HomeMy WebLinkAbout05-02-79
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RCC-84
(8- 77)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
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DATE 6. - - 79
ESTATE OFtlJ)~ 8. gjy~ol'J
FILE NO. 2/ - 7 g- - '3 9 F'
COUNTY OF (U J?2 Jer bl1c!'
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DATE OF DEATH ~ - Z- 7f
Fa t'r 11 ,~C.{ 1 . 117 /102 :;;-
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For County Information purposes only
COUNTY FILE NO: 10 - { 7 (; - ~
---------------------------------------------------.-----------
Appraised Value of Estate: S - 2 - 7 tj
Real Estate
Personal Property
Jointly Held Property/Transfers
$
_0 -
3~ ~1;~
J-/ ~ 700, x3
2-yq).{, 7 9
2 2) )tJ(:;, 0#
Total Gross Estate
$
Total Approved Deductions
Clear Value of Estate
$
Less: Approved Charitable Exemptions
_0-
Amount Taxable @ 6% Rate
$ 2. 2- lOb. ,,~
2. 2.. /()G. o~1
tax due
$ / 3..2~, 3({;
Clear Value of Estate Subject to Tax
$
Amount Taxable @ 15% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE $ I 3 Z (.. 3 b
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
"]- 1/- 7 Y
$ 13G:/.Cif
+ $
$ 3.;;-,/'1
=
$ I !,; 1 {, 'f 2_
+
=
!
~(10/!
$ ':3 Ztii.3G
+
=
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
rnterest will accrue at th~ rate ,of six (6) ~ercent per annum on the unpaid
Inheritance tax from 2.-2 - ?Z. to the e
C C ~ mes f. fe; d i Jr. r- 5-q tl Assessed by.
~ 0. 15c.xx, q 6 G Age
H~fr is hu'h jJll. 1'7 foe;;
SEE REVERSE SIDE FOR INSTRucnONS
TO BE DEliVERED TO TAXPAYER
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Form RC C ,10
;;c h '7?,'~9~'
DEDUCTIONS ALLOWED IN
$?~j9i'?'/
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Cumberland
STATEMENT OF DEBTS
AND DEDUCTIONS
THE SUM OF '......
OFFICE OF THE
REGISTER OF WILLS
COUNTY
AND AGENT OF THE COMMONWIi...LTH
ESTATE OF
Lula B. Robertson
L"'TE OF
West Fairview, Cumberland Co., Pa.
DATE OF FILING APPRAISEMENT
S-l-7cr
D"'TE OF DEATH
May 22, 1978
DATE NO. OF NAM&: OF PAYEE REM"'RKS "'MOUNT
VOUCHIii"
Register of Wills Probate and filing of
Inventorv 46 00
Pallas Publishing Co. Estate Notice 16 75
Cumberland Law Journal Estate Notice 18 00
Aurand Funeral Homes Funeral 2,444 00
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Aurand Memorials Gravemarker 510 00
Shirk's Flowers Flowers 119 25
John C. Schiro, .~LD. Medical 40 00
Medical Specialists, Richmon d, Va. Medical fiOS 00
Ota T. Graham, St. , M.D. Medical 609 00
Libbie & Monumert Radiologic al Assoc. , Inc. 179 70
Neurological Associates, Ric hmond, Va. 175 ~OO
St. Mary's Hospital, Richmon ki, Va. 10,458 23
St. Mary's Hospital, Richmon ki, Va. 112 71
Holv Snirit Hosoital Camo H IlL Pa. ? O?7 1 to;
Holy Spirit Hospital Radiolo Sy Assoc. 80 00
Dr. Gilbert Shover 12 00
Camp HIll Nursing Horn 282 00
Zion's Church Cemetery 75 00
Goldberg, Evans & Katzman Attorneys' fee 1,500 00
Frances Fetterolf Administratrix' Fee 2,285 00
Frances Fetterolf Family exemption 2,000 00
-
TOTAL V 23,594 79
COMMONWEALTH OF PENNSYLVANIA
I,
CUMBERLAND
FRANCES FETTEROLF
}..:
COUNTY OF
HEREBY CERTIFY, THAT. TO THE (jEeT OF
MY KNOWL.EDGE AND BELIEF, THE FOREGOING uI:ui~T ~~D ~g~1\T~~~T OF DEBTS. FUNERAL EXPENSES AND EXPENSU 01"
ADMINISTRATION SUBMlTTED TO THE ESTATE OF
INHERITANCE TAX PURPOSES.
~~~~
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SW~ AND SU:!!8CRI8fiD BEFORE ME THIS '.....'/
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DAY OP'
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RCC-33 (4-73)
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COMMONWEALTH QF PENNSYLVANIA
DEPARTMENT bF REVENUE
BUREAU OF COUNTY COLLECTIONS
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RESIDENT DECEDENT
COUNTY OF
CUMBERLAND
IMPORT ANT:
This return must be compleled in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months. after date of death, unless an extension is granted
by the Secretary of Re~enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
CUMBERLAND
PENNSYLVANIA
CUMBERLAND
} AFFIDAVIT OF
EXECUTOR
ADMINISTRA TOR
County
IN THE !\lATTER OF THE ESTATE OF
LULA B. ROBERTSON
(STATE FULL NAME OF DECEDENT)
County of
}..
Stote of
FRANCES FETTEROLF
Executor
Administrator
of the estote of the above-named decedent being duly sworn, depose
and say
Decedent died
May 2,
(MONTH)
Name and address of attorney or }
other authorized representative to whom
all correspondence should be mailed.
(DAY)
, 19~{testate I....ving a last will, copy of which is hereto attaChed.}
(YEAR) X..~
James E. Reid, Jr., Esquire
P. O. Box 966, HarriSburg, Pa. 17108
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
(EXECUTOR-ADMINISTRA TOR)
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 S.~FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
None
That the contents of said safe deposit box or boxes are itemized under Schedules
wi th the exception of the following, for the reasons hereinafter set forth:
of this return,
That Schedule A attached hereto and made part hereof sets forth fully 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, trus t companies, or other institutions, whether individually, or in trus t for any other person or persons
giving also separately the accrued interest thereon, if any, down to the last interest day prior fO decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases~ all bonds, postal-,
I ~ . I
savings, treasury certificates or notes and other evidence of indebtedness of the United State's to the d'e':'
cedent; all obligations, whether by statute or agreement they are designated as tax free, Of the United St~tes'
or any state, or political subdivision thereof, or of any foreign country, which are owned at the tim~6r de'ath;.
all wearing apparel, jewelry, silverware, pictures, 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 mortgages 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 policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of decedent's
death and other investment securities owned by the decedent at the time of death, with the market value there-
of a t such time.
~.
In the case of' securities of' close or f'amily corpoNtions, the values reported are as f'ar as
possible substantiated by f'inancial 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 sllch interest there is annexed to
said schedule, f'inancial statements showing the assets and liabilities of said co-partnership or t)lIsiness.
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 f'air and just appraisal of the decedent's interest
therein must be submi tted. It should also set f'orth in itemized form, together wi th 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 of property, 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 f'orth the nature and value of such property, to whom transf'erred, the
relationship of' the transferees to the decedent, the proportionate share received by each transferee and
all other racts of a pertinent nature regarding said transfers. In the case of transf'ers intended to
take effect in possession or enjoyment at or arter death, there is also attached to the schedule a copy
or 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 or 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 0 attached hereto and made part hereof' sets forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of' the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That Schedule E attached hereto and made a part hereof sets forth all property, real and per-
sonal, owned by the decedent jointly with another or others, including intangible, standing in the name
or the decedent and others, plus the date and place of' record of instnwlents effecting the "'esti ture 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 f'orth fully and in detail all debts
and deductions claimed ror and on behalf of this decedent's estate, including ftlneral 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 columns in Schedules" A", "B", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ..d~L.., ~
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NOTE: Bp.fore signing affidavit makp. sure all blllJlk spaces in U'e affidavit and schedules annexed are
filled in with details or the worn "None", :inn ill case the assets include rare and unliste<\ securities,
securities of close or family corporations or an interest in any co-partnership or business, that the
data anrl 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.
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,
LAST WILL AND TESTAMENT
OF
LULA B. ROBERTSON
I, LULA B. ROBERTSON, of Richmond, Virginia, being of
so~nd and disposing mind and memory, do make, publish and
declare this my Last Will and Testament, hereby revoking and
annulling any and all Wills by me heretofore made. .
ITEM I - I direct that all my debts and funeral expenses
be paid as soon after my decease as may be found convenient.
ITEM II - I give, devise and bequeath my entire estate,
real, personal or mixed, to by beloved daughter, Frances
Fetterolf. Should my daughter predecease me, or should she
fail to survive me for a period of fifteen (15) days, or should
we die under such conditions and circumstances as it is not
possible to determine which of uS,has died first, then I give,
devise and bequeath my entire estate as follows:
(a) I give and bequeath the sum of Three Thousand
($3,000.00) Dollars to my niece, Patricia Boyer, of
paxtonville, Pennsylvania.
(b) All the rest, residue,and remainder of my
estate after the Three Thousand ($3,000.00) Dollar bequest
has been deducted, shall be divided between my two
great grandchildren, John Franklin Fetterolf, II, who
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shall receive two-thirds (2/3) of the balance of my residue,
and Boyd Fetterolf, who shall receive the remaining one-third
(1/3) of my residue, all of which shall de~end per stirpes.
ITEM III - Should any person taking under this Will be a
minor, then I direct that my Executrix or Trustee hereinafter
named hold such share of such minor in trust for the following
purposes:
(a) The respective share of the respective minor
shall remain in trust until the said minor reaches the age
of eighteen (18) years. Until such minors reach the age
of eighteen (18) years or die prior thereto, my Trustee
hereinafter named shall payor apply the interest and/or
principal for the support, education, welfare and maintenance
of the said minors, in such amounts and in such manner
as in the sole discretion of the Trustee is proper and
desirable.
(b) It is my direction that my Trustee shall have,
and I hereby give my Trustee the power to apply any principal
or income for the support, maintenance and education of such
minor s .
(c) No distribution shall be made of the principal
of this Trust until the youngest of the said minors reach
the age of eighteen (18) years, at which time each respective
minor shall receive one-half (1/2) of the amount remaining
in trust for him or her.
WITNESSES:
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(d) Upon reaching the age of twenty-one (21)
years, the balance remaining in the respective trust of
each respective minor, together with any interest thereon
shall be paid over to each respective minor and the
trust shall then terminate.
(e) In the event a minor entitled to receive
funds should die without issue, then the balance of his
or her share shall go to the surviving eligible beneficiary
of the remaining trust.
ITEM IV - I nominate, constitute and appoint Frances
Fetterolf to be the Executrix of this my Last Will and Testament.
Should my'said daughter refuse or be unavailable for any reason
or fail to qualify or cease to act as such during the
administration of my estate, I nominate, constitute and appoint
the Dauphin Deposit Trust Company of HarrisLurg, Pennsylvania,
to be the Alternate Executor of this, my Last Will and
Testament, with the same duties, powers and discretions as
if originally appointed.
ITEM V - I appoint the Dauphin Deposit Trust Company of
Harrisburg, Pennsylvania, to be the Trustee of any trust
created hereunder.
ITEM VI - I direct that no person serving as Executrix or
Alternate Executor or Trustee under this Will be required to
enter security in any jurisdiction in which they may act as such.
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ITEM VII - I authorize my Executrix, Alternate Executor
or Trustee and their successors to exercise the following
powers, in addition to those given by law, which shall be
effective without court order or approval:
(a) To retain any or all of the assets of my
estate without regard to any principle of diversification
or risk.
(b) To invest in all forms of property without
restriction to investments authorized for any type of
fiduciary.
(c) To compromise any claim or controversy.
(d) To borrow money from any person, including
any Executor or Trustee, and to mortgage or pledge any
real or personal property.
(e) To sell at public or private sale, to exchange
or to least for any period of time any real or personal
property and to give options for sales, exchanges or
leases, all for such prices and upon such terms and
conditions as they deem proper.
(f) To allocate receipts and expenses to principal
or income or partly to each as they deem proper.
(f) To repair, alter or improve any real or personal
property.
WITNESSES:
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(h) To distribute assets in cash or in kind,
or partly in each at valuations fixed by them.
(i) To purchase investments at premiums and to
charge premiums to income or principal, or partly to each.
(j) To subscribe for or to exercise options for
stocks, bonds or other investments; to join in any plan of
lease, mortgage, merger, consolidation, reorganization,
foreclosure or voting trust, and to deposit securities
thereunder; and to generally exercise all the rights of
security holders or employees of any corporation.
(k) To register securities ~n the name of nominee
or in such manner that title shall pass by delivery.
(1) To carryon any busineps owned or controlled
by me at my death for whatever period of time they shall
think proper, and they shall have the power to do any
and all things they deem necessary or appropriate
including the power to incorporate the business, the power
to borrow and to pledge assets as security therefore,
and the power to close out, liquidate, or sell the business
at such time and upon such terms as to them shall seem best.
IN WITNESS WHEREOF, I hereunto set my hand and seal to
this my Last Will and Testament, this
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day of
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WITNESSES:
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THIS INSTRUMENT, consisting of six (6) typewritten pages,
five (5) of which bear the signature of LULA B. ROBERTSON, the
above named Testatrix, was by her on the date hereof signed,
published and declared by her to be her Last Will and Testament,
in our presence, who at her request and in the presence of
each other, we believing her to be of sound and disposing mind
and memory, have hereunto subscribed our names as witnesses:
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RC C-34 (4-73)
COM.v,ONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF .COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENI
SCHEDULE "A"
REAL PROPERTY
*'
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent os tenant in common with another or other, should be identified
os to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth af Pennsylvania shauld be (1) (2) (3\
described by lot and block number, street and street number, together with D!;PARTMENT
a general description of the property, with 0 reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent toak title; If a form stat. number of a- FaR YEAR OF ESTIMA TED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are
to b. listed on Schedule "F" and must not be deducted from this schedule, DEATH In thIs spac..)
NONE
N.{)~
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.
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RCC.-35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
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CO~WONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
I NSTHUCTIONS: This Schedule must disclose all tangible and~iingible personal property owned individually
by the decedent, at the time of his death. Property owned by the. decedent jointly with another or others
must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in anyundistributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item
No.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARIrel' VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
524 Shares of Common stock of
Exxon Corporation at $47.875
25,086 9.5-"'"
180 shares of Common stock of
Houston Industries, Inc. at $30.50
5,490.00'
100 shares of Common stock of General
Motors Corp. at $65.125
6,512.50
126 shares of Common stock of Sunbeam Cor>.
at $21. 50
2,709.00
Miscellaneous personalty
150 00
-'
Insert this total opposite "Personal Property", Schedule "Bft in
the "As Reported" column on the last page of this return.
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rOMMO:\WEALTH OF PENNSYLVANIA
TRAXS~ER INHERITANCE TAX
SCHEDULE "c"
T R:\,'l S FE ItS
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RESIDEXT DECEDENT
.............
(1) Did decedent, wi thin two years ot' death, make any transfer '01' ~ny material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no)
(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)
(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)
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no)
(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)
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no)
(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 c0111d revert to decedent under terms
of transfer or by operation of' law? (Answer yes or no)
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)
KOTE1: 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 descript:l.on 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
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
Cash transferred on March 11, 1978,
from Savings Account No. 02480-4
with The Central National Bank, Richmond,
Virginia, in joint names of Mrs. Lu1a B.
obertson and Mrs. Frances Fetterolf
$11,504.76 ~ 1/2 ,~-
U
,...--.......
,/
5,752.38
Insert this total opposite "Transfers", Schedule "e" in the
"As Reported" column on the last page of this return.
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RCC-37 (12-63)
COl\l~ION\\"EAL TH OF PENNSYYLANIA
_TRANSFER INHERITANCE TAX
! RESIDENT DECEDENT
SCHEDULE "0';-"
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED
(If step-children or DATE INTEREST OF
State tull names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY
ave an interest, vested, contingent or other are involved, set STATE YES IN ESTATE
wise, in estate) forth this fact.) OR NO BIRTH
FRANCES fetterolf daughter yes of age entire estate
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Deponent filrther says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
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SUMMARY
Real Property ............................... .......... ....... .... ..... ....... ( Sch. "A")
Personal Property............................................... ..............(Sch. "B")
Transfers ................................ ................ ..................... ............. (Sch. "C")
Gross Taxable Estate
( 1 )
(As Reported)
$....~.q.~
$ .}9.. ,..9..4.?~4.:5.
$.. ....5. #.7.5.2...38.
$.................... ...... ......
$................................
$ ..45,700.83 .
(2)
(As Determined)
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RC C-3B
CO'r\1\IONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
'.
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
wi th Ilnother 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 unner Schedule
"A", plus the date ann place of record of instrwnent effecting vesti ture, but rlo 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 de~e.ien t.
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
Unit
Value
percentage
Share
SEE SCHEDULE "C"
Estate
Valuation
DEPART~lliNT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
Insert this total opposite "Jointly Owned Property", Schedule "E" ~ ~
in the "As Reported" column on the last page of' this return.
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RCC-39 (5-68)'
COMMONWEAL TH OF PENNSYL VANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUMMARY
.~state of ROBERTSON, LULA
(Last Name) (First Name) (Initial)
B.
DAniuF DEATH 5/2/78
FILE NO.
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Cumberland
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".
Da ted:
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for Cumberland 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
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
VALUE AS REPORTED
$ -u-
39.948 145
5.752 38
-n-
45.700 83
23,594. 79
22,106 04
Valuation of life estates or
annuities. . . . . . . . . . . . . . . . . . . $
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ESTATE TAX ASSESSMENTS $
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
COMPUTA TION OF TAX
2%
6%
5%
10%
15%
.
$
$
$
$
$
TOTAL TAX
$
(.) 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
Add interest at rate of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED $
Estate tax paid $
BALANCE DUE
Add interest at rate of 6% from
to
$
t=
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$
TOTAL TAX BALANCE $
PAID $
FOR llSE 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.
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R E V-5 18 (8-78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
Frances Fetterolf
121 Third St.
Fe5t Fa.irvi~m, FA 17025
(Executor or Administrator)
In Re: Estate of
Lula B. Robertson
Cumberland
County - Fi Ie No.
?1-7R-OClQR
Dear
You are hereby notified that the Original
appraisement in the estate of Lula B. Robertson
has been filed in the office of the Register of Wills of Cumberland
County on t:]av 2 _, 19....1...9., Said appraisement reflects the following
vo I uoti OriS:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
Non~
39,948_45
5,752.38
None
$45.700.83
As to such tax that is paid within three months from date of death, 0 five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22,1965 to June 16,1971, inclusive;
and twelve months when decth occurred prior to December 22, 1965) from dote of death,
interest at the rote of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice os provided by Section 1001 of the Inheritance and
Estate Tox Act of 1961, 72 P. S. 2485-1001, P. L..'373.
Date
2 M.J.Y 1~7~
Signed
Title _
Arlrninis~~~~ivp Officer
Note: This is not a bill.
....
REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEM ENT
U':" i c. 5 /2 /7 9
COUNTY ("Im'h~", ..nn
FILENO. 21-78-0398
Whereas, Lu1a B. Robertson late of West Fairview
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the ? n t'I day of M ::lY 19 ..1.] , seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Lpn F'n 1 ~i n ; ti , 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 UNIT Appraisement
VALUES Made for Inheritance
Tax Purposes
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Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity
with the law on this ?nn day of M::lX, .., .- 19 ~.
Appraiser
(Number and Street)
Ha1"1"i~hu1"g
(Post Office)
, Penna.
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