe deposit box or boxes are itemized under Schedules A & B>f this return,
with the exception of the following, for the reasons hereinafter set forth:
That Scheau/e A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pcmnsylvaniil of which decedent died having an interest therein. It also sets forth the
ntortgagc encumbrances upon each p~rccl of real property at the date of death, giving the amount still due at
death, name of mortgal)t:c, date, rate of intercst, and book and pagc of record thercof. It also sets forth in the
columns provided therefore the asscssed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B aUachcd. herein and made.:: part hereof sets forth fully and in detail all personal property
whercsover situato:d owned by the decedent at the time of death; all mon~ys left by the decedent at the time of
death, whether in dccedtmt's immediale po:-;session. standing to decedent's credit in banks of deposit, silvings
banks, trust companies, or other in~ilitutions, whether individually, or in trust for any other lJerson or persons
giving also separately the accrued int~rest thereon, if any, down to the last interest day prior to decedent's
death in the case of savings banks, and to the d~tc of decedent's death in all other cases; all bonds, postal
savings, treasury certificatt:s or notes and other evidence of indebtedness of the United States to (he de~
cedent; all obligations, whether by statute or agreement they arc designated as tax free, of the United States,
or any state. or pulitical subdivision thereof. or of any foreign country. which arc owned at the timc of death;
all wearing apparel, jewelrY9 silverware, pictures, bouks, works of art, household furniture. hurses. carriages,
automobiles, boats. and any and all other personal chattels of whatsoever kind or nature, Idt hy decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all promissory notes or other inslruments in writing
for the payment of money of which decedent died possessed, of whatsoever nalure, with interest thereon, if
any, giving the face value and estimated fair ma(kel value thereof, ami if such estimated fair market value be
less than the face value, it scts forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent: all and the co'porate stocks and dividends
duc thereon and unpaid as of lhe clate of death, bonds and accrued interest thereon to the date of decedent's
death and other invcstment securities owned by the decedent at the time of death, with the market value therc~
of at such time.
In the calle of 5ccurlLios or close or rnmll.y corllcruLlonfi, the Vlllu(!s reJlorted rlre dB far a.s
pos.lble .ubstRntlotert by fln,ncl,1 .t"tements of tho corl'nr"U.."" showln~ the "..',t< nnrt lll\hllltles
th..eof ns of the dnte of ,I"nt'.. The schp,lnle nlso sets forlh tl.e lntert'st or ,h,cortent nt the ~ime of
desth In snl' eO_l'nrtnershl\, or 'Juslne"" 'In,1 In "'I'port 01" the vnlue 0\' ",.,h Inlerest there Is Mnexed to
said scln~ctlllet flnnnctJ\l $t\tf'ments 5ho',dn~ the~sqets und 11'lhtltLtt's of' .,Ilhl co-pl\rlfll~rshtll or hlt:ilneis.
,\ copy of tt,. co_p"rtnershll' ,,~reem''"t, (I I' nrol, 0 stnt"ment s.'ttln~ I"orth tho fIf,ture of th" o;;r.,p"",nt)
to~"ther with n stntemont settln~ forth the oh"rflct.r of t.I,.! ,,,..Ine,", Its local.lon, and such other fRcts
l'ert"lnln~ to the IllIslno,s ns mny he p,'rtlnent to n folr .",,1 .lust npl'rnl5nl of 1."0 decodenl." Inl.er"st
lllOreln m,,,1 he suhmlltort. \l should .150 set I"Mth In ltemll.O.1 I"orm, tOI~"t.I",. wi th tt., folr "nrkot volue
tlu'rf'of, 61lr other property nwncII or I1fHluent.hml hy tlw tltHwlh'nt nt t.1l1' t tme fir ell'nth.
Till' Slhpdulp C nt.tnchecl heret.o unet mlllle lHlrt. h...I.....nf' :-;1..!tS forth Ii t.rue Ims.....l~r t,o en~h inqu1ry
contnlnod theroln .nd In the easo or trnnsf"rs ofll,'operty, ronl or "ersonnl, within two yeors of docedont'.
denth, In contemplation of decedent's dent.h, or Into..lr,l to I.Rk" offocl. In "ossesslnn or en.loyment Rt or
lifter deoth, sllld schedule sets forth the nlllure "n,1 vllIIIO 01' .lIch property, tn whom trnosl'erred, the
relntlonshlp of the trllnsferee. to the ,h,ee,lomt, th" prol'"rUon"to shllre roc..lv,,,1 by elleh trllnsferee nod
1111 nther focts of a perUnent nlLlllrO rOl!;llrc1ln~ slll.1 tronsf..rs. In the ellso of trlln.fers Intended to
tllk" effect in possession or onjo~"IRent at or "fler .Iomth, \hor.' Is also Iltloeh..,1 to the .cl",rtule a COllY
of the deed, trust Ilgreement or other Instrnmenl c,'eullng lIw trust. Thor.' Is also set forth In sdd
schedule" list of all property, renl Ilnd persnnal, with Its v"lue, which PI"SOS ut decedent' 5 d..llth by
virtue of tho exercise by decedent, ..lther Indlvlrtnully, or.lolntly with anothor, 0" any power of I,\.polnt-
mellt vcsted In decedent, el.ther Individually or joinUy, byth.. will, Ilerd, or other Instrument of anothor,
with a copy of the 1nstrump.nt crent1n~ such power attached to the schedule.
Th.t Schedule 0 ottoched hereto Ilnd mnde part hereot' sels forth tho nIlmes and addresses of oil
persons beneficially Interestod In this estllte 01. tho time of docedent'S <lellth, the nature of their res-
pective Interests, their relationship, if allY, to th.. rtecedellt, to~ether with the ages lit the Ume of
decedent'S death of all mInors, nnnultllnts and beneflclorl"s for 11 fe under decedent' 5 Will. It also
contnlns a stalement showing which of the heneficlarles nllmed In tho .h,cellent's wHl, If Ilny, died prior
to decedent, the dates of their dellth, their issne, Iln.1 th.. rehl.lonshll' of such Issue to the heneflclary.
ThIlt Schedule E attached hereto and mllde a pllrt. hereof sets forth all property, relll and I,er-
sonlll, owned by the decedent Jointly with Illloth.." or others, Including Intangible, standing In the name
of the decedent Rnd others, plus the date Rnd plRce of record ot' InstrlUnents effecting the ,"stiture of
renl os tate and the date of Rcquisltion of personRltY, plus tho nfUlle, Ilddress and relationship, if Rny,
of co-owners to the decedent.
ThRt Schedule F attached hereto und mllde a port heroof sets forth fII11y and In detail all debts
ond deductions claimed for and on behal f of this decedent' 5 estllte, including funeral expenses paid;
family exempUon, where nl'pllcable; costs of nclmlnistrlltlon of thl. estllte; counsel fees ond fIIdieiary's
commissions paid or to be pnid; cost eXI,ended for hurlnl t,'usts, lombstones or gravemarkers, and reli-
giouS services, In conseqnence of the deRth of the decedent; dehts and claims owing anrt unl'"ld at time of
death; taxes Ilccrued ehargeahle for periort prior to decedent' 5 dOllth (exc,'pt those allowed under SecUon
651 of the Inheritnnce nnd Estute Tnx Act); together with 11 statement of collnteral I'ledgert for ohliga-
tions, If any. 11. is agreed that the I"Iduclnry will present proof lit' sllld claimed obllgatlons upon re-
'Illest, thot if the omounl nctunlly 1",id In settlement ot' any fec, commission or deht is less than the
esUmated amount claiming and ullowed, thllt tho Sllme .111 be re"or,-..d 1.01 th" lIoglster OIl' Wills, and that
t.he tlmount of tax /lsscsscrl CRIl be renssessed In nccorrlnnce therewt tho
That the totnls of the apl'rol'rlate c,)lumns In Sehe.lules "A", "Il", "CO, "E", and "F" RS directed therein,
have been carried f'orwllrd and properly registered In the SmMlflr)'.
.........._...-""':7:41. .. day of..September.,.....19..aO....
....i:;~OZi~~;~:-::~..~~~~~~t~~~..~.:~iC
~ii!~i:4~~"'----
...4.2.0....E.aS.t.-.!l.o.:r::th...S.t:r:c.e.t.........._-_..
(Street Numbl!T)
c:::.arlis.le.,...r.!':l.nnsy~v.ani3.,......1-1.o13 .
(City or Town and Sta.te)
~om: nernre .I;;nlng at"rldovlt mnke sure Hll hlank SpHOOS In the 1l1"l"ldavlt nnd scheolules .nnexeol are
fIlled In with detHUS or the worol "Sone", llnd In onse lhe assets Ineluole rHre .nd wIllst.eol securities,
soeurltles of close or flnnlly corl'orlltlons or Hn Interest In any cO-[lnrtnershlp or business, thot the
,Illtll nnd stotement. re'lnl r",1 unoler lho pnrllgrll"h nl)o\"O relating lo Schednle "II" ore atlnchert. ,\150 make
cl1rtlltn thllt. column #1 1.n the "SllnmR1"Y" has been properly completed us Ilbove-dlrected.
Subscribed and sworn to before me this _......................u....
.
IlEV0452 (S..78)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
-'\'
;$:!....*'~
' ;"~'.,
,~, r;.-_-, ~
' ',..., T
'(~~';:'"
.-.':".........1'",...1. # ,I
" "( :.. - ,. ','~
SCHEDULE "C"
TRANS!'E:~S
RESIDENT DECEDENT
----.---.-.- --- -_._---.,-~
(1)
(2)
i
(3)
Old decedont, within two years of death, make any transfer of l.Il1Y malt:rial P'Jrt of his t:~tatc. ......ithout receiving a valuable and
ddcquate consideration therefor? {Answer ve~ or liO} M n
Did decedent, within two ycar50 0: death, transf~r propluty from himself to himsdf and another or others (including a spouse)
in joint ownership? (answor yes or no) .';:10
If the answer to (1) cr (2) above is in the affirmative stato:
(a) Age of decedent at tin,e of transfer
(b) State of decedent's health attime of making the transfer. (Note 1 I.
(c) Cause of decedent's death. (Note 11.
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) Nn
(0) Was thero any possibility that the property transferred might return to transferer or his estate or be subject to his
power of disposition? (Answer yt'S or no) --1!0
(b) What was the transfcrcc~s age at time of deccdent')' death?
Did decedent in his lifetime ",ake any transfer without receiving a valuable and adequate consideration therefor under which
transferor expreSSly or impliedly reserves for his life or JOY period which docs not in fact end before his death:
(a) The possession or enjoyment of 01' the right to income from the property transferred? (Answer yes or no) Nn
(b) rhe right to designate the persons who 5h311 possess or enjoy the prc,perty transferred or income therefrom?
(Answer yes or no) >In
If the answer to (5) (b) above is in the affirmative, state whether the rioht wus reservt!d in decedent alone or others
(4)
(5)
(6)
Did decedent in his lifetime make a tral1sfer~ the consideration for which was transfcrce'~ promise to pay income to or for the
benefit of care of transferor? (An......er yes or no) Hn
Did decedent, at any time, tr'dnsfer 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 oT transfer or by operation of law?
(Answer yes or nol---1.Jn
(9) If the answer to (8) above is in the affirm;ltiva~ was the power to alter, amend, or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer yes or no) '10
NOTE 1: The answars 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 abo,e questions is yes, set forth below a description of the property transferred, it's fair market
value at date of death~ date~ of transfars and to whom transferred~ with relationship of transferees to decedent, if any. Submit
copy of any trust deed or instrument~ if transfers are claimed to be nan-taxable, also submit detailed statement of facts on which
said claim is based.
NOTE 3: List a~plicable property below in manner in which provided in Schedules A, B, or E.
MARKET VALUE
(Estimated)
(7)
(8)
ITEM
DESCRIPTION
DEPT. VALUATION
(Depl. Only)
NONE
NONE
Insert this total opposite "Transfers", Schedule "e" in the
"As Reported" column on the last page of this return.
/I.te~
~
NONE
.
REV-,uJ (1-781
.
COr.tolONWEALTIl OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCIIEDUU; <Oil"
IlENEFI('IAHIES
- -
BENEFICIARIES AND AllDRFSSES RELATIONSIIIP
(State rutl narneN and addresses of nil who (If step-children or SUR VI\' En 11ATE INTElIEST or-
have an interest, vested, contingent or other- illrSltimlllC childrt~n UECEIlENT OF IlENEl'ICIARY
wise, in CtlIU1C) IIrc involved, set STATE YES IllflTll IN ESTATE
forth this fact.) OR NO
'D""n~'t"'" .T Mnr-Fii-i-
??O .. --...
"..,., ,~, ~ One-third (1/3)
Penns"l vania. 17013 Son Yes ~~cd ~l1:::'ry j.!c:....~...o
u;~,~ T.' ,~
,..~,., isle Pike
. '_el-,..~M One-third (1/3\
P"'n-~'" "..n;". , 7055 Daucrhter Yes p.....-~ ..:Il1~Ml 'P.~T~""P
lTnhn l-l ~~nffi i-i:
" n J1,
u~_ ,,-~_......; --' ",..,\
P"'n-~' - "" , 7..,.." Son Yes RE"idn~~;' Esi:ate
- ~-
D~ponc:lt further says that all the aboveanomcd beneficiaries are I iving at thi 5 time except below:
NAME
OA TI: OF c::~ iii
RESIDENCE
"
f'
~'"
November 5 1977 ''''
~
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=" '"
"," "
.. " ~
c-
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e- -
"" Co 0
-tE"
, O.
~ " .
B...."g
" '" -
:J:::S "'"
U e g,
Yo "
!:! 00:
SUMMAlt Y
Real Properly
Personal Property
Transfers
~~;~~'Y P~'n P~nr~rty
(Sdl. HA") $
(Seh. "n") $
(Seh, "C") $
(~,..'h 1fT' ") $
$
$ ~,..90J...9..5.
(1)
(As Reported)
':!~ nnn nn
4',5::\3.40
Non",
q ,1':11 ~~
.
rlfOSS Taxable Estat~
E- "0
~ Z "
" UJ ""
" ::;; 3
;>- UJ "
on " ...I
:;;: Q <
'"
'" u.. " <;:
c..
~ 0 ;; '"
:;;: a..
;! !! W ;. a..
f= !:: f= E- ;:, -<
. ..: ""
Z ~ ~ E- " 0
c E- o " :z
on " -<
u.. W 0..
c 0 ~ "0 I-
.S: ~ '"
'" 0
- UJ a..
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~ E- w
- "
Ul E- ~ " '"
0
'c < ~ "
-"s ::;; 0 t,
" 5 e
:0="0 ;; c ~
:::=~ ...I U W
,
;
(2)
(As Determined)
$
$
$
$
$
$
.
.'REV04B4 EX+ (3'S0)
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
File Number
21-80-0497
MOFFITT, Viola A.
Estate Name
Date of Death
07/16/80
Saciol Security Number
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Approiser in and for the County of Cumberland
Pennsylvania, do respectfully report that I have appraised the real and personal praperty as reported in the foregoing
,.tum at the values set forth opposite each Item in the last column to the right in Schedules "All, uB", "e", and "E"
Dated:
October 23, 1980
$/flN/,' /-,f./,.Jl/J~,f )
INHERITANCE TAX APPRAISER
INVENTORY
VALUE AS APPRAISED
CODE
ADJUSTMENTS
(HARRISBURG USE ONLY)
REMAINDER APPRAISEMENT CODE
Rool Properly (S.hodulo A)
Penonal Property (Schedul. B)
Jolnt.Held Property (S.hodulo E)
Trander. (Schedule C)
S
35 000 00 OD+
4,538 40 10+
9 368 55 211+
None 30+
48,906 95
40-
92+
TOTAL GROSS ASSETS
Lo.. D.bt. and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
93-
Valuation of IIfa estote. or
annultle.. . . . . . . . , . . . . .
RATE
FACTOR
PRINCIPLE
VALUE
CODE
FOR USE OF REGISTER ONLY
Tax on $
CODE
COMPUTATION OF TAX
$
$
$
$
6%
TOTAl. TAX
INTEREST FROM
BALANCE
TO
$
$
$
Tax on $
15%
Tax on $
Tax on $
Tax on $
$
Exemptions
Total Estote
Leu Credits
DATE OF PAYMENT
AMOUNT PAID
TAX CREDIT
S
$
INTEREST FROM
BALANCE DUE
ReV-457o.aO)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
nESIDENT DECEDENT
INHERITANCE TAX
APPRAISEMENT
'*
_..
---..-
- ._-~
- _.-
Estate of
MOFFITT, Viola A.
File No. _____. 21-80-0497
County
Cumberland
Dale of [)cath 07/16/80
In the event that 8ny futurelntere.. in thlsutii811 trandorred In possosslon or enjoyment to coll..ternl heirs of the dOCtldent after the expiration of any
estlte for life or for years, the Commonwealth hereby expressly reserves the riCht to DIJprllise Ilnd I)SS~S transfer InherltaneB taxes at th.lewful collateral rate
on any such futurelnterllt.
PROPERTY REPORTED BY THE ESTATE
DEPARTMENT'S
APPRAISED VALUE
35,000.00
4,538,40
None
1. TOTAL REAL PROPERTY - SCHEDULE "A" . .
2. TOTAL PERSONAL PROPERTY - SCHEDULE "B"
3. TOTAL TRANSFERS - SCHEDULE "C" . . . .
4. TOTAL JOINTLY OWNED PROPERTY - SCHEDULE "E"
TOTAL REPORTED PROPERTY
9,368.55
48,906.95
PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH
TOTAL UNREPORTED PROPERTY
None
TOTAL GROSS ASSETS
48,906.95.
LIFE ESTATE OR ANNUITY CALCULATION
I do hereby certify that the above appraisement is made in conformity with Pennsylvania law and has been filed this day
with the Register of Wills.
/?'. . )
1t4/", 1(,/ ,
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,;,JI. 8"'" -'/""'{
REY-4&& (1-111
OFF ICE OF THE
REGISTER OF WILI.S
STATEMENT OF DEBTS
AND DEDUCTIONS
THE SUM OF
OF Cntnh"rlann COUNTY
ANO AGENT OF THE COMMONWEALTH
'I . '
..'/.:.(o{(,J'
0,~ ,l. . :J.,~. <t'A"l
EST A TE OF
VTOr.7\ 7\. HOFPI'rT
d?
LATE OF SII,v'm SPRING TO\"lNSHIP
OATE OF FILING APPRAISEMENT lid . .1.5 Nfl' OATE OF DEATH ,1ULY 16. ]QBO
-
DATE NO. OF NAME OF PA YEE REMARKS AMOUNT
VOUCHER
D"Ni Qt.e.l:..-Cli-,H , , Q T".....'rs Te~..~~till:Y 38 00
"rof'i'm"," ","0'; Dn..h J:'.un'" ri'l 1 r.:l{~'ieS ? .?'" nn
CArli!>]" ~lenlod;tl Service. -- - --.
T"~ "nttin9 Dat'" on S"'''''' 40 00
n ,.. T ....~ ~--- pi" , ~ 117
.
D~ p-..'- - r. T ~ -1..... - v',,-....~i~ Hi 1 1 ?1 nn
'N D~"n_ "'~~ "",-
l,,~tor 3 1-lonths' School Tax 46 32
R"n ",,,' Cnmn",nn Telenhone Bill 3 57
T .n....__ ~ n" _, "P........ l\ ; Q",l lnn nn
P." ,,~ ,,<, n. ,- p"",l T-'~""''''' "'~",nQ-F,,~ "''''v ~<;r nn
T"I~Q ",..",1,1 <. ",--"'--- M",Ai~"l BilT 60 00
""i ,'1" V_T>",,, ,--- -~ ",..,,~ Y-R"" flill 9 00
,_ _"' puhlir: S",l",
,,-F """Q"j,,, 1,1 r:""A Q'
l\ ,,~.. i "n",,~ 1 Q V"". 22'1 00
,I n 1:'nn. 1 t; <; ""
. '? 'In
2\;I..,,_..i ~'_N' ')<;<"1 <"If, I:<;~ 01:
Po"i "i' ,.H'1Q pili,.,,, Costs f 00
~- t.l. Houck Esnuire Attornev's Fce ') .!d" nn
{pt!(j '7 12.
COM,MONWEALTH OP PENNSYLVANIA I
SS,
COUNTY OF Cnmh"r] m,rJ
I. ROBERT .1 .-1!OPVITT , HEREBY CERTIFY. THAT TO THE BEST OF
MY KNOWLEDGE AND BELIEF, THE FOREGOING IS A JUST AND TRUE STATEMENT OF DEBTS, FUNERAL EXPENSES AND
EXPENSES OF ADMINISTRATION SUBMITTED TO THE ESTATE OF VIOI.A A. 1,IOFPITT.
DECEASED, AS DEDUCTIONS FOR INHERITANCE TAX PURPOSES.
..ao-t!t..:f j
...
SWORN AND SUBSCRIBED BEFORE ME THIS .-;;,-5/;(t{
mbe 19.!Q..
DAY OF
/~#~
/ .
(L.S.)
, ..
ission Expires August II, 1983