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NO. 21-80 772
PETITION FOR LETTERS OF ADMINISTRATION
IN Tin; ~;STATt; 01' .....~9.~);;gr....!';.,...JU~~~.Rr...................... IlEn;ASED.
To ..................~~.r....c:;.,. ...~)i;W.:q?..... ........ .... ..... .............. ... ....................... ............
RegiHtcr of Wills fOI' (he County of ClImbcrland. ill thc Commollwealth of PCllnsylvania.
The Petition of .....~.R-Y.l~M~...!';.., ...!,g9.!9:;~'!:... ........................... ................... ............................. ......
....................................................... ... rCHpcctfull)' showcl h I hat .. ...~Q);\I::.E~...~......R+.C;;~J;:.!l.r..........................
was a reHident of ...!'!.~~...~!:I.~~.~~.~.~!?................. .'IJ!t>>9Q,QI,ip . Cumherland Count).. Sta(c of PcnnHyl-
. ")Ol'OUg 1
vania, and II Citizen of United States. and departed this lifc intc"tatc ill thc COllnty of ..G.\lmP..'?X'J..<;\p.g
........................................ and Stalc of .............I?~.m:\~y;1..Yi:l.!l.j,i:l.............................................................. ..............
on ....:r.!,I.~.~g.9Y................ the ..........?t~!;..,................. day of .....Q9.!;..9.!?~.+:........................... A. IJ., 19.(!.Q.....,
at the age of ...A.~....... years.
That the said ......~.9.~~.~~..!!:.:...!:l:~.<::~!?~~............................ dcccased. left sllrviving the following
named widow or -husband, heirs and next (0 kin, to wit:
................................................................
JAMES R. RICKERT
SON
Residence
......~~.!:.Y.:;;y.~~.~~..~....~~.......................
Name
Relationship
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That those above named include all of tbe nexl of kin. so far as known.
The said decedent was possessed of personal property to thc estimated value of $.....l.O..,.O.O.O...QO......
and of Real Estate. less incumbrance. to the cstimated value of $.........::-.~.-::................. as near as can be
ascertained.
That the said Real Estate in so far as is known is located in ................................................................
........................................................................................................................................................................................
Therefore, your plltitioner(s) respectfully appl)'(ics) for Letters of Administration in the above
named estate.
Dated ............!?.7.~..~....~.~..................... A. IJ., 1!J..~~...
Signature and Address
of Petitioncr(s)
. ......, ..z~"..."-Z/.?(:Y.: ..(::../~r:,X~.../.:.. ............ .........
ARVILLA E. RICKERT
...... ..!.l.B ...J.3.Q.$.~)))9.1).t....h~~.P..\l~............ ...... ....... ......
........................................................................................
New Cumberland, Fa. 17070
........................................................................................
COMMONWEALTH OF PElI:lI:SYLVANIA 1
COUNTY OF CUMBERLAND I ss:
........................ARY.ILLA..E.....RICKERT.................................................................................................... named
in the above application bcing duly ..........:.~o.rn......................... according to law, ;my that the facts set
forth in the above application are trlle to the bcst of .!1.~.JC....... knowledge and belief.
...........~~9.~!:l:...~~........................... and subscribed 1
I
t
.......')~i......................;........;..:....:...................................
{/. ':.} .Ji~; ~ (', /l~,.(.:~./
.....ARVIL'LiX..E.;...RTCKdl\f..................................
before me,
Dec. 10 80
............................................................ A. D.. 19..........
.....q{ay....(!..:....~'"~~~.i.~~~.~....
Filed: ......!?~~.~~?7..~...~?.~.......~.~~.~.................. Atlol'ne)' 4f~~"F1="..~~~ /fp-'1
(ovcd . /~/3 ~
c:ll-/b -7'Jz- )/'/"" -3 I~/Y'
........................................................................................
........................................................................................
0%
COMMONWEALTH OF PENNSYLVANIA \
COUNTY OF CUMBERLAND J
ss:
ARVILLA E. RICKERT
being duly sworn .___ according to law, deposes a..d says thatS he _ is Administratrix
__ of tho Estate of Robert E. Rickert
late of --Borough_oLNeW..cumb.er1and_._--._, Cumberland County, Pa., deceased and that the
within is an invontory made by . her--__ .__ __ , the said Administratrix
of the entire estate of said decedent, consisting of all the personal prop..ty and real estate, except reat estate outside
the Commonwealth of Pennsylvania, and that the liguros opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
Sworn to and subscribed before me,
~""--<-- / 2. 19?/
C\,.:,,~~ ~~ I
NOTARYPUB~ ~
My CommisslOl1 Ezplte. Doo. :n, 19111
"'lI1oyco, Pa. CUlIlbetlaAd Coual1
~. J.:?,;'k"r
k~ . Administrat)(r rix
Arvil1a E. Rickert
814 lbSeIlOnt Avenue
Na-I CUIlberland, PA 17070
Addreu
Date of Death
Day
Month
Vur
INSTRUCTIONS
I. An inventory must be liled within three months after appointment of personal representative.
2. A supplement inventory must be liled within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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!d~4~Mi"('<:':;': .:.. COMMONWEALTH OF PENNSYLVANIA
i 4 'No.Kt~~9588" '.' DEPARTMENT OF REVENUE
i ,.N;~:. ::'',,:: '" ,:' ,'.' 'OFFICIAL' RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
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:=
,
~~ RECEIVED ,,"ill. B. Rickert
I FROM
.~ .
I 'ADDRESS 1 w. BilJh st:reot
\
--
TAX AT 6%
TAX AT 15%
TAXAT_%
,
.
ESTATE TAX_
1,876.27
Caf:liale,
l'a.
17013
TOTAL TAX CREDIT
'--ESTATEINFOfiMATj(iN:-liov:--2i~-T98(f---------
DATE OF DEATH
21-80-172
NAME OF DECEDENT
aoBBRT B. RICI<BRT
cwaberland
m
m
LESS DISCOUNT
PLUS % INTEREST
(FROM 10_1
FILE NUMBER
June 16, 1981
DATE OF PAYMENT
1,876.27
COUNTY
- ---------------------.----
TOTAL AMOUNT PAID
------------
POSTMARK DATE
REMARKS: "PAID OM ACCOUNT"
RECEIVED BY
SEAL
I
REGISTER OF WILLS
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PRINCIPAL RECEIPTS
Inventory Filed
Per Copy of Inventory Attached
subsequent Receipts
Sale of decedent's one-half interest
in 1974 Sears Boat -
TOTAL PRINCIPAL RECEIPTS
$ 42,031.91
50.00
$ 42,081.91
PRINCIPAL CONVERSIONS INTO CASH
~ Loss
4/3/81 -
1975 Yarbrough Boat Trailer
Inventoried at $50.00
Proceeds 50.00 -0- -0-
TOTAL -0-
No Gain or Loss Transferred to Summary
12/11/80
118/81
1/12/81
2/2181
2/2/81
2/2/80
2/27/81
4/6181
4/7/81
5/18/81
6/12/81
PRINCIPAL DISBURSEMENTS
Register of Will.s - Probate, Letters &
Short certificates
Cumberland Law Journal - Advertise Letters
patriot-Evening News - Advertise Letters
Musselman Funeral Home - Funeral expenses
Holy spirit Hospital - balance - Decedent's
account
Arvilla E. Rickert - reimbursement for
Datsun inspection fee
Register of Wills - Short certificate
PA. Dept. of Revenue - Decedent's 1980 income
tax
Register of Wills - Short Certificate
Register of Wills - Short Certificate
Register of Wills - File Inventory, Debts &
Deductions & RCC Forms
Notary Fees - all documents
Arvilla E. Rickert - Family Exemption
Arvilla E.Rickert - Administratrix Fee
Myers, Myers, Flower & Johnson - attorney fee
Register of Wills - Inheritance Tax
Reserve for f.iling Account, Distribution
& Re lease -
TOTAL PRINCIPAL DISBURSE~reNTS
lIB[R 99 PAGE 426
-2-
26.00
18.00
24.24
1,807.15
70.20
10.60
2.00
19 .41
2.00
2.00
9.00
3.00
2,000.00
2,100.00
2,100.00
1,876.27
50.00
$10,119.87
InvunlolV 01 the IUdl tllld pelsulhlll:~,ldlu 01
BOIl r: WI' 13. l!l (' K r: H'I'
1. 1 Seiko Wri~twdtch
2. 1 Caravelle Wristw3tch
3. Miscellaneous wearing dpparel.
4. pana.onic Black & White Television
5. Bearcat Scanner 4 -
6. Miscellaneous fishing rods & fishing equipment -
7. Miscellaneous tools
B. 1979 Kreidler Moped
9. 1974 Datson Truck
10. 1975 Yarbrough Boat Trailer
11. CCNB Bank, N.A.
Checking Account No. 736-488-8
Certificate of Deposit No. 128522
Certificate of Deposit No. 128523
Certificate of Deposit No. 128530
Certificate of Deposit No. 128531
Certificate of Deposit No. 128532
12. New Cumberland Federal Credit Union
Account No. 4541
13. New Cumberland Federal Credit union
Insurance on Account No. 4541- paid to Estate
14. Federal Employees' Group Life Insurance
Group No. 1700-G - paid to estate
15. New Cumberland Army Depot - unpaid
compensation due deceased civilian employee
paid to estate -
16. Internal Revenue - refund - decedent's
1980 income tax
L&r: 98 PAGE '12;)
IllJclJa~lld
TOTAL
- -'-'~ ,--- ... ,_. -. ....
---. -.
25 00
25 00
25 00
50 00
150 00
15 CO
100 00
400 00
1,300 CO
50 00
3,795 41
537 26
4,298 01
536 16
536 16
536 16
3,505 65
2,552 15
19,453 26
3,325 97
815 72
42,031 91
PRINCIPAL DISTRIBUTIONS TO BENEFICIARIES
5/21/81
CCNB Bank, N.A., Guardian of
the Estate of James R. Rickert,
a minor -
Truck, Moped, Tools, Fishing
Equipment, Scanner, Television,
W~aring apparel & Wristwatches -
$ 2,090.00
TOTAL PRINCIPAL DISTRIBUTIONS
$ 2,090.00
ADVANCE DISTRIBUTIONS TO BENEFICIARIES
6/2/81
To: CCNB Bank, N.A., Guardian of
the Estate of James R. Rickert,
a minor.
Cash
$ 500.00
TOTAL ADVANCE DISTRIBUTIONS
$ 500.00
PRINCIPAL INVESTMENTS
Dauphin Deposit Bank & Trust Company
Statement Savings Account No.
12-60915-3.
Balance 7/1/81 - $36,439.62
INCOME RECEIPTS
Additional interest earned on CCNB Bank,
N.A. Certificates of Deposit from date of
death to date cashed - 6/3/81 -
$
431.17
Additional interest on Credit Union Account
from date of death to 3/12/81 -
61.10
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REV-455 EX+ (3.801
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT OECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
Estate of ROBERT E. RICKERT Date 01 Death 10/21/80 File NO,~ - ~- '17>>
WHEN CLAIMING THE FAMIL V EXEMPTION, COMPLETE THE FOLLOWING:
.-
Claimant ARVILLA E. RICKERT
Rl!lillillnship to Decndent
Mother
Claimant's Address at ti!llOOf O"cmlent'sD""tl1 814 Rosemont J\venue, New Cumberland, Pa. 17070
ITEM 0 --0 - I
NO. DATE NAME OF PAYEE REMARKS AMOUNT
1 D~niD""r of wi.lls Letters & Short Certificates 26.00
2 Cumberland Law Journal J\dvertise Letters 18.00
3 Patriot-EveninD News J\dvertise Letters 24.24
4 Holv soirit lIoBl)ital Decedent's Account 2,322.14
c: C!~I,l1n V_D~" >DDOca...- n___...'~..' D ""'" '''' nn
6 Musselman Funeral lIome Funeral Exnenses 2,357.15
7 D> n~Dt. of Revenu" D"cedent's 1980 Income Tax 19.41
B 1\,.,,111 n R. Ilinlc"rt Famil v Exemotion 2,000.00
9 ReDister of WIlls 3 Short Certificates 6.00
10 J\rvilla E. Rickert Ret\!furs~IJl!':!!tr!~r auto 10.60
11 ReDister of Wills Fi!.e Inv~ntory, .~bts & o nn
1 ? ,,-~-_. r,o--- ,,1 1 ~. >i'S 3.00
1 3 lIr"ll 1 a E. Rickert Administratrix Fee 2,100.00
14 Myers r Myers r Flower & Joh son Attorney Fee 2,100.00
1.~ D~Dn""" for ,.1 "s,,-out cost 100.00
I
TOTAL I 11 109.54
I hereby certify Ihat 10 Iho host of my I<oowlodge and beliel the foregoing is a just and true statement of debts, funeral
exponsos and oxponses of administration ~lIhmi\led to the estate as deductions for Inheritance Tax purposes,
t2r-1-r~-,g. Ii2A~-"J- t/;b/.f/
SIGNATURE OF FIDUCIARY / DATE
OFFICIAL USE ONL V
DEIJTS AND DEDUCTIONS AnE ALI.OWED IN THE SUM OF S / I, /tf 1.. -'J-fI' AT
,
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% TAX RATE
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P:-EGISTER biLLS
1-..11-1'/
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfied liabilities incurred by the decedent prior to his/her deoth ore deductible ogoinst his/her toxoble
estote. In addition to debts incurred by the decedent or estote, other items are claimable including the cast of
odministrotion, attorney fees, fiduciary fees, funeral ond burial expenses including the cast of a burial lot, tombstone
or grave morker ond ather related burial expenses.
All debts being claimed ogoinst on estote ore subject to the approval of the Register of Wills with whom the
Inheritonce Tax Return is filed. Evidence .to support the decedent's or the estote's liability for the debts being
c10imed should be attached to this schedule.
A family exemption may be claimed by a spouse of 0 decedent who died domiciled in Pennsylvania. If there is
no spouse, or if the spouse has forfeited his/her rights, then ony child of the decedent who is 0 member of the some
household can claim the exemption. In the event there is no such spouse or child, the exemption con be claimed by
o parent or parents who ore members of the some household os the decedent. The family exemption is allowable only
ogoinst assets which poss by 0 will or by the Pennsylvonio Intestote Lows.
NOTE: Compensation paid to on estote representotive; nomely, on executor or odministrotor, for services
performed in administering an estote is reportable for Pennsylvonia Income Tax purposes. This taxoble income
item should be reported on form PA.40.lndividuollncome Tox Retllln.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the family exemption is being claimed, indicote the c1oimont's nome, oddress ond his/her relationship to
the decedent. Enter "family exemption" in the remarks column and the omount c10imed in the amount column.
2. Assign consecutive numbers to eoch item listed.
3. Enter the dote on which each debt wos incurred ond/ar paid.
4. Enter the nomes of eoch payee.
5. Provide 0 briel explanation in the remorks column for each debt c1oimed.
6. Enter the omaunt of each debt being c1oimed..
7. The form must be signed by the person who has ossumed the responsibility for poying the debts.
IF ADDITIONAL SPACE IS NECESSARY USE 8Yz" x 11" SHEETS.
REV.US FO (7.80)
.
COMMONWEAL.TH OF PENNSVL.VANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
NOTICE OF FILING OF APPRAISEMENT
Arvil1a E. Rickert
814 Rosemont Avenue
New Cumberland. PA
17070
RE: Estate 01
County 01
File No.
Robert. E. R;ck~~t.
Cumberland
21-80-0772
Dear Ms. Rickert:
You are hereby notified that the orii;:ina1
appraisement in the estote 01 Robert E. Rickert
has been Iiled in the office 01 the Register 01 Wills 01 Cumber] And
County on .July ?4 , 19.8l... Soid approisement reflects the lollowing voluations:
Real Estate
Personal Property
Jo in tl y Owned
Transfers
Total
Nnnp.
42.031.91
341\ 73
Nnne
542.380.64
As to such tax that is paid within three months Irom date of death, a five (5%) percent
discount is allowable. As to any tax that remains unpaid olter nine (9) months (Iifteen months
when death occurred from December 22, 1965 to June 16, 1971, inclusive; ond twelve months when
death occurred prior to December 22, 1965) from date of death, interest at the rate of six (6%) percent
per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within sixty doys
alter receipt of said notice as provided by Section 1001 01 the Inheritance and Estate Tax Act of
1961,72 P.S. 2485-1001, P.L. 373.
Date
Julv 24. 1981
Signed
~ f) fir rcJ iO'J-t0uuIC,
Title
AppraiRer
NOTE: This is nolo bill.
REY-.I46 (,-eo)
CO"'MONthiAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
AFFIDAVIT OF
FIDUCIARY
(Instructions on Rovene Side)
.
---~
Estate 01 ROBERT E. RICKERT
Dote 01 Death October 21, 1980
Social Security No. , ~R_?,,_C;C;R'
Lost Address 814 Rosemont Avenue
New cumberland, FA 17070
Bureau File No.
(CITY'
(STATE)
(ZIP)
County File No.
21-80-772
J. Decedent di ed:
(x) Intestote (without 0 will)
( ) Testate (leaving 0 lost will--copy ottached)
2. Is the filing 01 0 Federal Estote Tax Return required lor this estate? Yes_ No x
3. (
) Executor/Executrix
Nome Arvi11a
( x) Administratorl Administratrix
E. Rickert, Administratrix
Address
814 Rosemont Avenue
l\(C.lJ ('l'1Tih~,...l ~nn pn.
(CITY1 (STATEI
'7070
(ZIPI
4. All correspondence should be moiled to (x Attorney
) Fiduciary.
5. If on attorney is representing the estate, indicate:
Nome Horace A. Johnson
Myers, Myers, Flower & Johnson
Address P.O. Box 125
T,c.mnynCII
(CITY1 .
'On
t~TATE1
'704 '1
(ZIP)
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List all sole deposit boxes registered in the decedent's individuol nome, or jointly with, or os on ogent or deputy
01 another, or in decedent's individual nome with right 01 occess by onotner as ogent or deputy. Include the nome
and oddress 01 the bonk or other institution where the sole deposit box is locoted, the nome (s) in which the box
is registered and the relationship 01 the joint holders to the decedent.
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT MAINTAINED A SAFE DEPOSIT BOX
HAME OR HAMES IN WHiCH
SAFE DEPOSIT BOX IS REGISTERED
None
RELATIOHSHIP OF JOIsT
HOLDERS TO DECEDENT
Under penolties 01 perjury, I declare thot I hove exomined this return, including accomponying schedules and
statements, ond to the best 01 my knowledge and beliel it is true, correct ond complete.
a,~~ hf~ f', ~AA'~
SIGNATURE OF FlauCIARY
~;/~lfI
DATE
PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inherilonce and Estate Tax Act 011961 provides Ihal the following persons shall prepare and file
a return:
'.
a, The personal representotive 01 the eslote uf Ihe decedenl as to plOperty of Ihe decedent administered by him
and such additional properly which is or may be subject to Inheritonce Tox of which he/she sholl have or
ocqui re knowledge;
b. The transferee of property upon the transfer of which Inheritance Tax is or may be imposed by the 1961 Statute,
including a trustee of property transferred in trust, provided thot 110 separate return need be made by the transferee
of ploperty included in the return of a personal representative.
I
'1
2. PLACE FOR FILING
The return is 10 be filed in duplicate with the Register of Wills of tlle county wherein the decedent resided,
3. TIME FOR FILING
The return is due nine months afler the decedent's death, unless on extension for filing has been applied for and
gran lea by the Secretary of Revenue within the nine-month period.
4. FAilURE -:-0 FilE RETURN
Section 791 of the 1961 Statute provides that" , . .any person who willfully fails to file a return or other report
required of him, , ,shall be personally liable, , .to a penalty of 25% of the tax ultimately found to be due or $1,000
whichevef'is the lesser to be recovered by the Department of Revenue as debts of like amount are recoverable by
law."
5. TAX RATES
i
I
I
I
I
I
!
I
!
i
Inheritance Tax is payable at the rate of 6% on transfers to lineal descendants, such as father, mother, husband, wife,
son, daughter, grandchildren, grandparent, son-in-law and doughter.in.law and at the rate of 15% as to all others.
6. PAYMENT OFTAX
The tax assessed on the transfer of property reported in the return is due 9 months after the decedent's death. Interest
at the rate of 6% per annum accrues thereafter until payment is made. All payments received are first applied to any
interest which may be due with any remainder applied to the tax. IF TAX IS PAID WITHIN 3 MONTHS AFTER THE
DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS AllOWED.
All checks should be made payoble to the Register of Wills of the county wherein the decedent resided and are
received subject to the final determination of the Department of Revenue.
7, FAilURE TO PAY
The taxes imposed, together with any interest thereon, are a lien upon real property, which lien remains in effect until
the taxes and interest have been paid in full. The taxes may be sued for against any real property in the decedent's
estate or against any property belonging to a transferee liable for the tax.
8. FILING OF FALSE RETURN
Any persen who willfully makes a false return or report required of him sholl, in accordance with Section 793 of the
1961 Statul.e, be guilty of a misdemeanor and, on conviction thereof, shall be sentenced to pay a fine not exceeding
$1,000 or undergo imprisonment not exceeding one year or both.
,
,
i
INSTRUCTIONS FOR COMPLETING SCHEDULE "A"
Schedule "A" should include 0 detailed description of all real property located in Pennsylvania
ond held solely by the decedent or held jointly with onother individual (s) os tenants in comman. List the
decedent's percentage of ownership and the estimated morket volue of the decedent's interest. (Property held
as joint tenants with the right of survivorship or tenants by entireties should be reported on Schedule "E".)
All real estate located in Pennsylvania should be described by lot and block number, street
address, number of acres and general description of land and buildings. Also, include the book and page
number in which the deed is recorded and the exoct title as indicoted on the deed. If the property has been
sold, attach a copy of the settlement sheet. If the property is subject to a mortgage encumbrance, include
the name of the mortgogee, dote, rate of interest and the outstanding bolonce on the date af death and
attach a statement from the mortgagor verifying the outstanding bolonce.
Property toxes ond interest on mortgoges as of the dote of death, assessments ond other
encumbrances shauld be listed on Schedule "F". Do not deduct them on Schedule "A".
REV-4,Z EX. (3.00)
COMMOHweAl TH OF PEHHSYL V AHIA
DePARTMeHT OF REVEHue
. "TRAHSFER IHHERITANCE TAX
ReSIDeHT DeceDEHT
ESTAT! OF ROBERT E. RICKERT
SCHEDULE "C"
TRANSFERS
-
INSTRUCTIONS:
1. Answer the Questions on reverse side.
2. If the answer to any of the Questions on the reverse side is "Yes," provide a description of the properly transferred per
Schedules "A," "8," or "E," its estimated market value at date of death, dates of transfer, to whom transferred and
relationship of transferees to decedent. Attach a copy of any llUst deed or instrument relating to the transferred properly.
-
ITEM DESCRIPTION ESTIMATED DEPT. VALUATION
NO. MARKET VALUE (OFFICIAL USE ONL YI
NONE
TOTAL THIS PAGE NONE -y) )in!
I, Did decedent, within lwo years of death, nwke any transler ef any matelial part 01 his estate without receiving
valuable and adeQuale consideration? (Answer "Yes" or "No",).JilL-
2, Did decedent, wilhin two yearsol death, transfer prt1perty from himself' herscll In himself/herself and another party
or parties (including a spouse) in joint ownership? (Ans'/lcr "Yes" or "No",) .-No-
3, If the answer to one or two ahove is "Yes" ami the tr~lns[us are c\ail:lCd tll he nontilxable, provide the following
information:
a. Age of decedent at time of transfer,
b, Copy of death certi fi cale.
c, Affidavit by the attending physician indicatin~ the stale of decedent's health ~t limo of transler,
d. All other information supporting nontaxability of transler.
4, Did decedent, in his/her lifetime, make any transfer of properly wilhout receiving a '1alllallle or adequate consideration
lherefor which was to take effecl in possession or enjoYllwrrl alar after !Iis/twr death? (A'lswer "Yes" or "No",)
a. Was there any possibility thatlhe properly trans[erred might retllrn to lrans[emrlll his/her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No" ,) --
b. What was the transleree's age altime 01 decedent's de~lth?
5. Did decedent in his/her lifetime make any transfer withoul receiving a valuable and adeQllate consideration therefor
under which transferor expressly or impliedly reserves lor his/ber Ii fe or any peried which does in lact end before his/her
death:
a. The possession or enjoyment 01 or the right to income lrom the property transferred? (Answer "Yes" or "No".) -
b. The right to designate the persons WllO shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No",)
6. If the answer to five b, above is "Yes," state whether the right \-Ias reserved in dEcedenl alone or others,
QUESTIONS CONCERNING PROPERTY TRANSFERS
.'
7. Did decedent in his/her lifetime make a transler, the consideration for which was transferee's promise to pay income
to or for the benefit or care 01 transleror? (Answer "Yes" or "No".)
8. Did decedent, at any time, transfer property, the bmeficial enjoyment of which was subject to cllonge, because of
a reserved power to alter, amend, or revalIC, or which could revert to decedent under terms altransfer or by operation of
law? (Answer "Yes" or "No" ,)
9, If the answer to eight above is "Yes," was the power to alter, amend or revoke the interesl of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Yes" or "No" ,)
REV-45.t. 0.80)
COMMONWE'AL TH OF PENNSYLVANIA
DEPARTMENT OF ReVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTL Y OWNEO PROPERTY
*
(Instructions on Reverse Side)
Estate of
ROBERT E. RICKERT
P
ITEM TOTAL E VALUE OF DEPARTMENT
R
NO. DESCRIPTION MARKET CE DECEDENT'S VALUATION
VALUE N INTEREST (Official Usa On/vi
T
1- 26 Series E Bonds - all $25.00 Bonds
Decedent or James R. Rickert. &11L/
(See attached for dates & values) 597.46 50% 298.73""'-
2. 1974 Sears 12 foot ~at - Decedent
and Edwin Rickert rcA~ 100.00 50% 50.00/
J
-
TOTAL THIS PAGE 348.73 ."4~,'1,~
. ..;,..
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included. List real estate first,
1, Describe all real property as indicated in the instructions for Schedule "A", Describe all personal property
as indicated in the instructions for Schedule "B". Include the name. address and relationship to the
decedent of the co-owner {sl and the date the joint ownership was established,
2. Indicate the total market value of the jointiy owned Ilroperty,
3. Indicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest.
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INFORMATION
To insure proper credit 10 your account, thu name of tho CSUue and file number should bo clearly print-
ed on lho check or money order,
This assessment is made in accordance with Section 708 of the Inheritance and Estate Tnx Act of
1961 (72 P.S. ~ 2485.7081.
To the extent that inheritance tax is paid withm three (3) months aher the death of tho decedent. a
discount of fivo 15) porcent is allowed 172 P.S. 9 2485.716).
Inheritance Tax, other thr.n tax on a future interest. is due at the date of the decedenfs death and becomes
delinquent at the expiration of nine (9) months after the decedent's death 172 P.S. ~ 2485.711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. g 2485.1121. Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment USing the 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 mOnlhs .045 12 months .060
1 days .00017 11 days .00186 21 days .00352
2 days .00034 12 days .00203 22 days .00369
3 days .00051 13 days .00220 23 days .00386
4 days .00068 14 days .00237 24 days .00403
5 days .00085 15 days .00250 25 days .00420
6 days .00101 16 days .00267 26 days .00437
7 days .00118 17 days .00284 27 days .00454
8 days ,00135 18 days .00301 28 days .00471
9 days .00152 19 days .00318 29 days .00488
10 days .00169 20 days .00335 30 days .00500
----------- ---------- ------_. -- --- --- - - --- - - ---- ---- - -- - --------- ------
Any party in interest, including the Commonwealth and the personal representative. not salisfied with
the assessment may object thereto within sixty (60l days after receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961 (72 P.S. 2 2485.' 001).
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below: