Loading...
HomeMy WebLinkAbout01-29-79 -, COMMONWEAL TH OF PENNSYLVANIA \ \ DEPARTMENT OF REVENUE oJ; BUREAU OF COUNTY COLLECTIONS c2/-1f-~~rlf RCC-S3 (4-73~.' RESIDENT DECEDENT COUNTY OF CUMBERLAND IMPORT ANT: This return must be completed 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 } AFFIDAVIT OF EXECUTOR ADMINISTRA TOR County IN THE MATTER OF THE EST A TE OF JAMES RICHARD BEVAN (STATE FULL NAME OF DECEDENTI Pennsylvania State of )" County of Cumberland KATHLEEN ANN OWENS ~~x~\X Administrator of the estate of the above-named decedent being duly sworn, depos.s and say S (MONTH) Name and address of attorney or } other authorized repres,entotive to whom all correspondence should be mailed. KATHLEEN ANN OWENS That as such deponent is familiar with the affairs of said estate and the property constituting ~M.MK~ADMINISTRATORI 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: - None (DAY) , 19~{~XK~~~HH~K~~~~~H~HH~~HX} (YEAR) Intestate Decedent died July 14th Philip J. Wydro 1348 Greenland Drive, Atlanta, Georgia 30306 NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX 1 N N AM E 0 R N AM ES 0 F HOLDERS TO DECEDENT Not Applicable That the contents of said safe deposit box or boxes are itemized under Schedulesn/a with 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 col umnS provided therefore the as se s sed 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 ins titutions, 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 to decedent's death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de- cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States, or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death; 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 interes t thereon to the date of decedent's death and other investment secuuics owned by the decedent at the time of death, with the market value there- of at such time. In the case of securities of close or family corporations, the values report.ed are as far as possible subst.itntiated by financial st.atements of t.he corporations, showing the assets and Uhbili t.ies thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of death in any co-partnership or business, and in support of the value of such interest t'.1.ere is annexed t.o said schedule, financial st.atement.s showing; the assets and liabilities of said co-partnership or tmsiness. A copy of the co-part.nership agreement, (if oral, a statement setting forth the nature of the ag;reement) together with a statement setting forth the character of the business, its location, and such other facts pertaining to the business as may be pertinent to a fair and just appraisal of the dec.~dent' s interest therein mllst be submitted. It should also set forth in itemized form, together with the fair market value thereof, any other propert.y 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 eff'ect in possession or enjoyment at or after death, said schedule sets forth the nature and value of' such property, to whom transferred, the relationship of the transferees to the decedent, the proportionate share received by each transferee and all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to take effect in possession or enjoyment at or after death, there is also attached to the schedule a copy of the deed, trust agreement or other instrument creating the trust. Ther'~ is also set forth in said schedule a list of all property, real and personal, with its value, which passes at decedent's death by virtue of' the exercise by decedent, either individually, or jointly with another, or any power of appoint- ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of' another, with a copy of the instnooent creating such power attached to the sche~~e. That Schedule D attached hereto and made part hereof sets forth the nlimes awl addresses of all persons beneficially interested 1.n 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 Ufe under decedent's Wil}' 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 wi th another or others, including intangible, standing in the name of the decedent ami others, plus the date and place of record of instruments effecting the vesti 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 forth fully and in detail all debts and deductions claimed for and on behal l' of this decedent's estate, including f'uneral expo:mses paid; family exemption, where applicable; costs of administration of this estate; counsel fees and hldiciary's commissions paid or LO 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 ann llnpa ir1 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 pledger! 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", "en, "E", and "F" as directed therein, have been carried forward and properly registered in the Summary. Subscribed and sworn to before me this .a1..:?4Uf?...... .............. ... .... .... day OfJ/i41~ 4;rfJd6uz~ ....... 19.2.7:.. ..'-~~~~:lfe~~_ ..........SCrs~~~;;'(~._- <2~~~-~;a~ :'-,.:! NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are filled in with details or the word "None", and in case the assets include rare and unlisted securities, securities of close or family corporations or an interest in any co-partnership or business, that the data Ilnd statements required under the paragraph above relating to Schedule "B" are attached. Also make certain that column #1 in the "Summary" has been properly completed as above-directed. RC C-34 (4-' 3) . COMMONWEALTH OF PENNSYLVANIA .DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFE'R INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "Au REAL PROPERTY * Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece- dent. Property held by the decedent as tenant in common with another or other, should be identified as 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 locatad In the Commonwealth of Pennsylvania should be described by lot and block number, streat and street numbar, together wi th a general description of the property, with a reference to the record of the conveyance by whl ch the decedent took title; If a farm state number of a. cres; also statement of mortgage ancumbrances upon each parcel at death of decadent. Taxes, assessments, accrued Interest on mortgages, etc.,are to ba listed on Schedule "Fit and must not be deducted from this schedule. (1) (2) (3) DEPARTMENT VALUATION CAUTION (Do not write In this space) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH ESTIMATED MARKET VALUE )\2:JI. t:lat certain tract of land vJibl the i: '~)roverGnts thereon erected , situate in :-:outh:'iddlcton r.::'o~vnshi;:1, CUJ:Y'herland County, ~ennsylv?nia, bounded an~ JGscri~ed a3 follows .,,1{11IO, V ?32 ~ 500. OOf -3:~,]I.:.'TI~ or; d,t a paint on tj:le ---restern lirlc or: ~.I:. 21008, on the (Jividinq line be-- bleen IJot.Jos. 3 and 4 on t:w herein a~ter ':lf~ntione(l -r:lan of 'Lots: thence by silid dividinc- line, fouth 5F; r1e0rees 58 ~inutes 30 seconds, west 160 feet to a point; thence by lan~ of the Grantor, ~ort:'1 31 der'"rees 1 L\inute 30 seconds 'est 100 feet to a ;,oint ~ thence by t:le c:i vicUnl! line betiveen 'Lot :;08 2 and 3 on said Plfm of Lots, lorth 58 degrees 58 T,'inutes 30 seconds Eo.st 160 feet to a point on the '~stern line of L.R. 21008, South 31 deorees 1 minute 30 seconds rast 100 feet to the nlRce o~ heqinnin~. c'~ 8},rrr Got ';0. 3 of ::-lan ~o _ 2 01- C:cction "']; of :?orce 'R.oad?''.cres, as recorded in the office of the ~ccorder of Deeds for Cu::c!JerlaYld -::::ounty in '')1a11 '.ook'io. 15, .['a('e ;) 3; and ~)eiI1C) subject to the hui1d." inn and use conditions and restrictions n~corded in the office 2f'ores;1id inr~isc. Gook 166, ia09 512. D'::LI'; i"lproved ~vi t:: a Lrich ranch type di'lcllinn house ':/i th atto3cheri carport am: bein'-r ;)ett2::::- };nc.-:m as 5G8 "';'orc;p :003(1 accordinc to the nresent syste~ 01- nUl~berin("~ l.cuses in ,::C1rli312, "'enna. '3f'LTf' the Sil;le property "Thic11 )D&'~ Cor~. bv its deed datec; :Tune 12, In~7, 21ne1 recorded June 12, l~) ( 7 f in C'_1-;-1ber1an(1 ~ounty Deer'! "ook 22 :',J" 508, r-ranteo and conveyed unto ;"t~rnar(l lJ. 211.:1 ,Tane L . ~ ~inkler-'an, Crantors to !:r. and !'rs. Bevan 10he T\evan' s 7)eed beinG recorden in DeeJ Dook I 24, Faqe 389 of eumberland County f)eec Records 32,S00,00 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. RGC -35 RESIflL;:I DECEDENT SCHEDULE "B" PERSONAL PROPERTY CO~WONWEALTH OF PENNSYLVANIA TRANB~~R INHERITANCE TAX INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually by the decedent, at the time o~ 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 o~ 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 ~act that they are not o~ the administered estate. Tangible personal property should be listed ~irst (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 MARKEr VALUE DEPARTMENT VALUATION (Do not write in this space) 1. Car1is12'~ui1:1in(-: &;.,OFln, ~2vinqs ~ccount ;u;~1.:ler :)553, 17 ' t,.. , ,es :1C,:1 ~~treet, C\r1is1 f.'ennsy1 vania 2 . Carlisle "-;uilc:in<' ~.. Loan, 17 ':'est ;Iiqh rtreet r~r11'c1"" - . ,~- , '", '=> C, L ennsy .L van1- C' , ~avin0s Certificate :;os. 06-1896 & (16-1263 \\\--i.\A~ C----.~- <----' -d ,--.-,.------> ~ \ ll.U .Lt(( 5. pi ve shares of I'ublicker Industries, Inc. conT'.on stock 31. 0 Dension fund 4. Fa.rners 'l'rust Company, 1 r'Test Fi<1'h Pt. , Carlisle, "enna. Checkin0 ~ccount '~'urber 4- 8091-6 3--t \ 8 ~L\, 3'1, Insert this total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page o~ this return. x X 3.09 . ~."..- ~ -{ ) '::L~ Y. ..... j _.J FARMERS TRUST COMPANY CARLISLE, PENNSYLVANIA Date Re: Estate of Date of Death Dear In answer to your request concerning accounts owned, either separately or jointly, by the above referenced decedent and the balance in each account .as of the date of death, we have checked our records and are submitting the following information in duplicate. We suggest that you file one of these letters attached to the Pennsylvania Inven- tory forms (RCC) to substantiate the balance you report. Note that we have shown the correct registration for each account. Also, interest accrued to the date of death, if any, is listed as a separate figure. Very truly yours, RC:C-jLJ ('tlMMI1\WEALTlf lW P~:\\SYL\-i\:-;Ii\ T!{A\SF:~'i\ I\lW!U'P\TF '1'.\.\ scmmULE "e" T 1{\ \' <-::[.1.] tS ~~ ~.-~ t ~ti;Ir ~ /j, ,~"~'41!'\ ,~~:",!>~:.t;.:;:2? i\l:'~S nW\T m:n:nj'\T (1) Dill elecedent, within two years ordeath, make any tl'/i1lsl."r of any material part of his estatP, without recpiving a valuable anel adequate consideration then~ror? (Answ'~r yes or no)_~_ . (2) Did rlecellent, within two years of rleath, transfer properLY from himself to himself and another or "thers (inclwiing a spouse) in .joint ownership? (Answer yes or no)_nO___ (:3) If thp answer to (1) or (2) above is.in the af'f'irm'-1Live state: (a) Age of rlecerlent at time of transfer nl a (b) State of deceelent's health at time of making the transfer. (Note 1). (c) Cause of decedent's death. (Note 1). (4) Did elecedent, in his lifetime, make any transfer of property without receiving a valuable or adequate consideration therefor which was to take effect in possession or enjoymert at or after his dpath? (Answer yes or no) no (a) lias there any jJossibility that the property transferred might return to transferer or his estate or be subject to his power of disposition? (Answer yes or no) no (b) What was the transferee's age at time of decedent's death? n/a (5) Did decelient in his lifetime make any transfer without receiving a valuable and adequate consideration therefor under whl ch transferor expressly or impl iedly reserves for his li fe or any period which does not in fact end l)e1'orp his death: (a) The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no) no (h) The right to designate the persons who shall possess cr enjoy the property transferred or income therefrom? (Answer yes or no) no (G) If the answer to (5) (b) a):Jove is in the affirmative, state whether the right was reserved in decedent a] one Qr others 11/ a _ (7) Did <lecedent in his lifetime make a transfer, the consideration for which was transferee's promise to pay income to or 1'0 I' the benet'i t of care of tl'ar,sferor? (lmswer yes or no) no (8) Did decpelent, at any time, transfer property, the beneficial enjoyment of which was subject to change, hecause of a reserved power to alter, amend, or revoke, or which cOllld revert to decedent under terms of transfer or by operation of law? (Answer yes or no)nO (9) If the answer to (8) above i3 in the affirmative, was the power to alter, amend, or revoke the inter- e.'it of the bepeficiary reserveel in the deceelent alone or the decedent and others? no (Answer yes or no) t-iOTE1: The answers to these questions shou] d be supporteel hy affidavit by the attefHli ng physician as well as a copy of' the death cert i fica te. ";OTE 2: If answer to any of the above questions is yes, set forth below a description of the property transferred, it's fall' market value at elate of death, dates of transfers and to ~'hom transferred, with relationshIp of transferees to decpdent, if any. Submit copy of any trust need or instrument, if trans- fers are claimed to be non-taxable, also submit eletail en. st.atement of' facts on which said claim Is based. 'iOTE :3: List applicable property below In manner in which provieled in Schedules A, n, or E. ITEM lJESCRIPTION MARKET VALUE (Es t ima teel) DEPT. VALUATWN (Dept. Only) 'Jot :\p:-)lic<1ble N~ Insert this totrd opposite "Transfers", Schedulp "CO in the "As Reported" co]urrm on the last page of this return. RCC-'J? (12-63) 'Cm!:\!()\:\n:.\(;r!r OF rE~~;,\SYYL\NIA TRANSr""El, INHERITA::'\CE TAX RESIDENT DECEDENT SCHEDULE "D" r"", ~'~,'~,~, f\~~)\_~;, /j: <,Wi~j;i~. !,'\ < .':5,;,':., <t~<, ,-~',>:~;-:~ BEi',EFI C;IA HIES BENEFICIARIES AND ADDRESSES (Jr~~~~1~~~~~Por I S{;;;~~;;;-j----~-i\~;'F 1,-------- INTEREST OF \Stat e fuII na.mes, and addres~, es of all who ilIp'git,imaic ChIn, cen I ~~'P>E,N'~ i (,Hi' " , BENEYJCJ1\I~Y have an interest, vested, contingent or other-I are ,nvolved, set ST(;riEN~E~ i BIRTH i IN F_ST.\.1f, wif:e, in ests.te) t----for~~~hls fac~_. __-+_____._+_____. _____ r:-L~:::"~~:; !\~;i .j.~:~I<~ I dauqhter i res ~19/55 i One..='!'hirrl (1L3.L_ ~:~1~~~:~ ~':~:a. 17013 ~_I 'n L".1 CU~;\.1 T'5}V1\'r ,3auchter I "es I 6/8/5J I -i=-~- 1 yes -+ 8/8/56 "ne - '7"'.i rr'! (1/3) 1348 Green1anJ Drive T.t1anta, ~;a. 303,)6 I I- I son (1/3 ) 503 }'orce Eo? :] ':a.rlisle, T'(!lln'1. 17013 I +- I I ~ I I I I DnC' -'::'hi ri'l I.Jl\LU.. ':~ !"()E L pT :..;,::IJ:' -I ~ I I I ~ I i I I ! " ~ (<~ tJ" i I ~ -n- i= I >C1 I , :~-~ ~ h ..-'.; m 0 I~~ h. H h ~l + '," u ~ --. ~ :.~ I ~" I +-- =3--== t 1- J I I -l L-- ~ , . I'"~.. X >:~ Deponent. further says that all the above-named beneficiaries are living at this time exce-pt below: NAME DATE OF DEATH RESIDENCE 'lOt \.nDlicable ..I... '" I (21 (As Df'tI'rllliJwc!) 2 SUM~IAHY (Seh. "A") ( Seh. "B") (Seh. "e") ::-: ..~- Heal Property Personal Property Transfers .~;~ E 'E- ~..:: - 0 "0 =- <.J ~ '= . ,~ u ~ -..... ..... :::s :r. l-l <.J ;:J 0 ~ E fr l::. ~ Gross Taxable Estate ( 1 ) (As Hl'ported) $'2,500.00 $ 34,~:83. 09 $ (J $ $ $ .:, 7,3i) 3.09 $ $ $ $ $ $ '" "C Z Q) .... ~ rn <:':l ~~ ..l Q; ~ .( >-< ~ :>Q) (I'J (/J j:ijo - ...... .( -< f!l oj =: 0::; ~ 'd s::: =.. 0.. 0 0 ,::: oj =.. 0.. ~ ('(j > .( w < w :I: :I: ~ ~. Q) r-I >. '" '"' ~ .... E-< ::c: r-I l-l ~ ~ - ~ ..,. IJ.. -< U Ul Q) ~ Z C ...... c E-< H .,-i ~ i! 4l'. % t-< (/J ~ r-I i:l. ~ ~ l-l ::l ...... /- ~ c 0 [J) ('(j U ~ =: s::: 0::; ~ U ..... 0 c ~ Q.. :c ~ ...: ~ t-< IJ ...... > Q:: 0 ~ E-< !:: "@ -< ...... >. ;:: c ..... .:: ~.2 ,/. Q; s::: ~ ~ ..... C <:':l ~-< .....l U U RC C;;38. 'COMMONWEALTH 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 another or others, including intangibles, standing in the name of' the decedent and others. List real estate first. as entireties, or joint tenants, giving brief description, as indicated Imder Schedule "A", I'll,s the date and place of' record of instrument effecting vestiture, but do not include entireties or out of state real estate value in estate valuation column. Personal property should be listed as in Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of' co-owners to the decedent. Description of Property, Date of Acquisition, Name Address and Relationship of Co-Owners, and Place of Record of Instrument, where Real Estate. Unit Value pe reen tage Share Estate Valuation :;(): ;!" Insert this total opposite ".Jointly Owned Property", Schedule "En in the n As Rejlorted" colullm on the last page of this return. DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of' Value of' Entire Decedent's Property Interest ~\ll~ R E V-5 \8 (8-78) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIOHS P,O. BOX 2970 HARRISBURG 17105 IN YOUR REPLY Pl.EA5E REFER TO Inheritance Tax Division HOTICE OF FILiNG OF APPRAISEMENT Kathleen A. Owens 508 Forge Rd. CaplislQ, P.II, (Executor or Administrator) In Re: Estate of .Jawes R. Be"an Cumberland County - Fi Ie No. ?1-7R-()~q4 Dear You are hereby notified that the Original appraisement in the estate of James R. Bevan has been filed in the office of the Register of Wills of Cumberland County on 9 April , 19li, Said appraisement reflects the following valuations: Real Estate Personal Property Transfers Jointly Owned Total 32~500.00 34.834.33 None None $67,331J.33 As to such tax that is paid within three months from date of death, a five (5%) percent discount is allowable. As to any tax that remains unpaid after nine (9) months (fifteen months when death occurred from December 22,1965 to June 16,1971, inclusive; and 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 days after receipt of said notice as provided by Section 1001 of the Inheritance and Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373. Dote CJ Ap'Y'i 1 1 CJ 7q Signed Title _ Administrative Officer L Note: This is not a bi II. . REV-457 (8-78) DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P.O. BOX 2970 HARRISBURG, PENNA. 17105 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE q April 1979 Cumberland 21-78-0394 COUNTY FILE rw. Whereas, .T~m"'~ R 'RPV;!Tl late of Carlisle in the County of Cumberland Commonwealth of Pennsylvania, having died on the 14th day of July 19 2!., seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, T <> r> '1'"'" 1 g; n ; +; , 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 $ ~ . ~ ~ :l? snn nn p~~~~~~, 'D ~~-4-" ~LL ~~ll ~~ . 'l''Y'~n~-F<>'Y'''' None T ~ ~ ~ -4- ,.. (\ ..:l ~T TnT;!l 867 334 33 I Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with the law on this Q+n day of ,<: Ap1"'--il, . . {__' 19 .1JL. Appraiser (Number and Street) Hr:l'Y'J?ia:lnarg (Post Office) . Penna. rr. . 1:-: ~ 0\ ""0 '" . ...... ::>.. I- m .~: ..... z 1\i 00: W t::: W Q) 1:-: ::> ::l () .-I: 0 :2: Q) co: Z Q OH: 0 W .-I: 0"1: H: W U) 0: > :;;: ~ .-I: P-" <1;: W a: .-I: c: c.. ::1: ~ c.. Z: 0"1: LL. < <1;: >J: Q)' 0 X >: 0 .. '0 .:t: () I- '~. < r..:<: '0 .-I: > ~ ~. Z I- in: <<S' Q) Q) ..... 0 Q)' W w ..... ..... Q) ~n u ~ . : l'Cl ~ ,U} ::l ~ Z U} P::;: .....:j g So., ""0 I- ~: < k:l <IJ: Q) >: c: j I- Q ..... l'Cl ~: UJ: .-I: U} ..... <( C\:, a: r..:<: 00: ...c: ..... 's, ...... 0.. ...:f w ~: oH: ..... ~ LD: Q) 0 W t:' p::;; ::t <1;: .-I: l'Cl ~ ~: 0::; ..... Cl Q) / ~ Z >J: H: Q .-I: .S t::: >n: f1j: U} ::l -- I- ...... 'ra ""0 0 ...- CJ: 0 '!Y ""-': z 5. ~ Q) ~ :::>: w Q) -. u: c ..... n. ~ k: en q ~ w a: ""0' ~ 'Q) () Q) 0::; ....;- .....' t::: t::: Q) ""0' Q) ~ ~ ~ ""0 U} ~ ~ U} 'ra 'ra 5- io n. 5- n. i3 ~ n. ~ ""0 ~ S ""0 ..... t::: t::: ::l 0 l'Cl l'Cl 0 c.t:1 ""0 ""0 ,.Q ~ Q) l'Cl ".... t::: l'Cl Q) '6 Q) Q) ..... ..... a.. ~ 0 a.. l'Cl ~ ~ ~ Form ~C ~ .10 DEDUCTIONS ALLOWED IN ~ -:A (- I J'~7'Y STATEMENT OF DEBTS AND DEDUCTIONS :), (, , .; ?c.:; THE SUM OF """""" $__9'f!Q;:fi~_Y: -----f~/9d1-? .. ~FICE OF TME RE'GISTER OF WILLS OF Cumber land COUNTY AND AGENT OF THE COMMONW&ALTH ESTATE OF JAMES RICHARD BEVAN LATE OF -5: o,r-/; ./'OJ'':''di ~ 'fe/I/ 71-.,,:- cumberlan County, enna. n J('iJ n 9 IflJ'?9 July 14, 1978 DATE OF FILING APPRAISEMENT , ". DATE OF DEATH \ , DATI!' NO. OF NAME OF PAYEE REMARKS AMOUNT VOUCH"" 508 Forge 200 00 7-29 78 1 Carlisle Buildinq & Loan Mortqaae pavment-Road 7 29 78 2 United Telephone Co. phone bill 508 ~ 'Rn 32 08 7-29 78 3 T.V. Cable of Carlisle Cable System 7 89 8-9 78 4 Bettv Williams ~ ., " 'T'rlY ":laa An --. 8-14 78 5 UGI Corporation Gas Bill 20 75 8-31 78 6 E~..ling Bros. Funeral Home Funeral Expenses 1267 00 8-31 78 7 united Telephone Co. phone bill-508 Forqe Rd. 43 22 ~~~~~ xxxx xxxx xxxxx 9-29 78 8 C.C.N. Bank check drawn on account 20 00 11-10 78 9 Dr. Rodney K. Hough Doctor Bill 469 20 7-6 78 10 Belvedere Medical Center Expense of last illness 55 00 78 11 Harris Associates X-Rav Interpretation 13 00 78 12 Carlisle Hospital Expense of last illne!';!'; "17 r:;o 1-9 79 13 Philip J. Wydro Attorney Fees 3000 00 1 .q 79 14 Kathleen Ann Owens Administrator'!=: '!<'pp ~c;oo 00 I - COMMONWEALTH OF PENNSYLVANIA }ss: COUNTY OF CUHBERLAND I. KATHLEEN fu~N OWENS HEREBY CERTIFY. THAT. TO THE BEaT OF MY KNOWLe:OGE AND BELIEF. THe: FOREGOING IS A JUST AND TRU I! STATEMENT OF DEBTS. FUNERAL EXPENSES AND EXPENlID OF ADMINISTRATION SUBMITTED TO THE ESTATE OF JAMES RICHARD BEVAN DECu.saD. AS DEDUCTIONS f"OR 'N",."ANOHAnUR~" ,7/1 ,~#kA"..J~) a~~ 'L.'.' ND SUBSCRIBED !!lEFORE ME THIS ~o/r?UfL DAY ~~EN AN. ENS ?E-~ Notary PUbl,c, !,3"'sle My Cornmls<../ ~n c ( . 1;0. !""