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HomeMy WebLinkAbout10-12-78 RCC-33 (4-73) COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS nrT ~ " ,~' '.J. J RESIDENT DECEDENT COUNTY OF CUMBERLAND IMPORTANT: 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'ltenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) Cumberland } AFFIDAVIT OF EXECUTOR ~ IN THE MATTER OF THE ESTATE OF CLARA E HEWETT' (STATE FULL NAME OF DECEDENT) Late of County County of Pennsylvania Cumberland }" State of Administrator Edith S. Hollinger of the estate of the above.named decedent being duly sworn, deposeS Execu~rix and say S Decedent died Aor il (MONTH) Nome and address of attorney or } other authorized representative to whom 011 correspondence should be mailed. 21st , 19~J testate leaving a lost will, copy of which is hereto attoched. } (YEAR) Qa)6~ (DAY) ~nplh~kp~) M0r.~lph ~ F.li0kp~ 44 West Main Street,Mechanicsburg, Pennsylvania 17055 That as such Executrix deponent is familiar with the affairs of said estate and the property constituting ( EX ECU TO R-ADMIN I ST RA TO R) 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 SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT 'T'he r.nmmnnwP~lTh N~Tinn::> 1 lbnk Decedent and Main and Market Streets Edith Hollin2:er Dau2:hter Mechanicsburg, Pennsv 1 van ia 17055 That the contents of said safe deposit box or boxes are itemized under Schedules H 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 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, trust companies, or other institutions, whether individually, or in trust for any other person or persons giving also separately the accrued interes t 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 otherinstrunients 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; aJl 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 seem ,,:,'5 owned by the decedent at the time of death, with the market value there- of at such time. RC C-34 14-73) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDEl'oIT 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 as 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 liE.") The real property located In the Commonwealth of Pennsylvania should be (1) (2) (3\ described by lot and block number, street and street number, together with DEPARTMENT a general descrfptlon of the property, with a reference to the record of the ASSESSED VALUE VALUATION conveyance by whi ch the decedent took title; If a farm state number of a. FOR YEAR OF ESTIMA TED CAUTION cres; also statement of mortgage encumbrances upon each parcel at death of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DECEDENT'S MARKET VALUE (Do not write to be listed on Schedule "F" and must not be deducted from this schedule. DEA TH In th I. space) NONE 7 t.. f~0.. - NONE , . " _7 CCf~ Insert this total opposite "real prop€:. ," f Schedule" A" in the X X X X X "As Reported" column on the lost page of this return. P.CC -35 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX REsrDEir DECEDENT SCHEDULE "B" PERSONAL PROPERTY Item No. 1. 2 . 3 . 4-. 5 . 6. 7 . 8 . 9 . 10. INSTRUCTIONS: This Schedule must disclose all tangible and intangible 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 List and describe fully UNIT VALUE DEPARTMENT VALUATION (Do not write in this space) ESTIMATED MARKET VALUE v'/ Checking Account No. 14-2-4-62096-9, Commonweal h National Bank; Balance on the Date of Death $ 54-9.03 ,~9< ()] /, ' -SO ,- 71. tJ 0 '3 . ,/3 ;?- 3 Evergreen Savings Account No. 14--00104-93-9, ~/ Commonwealth National Bank; Balance on Date 0 Death Accrued inter st Statement Savings Account No. 14--0005032-2,~ Commonwealth National Bank, Balance on Date 0 Death Accrued inter st Return premium: Columbia Accident and Health Insurance Company 14-,809.76 4-6.93, < R- (9. 7 ,. / L// 0 '3 L/t:, 7 - 7,094-.23 20.tH 70 C; ,-/1 ?-- 3 / s;.-o" 1./1 C/ '-I, ;J) //;t./r of) 1& ~/, 94-.38 Income Tax Refund (1977): United States Treas ry 164-.00 Refund: Bell of Pennsylvania Final annuity check: Public School Employes Retirement System, Commonwealth of pennsylvan'a 4-4-9.4-3 /..; '-/9, 1/3 Net proceeds from public sale of household contents Household contents, appraised value Refund: UGI Corporation 11. Refund: Penna. Power & Light Company 12. 16.00J 6tJO / # Return premium: Hulse Insurance Associates Insert this total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page of this return. x X J )'-1;/1./1 Lj I ~24-,14-1.4-9 ' RCC-l' C'()M:\Hf'\Wl':I\T.II! lll' PE:\\'-;YL\.P{I,\ r{A\~FFi\ nm:!U-U\CF TAX Sf:fWDULE "e" Tit \S"FEW'; ~ ~<i'~.. ?^ ~ ~:",,;;, ~y~ TJ . ,.:~:(t!/~,,,... ~.. I .;- ,....._~! 'j - , :.."",/~:.S:.AA~~(;,'-:-;', ",~~,,;~~);.-,~''''~~'1i? l\:::S IDE',T ])!TFl1F\T (1) Did decedent, within two years oi'deatil, make any tl'imsf'~r' of Ilny nntertat part of llis estate, without receiving il valuable iwd adequate consirlerat.ion thecef'or? (t\nswec .'ies or no) __jI;j~._ (2) Did rleeedent, within two years of dr~ath, transr'er properLY from himself to himself and another 01' nthers (inclwiing a spouse) in joint ownership? (Answer yes or nol-1fO..._ un If the answer to (1) or (2) above is in the affirmative state: (al Age of decerlent at time of transfer ____ (h) State of decedent's health at time of making the transfer. (Note 1). (c) Cause of (!ecedent's death. (Note 1), (4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate consideraUon therefor which was to take effect in possession or enjoymef't at or "f'ter his death? (Answer yes or no) No (a) Was there any possibility t.hat the property transferred might return to transferer or his estate or be subject. to his power of disposition? (Answer yes or no) (b) Wbat was the transferee's age at time of decedent's death? (5) Did decedent in his lifetime make any transfer without receiving a valuable alllladequilte consideration therefor under which transferor expr<',ssly or impliedly reserves for his life or any I](>riod which does not in ract end bel'ore his death: (a) The possession or eT'joyment of or the right to income from the property transferred? Umswer yes or no) No (h) The right to designate the persons who shall possess er enjoy the property transferred or income therefrom? (Answer yes or no)~_ (fj) If the answer t.o (5) (b) above is in the affirmative, state whether the right was reserved in decedent alone or ot.hers '__.~__._. (7) Did decedent in his lifetime make a t.ransfer, the cons.i.deration f'or wbich was transferee's promise to pay income to or for the benefit of care of tl'ar:sferor? (Answer yes or no) No (8) Did decedent, at any ttme, transfer property, the beneficial enjoyment of which was subject to change, because of a reserved power to al tel', amend, or revoke, or which cOllld revert to dece<lent un(h,r terms of transfer or by operation of law? (Answer yes or no) No (9) If the answer to (8) above L5 in the affirmative, was the Jlower tr) alter, amend, or revoke the inter- est of the bepe:ficiary reserve,i in the riecedent alone or the decedent and others? (Answer yes or no) l'iOTE1: The answers to these questions should be supporteo by affidavit hy the attending physician as well as a copy of' the death certificllte. \OTE 2: If answer to any of the above qllc~stions is yes, s,~t forth below a descT'iption of the property transferred, it's fair market value at date of death, dates of transfers awl to ~'hom transferrer!, with relationship of transferees to decedent, if' any. Submit copy of any trust deed or instrument, if' trans- fers aI"" claimed to be non-taxable, also suhmit detail ed stcltement of f'acts on which said claim is based. -'lOTE:J: List ap/llicable property below in manner in which provided in Schedules A, B, or E. ITEM UESCRIPTIOr-; MARKET VALVE (Es tlma ted) DEPT. VALVATeO!\' (Dept. Only) NONE NONE C-- -/( (I""-..~- .~"2- -<1-""" L Insert this totrd opposite "Transfers", Schedule "e" in the "As Reported" column on the last p'lge of this return. RCC-37 (12-63) COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "0" BENEFICIARIES \ h BENEFICIARIES AND ADDRESSES RELA TIONSHIP SURVIVED (If step-children or DATE INTEREST OF State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY aye an interest, vested, contingent or other are involved, set STATE YES IN ESTATE wise, in estate) forth this fact.) OR NO BIRTH Christine L He ilman Damrhter Yes One-half of residue 323 Fairview Ave Ambler. Pa. 19002 I Edith S. Hollinger Daughter Yes One-half of residue S2S P:=Jl"k 0P H::l"Y'"Y'; , P::l 17111 Deponent further says that all the above-named benericiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE R C (:-38 COMMONWEAL TH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEVENT SCHEDULE" E" JOINTLY OWNED PROPERTY INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the llecedent ,jointly with 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 indi.cated tmder Schedule "A", plus the date, and place of record of instnunent 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 unit percentage Estate Address and Relationship of Co-Owners, and Place Value Share Valuation of Record of Instrument, where Real Estate. United States Savings Bonds, Series TlEII, are registered as follows: 1. Mrs. Clara E. Hewett or Miss Ruth D. Royer (Sister) DJIDomination v $100.00 Issue Date Sept. 1960 Date of Deat 1 Value $167.08 One~half taxa)le 2. .c Mrs. Clara E. Hewett POD Miss · ~100.00 March 1975 $ .' 100.00 Nov. 1975 Ruth Roy~r 86.84- 82.4-0 $169.24- Fully taxable 3. /Mrs. Clara E. Hewett POD Shields (Granddaughter) $100.00 May 1975 100.00 March 1975 100.00 March 1975 100.00 March 1975 100.00 March 1975 100.00 Nov. 1975 100.00 May 1975 100.00 May 1975 100.00 April 1975 4-.. Clara E. Hewett or Mrs. $100.00 Jan. 1975 100.00 Jan. 1975 5.~Mrs. Clara E. Hewett POD Heilman (Daughter) $100.00 Nov. 1975 100.00 May 1975 100.00 May 1975 100.00 March 1975 100.00 March 1975 100.00 March 1975 100.00 March 1975 Mrs. Deborah $ 84-.56 86.84- 86.84- 86.84- 86.84- 82.4-0 84-.56 84-.56 86.84- $770.28 Fully taxable Deborah Shield~ $ 86.84- 86.84- $173.68 One-half taxa)le l' Mrs. Christ in > $ 82.4-0 84-.56 84-.56 86.84- 86.84- 86.84- 86.84- $598.88 Fully taxable Continued on Page 2 Insert this total opposite ",Jointly Owned Property", Schedule "E" in the" As Reported" colurrm on the last page of this return. ,'$ 83.54- 169.24- 770.28 C!~~.~~. 598.88 DEPART1fENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's property Interest I ! . J -'; !b~O~ *, .J / /. '~.!1.'. ,. , t L1 ~. : /" '~ I r:,Y'J L/ r J,...-, or-"' JA;, 0"-/ J / ,"," ...,.., 0 I . 110,;l.J / -J 'i. i I :;), C" y /''7/1. tJ ( xC; ....J ; ,/ /'1 '. ' ")- '7 6'~ ~ ,.- ,. R C C-38 COMMONWEAL TH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE" En JOINTLY OWNED PROPERTY INSTRUCTIONS: This sehectule 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 lmder Schedule "A", plus 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 "8", plus date of acquisi tion, and the name, address and relationship (if any) of co-owners to the decedent. Description of Property, Date of Acquisition, Name unit percentage Estate Address and Relationship of Co-Owners, and Place Value Share Valuation of Record of Instrument, where Real Estate. "v 6. Clara E. Hewett or Mrs. Christine Heilman (Daughter) V"Denomination $100.00 100.00 100.00 100.00 Date of Death Value $167 .48 ~ 163.60 v' .~. 164.00.V: -../ 86.84...... $58L 92 One-half taxablp S9/,q,t- $290.9Q) Issue Date Jan. 1961 April 1961 June 1961 Feb. 1975 ":.:;.:- 7.~lara E. Hewett POD (Daughter) $100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 Mrs. Edith Hollinger $ 86.84"/ 8 2 . 40 v 82.40 V 84.56 v" 84.~6 / 86.84('/ 86.84/, 86.84 . 86.84. $768.12 Fully taxable March 1975 April 1976 Nov. 1975 May 1975 May 1975 April 1975 March 1975 March 1975 March 1975 DEPART1ffiNT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's property Interest 5'1/, ,~~ 768 . 12 /'; '..S r ,/ 8. / Mrs Clara E. Hewett or (Daughter) $100.00 100.00 ! %~ ? V 86 .841// I, ~ I :, q Edith Hollinger $ 86.84 /' 86.84 .,// $173.68 One-half taxabl~ March 1975 Jan. 1975 9. Mrs. Clara E. Hewett or Miss Christine Louise Hewett (Daughter) $ 65.09 ,/ $ .25.00 June 1945 25.00 Aug. 1944 67 .24~: 25.00 Oct. 1947 61. 55 V' 25.00 Sept.1946 63.;5v' 25.00 Oct. 1948 58.86 V 25.00 March 1954 49.86 V- 100.00 Feb. 1954 205.44 I,..-- 100.00 March 1954 199.44 v: 100.00 Aug. 1953 208.92 ;r- 100.00 Aug. 1954 202;04 /' 100.00 Aug. 1954 202.04 v' 100.00 Jan. 1955 198.76 ....-- 100.00 June 1956 191. 96 ....- 100.00 March 1957 191.76 V- 100.00 Feb. 1956 192.36 V- 100.00 July 1960 172.72 V 100.00 Aug 1960 165.56 V 100.00 March 1960 172.40 V 100.00 Dec. 1959 176.00 ~ Continuen on P;HTe 3 Insert this total opposite "Jointly Owned Property", Schedule "E" in the "As Reported" column on the last page of this return. ~f/7L /7 b ~>, / '2 &'t;g if R C C-38 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY INSTRUCTIONS: This schpdule must disclose all property, real and personal, owned by the decedent ,jointly with 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 under Schedule "A", plus the date and place of record of instrument effecting vesti ture, 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 acquisi tion, and the name, address ami relationship (if any) of co-owners to the decedent. unit Value percentage Share Description of Property, Date of Acquisition, Name Address and Relationship of Co-Owners, and Place of Record of Instrument, where Real Estate. Pgge 3 2enomination v- $100.00 100.00 100.00 100.00 100.00 100.00 Issue Date Oct. 1959 March 1958 May 1958 Oct. 1964- Oct. 1964- Oct. 1964- >< Date of Death 'falue $175.60 V 185.64- v: 185.64- vi' 14-3.4-0 v' 14-3.4-0 I 14-3.4-0 I $3822.63 v One-half taxab e TOTAL Estate Valuation DEPART}JENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's Property Interest ~ (,t. J)'l :;)/ '" ( " , () /"'..... -"", ;i1. 911. 32 j ~~ f.?, . &3 ;i4-,766.02 ~ DEf" 13 Insert this total opposite "Jointly Owned Property", Schedule "E" in the" As Reported" column on the last page of this return. r'l ;:tJ't , / .. R E V-SI8 (8-78) COMMONWEAL TH 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 Edith S. Hellinger (Executor or Administrator) In Re: Estate of Clc:ra E. Hetvctt Cumberland County - Fi Ie No. 2.1-73-(:;'46 Dear Mrs. Hollinger: Yau are hereby notified that the original appraisement in the estate of Clara E. HetJett has been filee! in th~ office of the Register of Wi lis of Cumberland County on Decemoer 14 , 19 78, Said appraisement reflects the following valuations: Real Estate Personal Property Transfers Jointly Owned Total None $24,141.L;9 None 7,138.67 $31,280.16 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. Date December 14. 1978 Signed ~~_'1'"",?'---- /<', ~Vh~.~-- Title Chief Appr.::iser Note: This is not Q bi II. RCC.39 (8-77) County, Number and Name 21- Cumberld nd File Number 21- 7 8- 246 SUMMARY Date of Death Estate Name April 21, 1978 Hewett Clara E COMMONWEALTH OF P ENNSYL VANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT (LAST NAME) (FIRST NAME) (INITIAL) REPORT OF INHERIT ANCE 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". , \, Dated: December 14, 1978 >j... /1./( ___ J(. \;-11' 'f ~ 2~- INHERITANCE TAX APPRAISER -- REPORT Of THE REGISTER OF WILLS I, th,e undersigned duly elected Register of Wills in and for 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 ADJUSTMENTS INVENTORY VALUE AS APPRAISED CODE (HARRISBURG USE ONL YI REMAINDER APPRAISEMENT CODe Real Property (Schedule A) $ NONE 00+ Nonl 92+ Personal Property (Schedule B) 24 141 49 10+ 24 1i,1 49 Joint-Held Property (Schedule E) 4.766 02 20+ 7.138 67 Transfers (Schedule C) NONE 30+ Non( TOTAL GROSS ASSETS 28 907 Sl ~':l' ?Af'l lfJ less Debts and Deductions 40- 93- (SCHEDULE F) CLEAR VALUE OF ESTATE 1= VALUE CODE Valuation of life estates or ~ onriuities...................... $ PRINCIPLE FACTOR 1= ESTATE TAX ASSESSMENTS _ $ FOR USE OF REGISTER ONLY Tax on $ Tax on $ Tax on $ Tax on $ Tax on $ Exemptions Total Estate CODE COMPUTATION OF TAX $ $ $ $ $ 2% 6% 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 month s after death $ $ t= $ BALANCE OF INHERITANCE TAX DUE Add interest at rote of 6% from to AMOUNT OF ESTATE TAX ASSESSED Estate tax paid $ $ c $ $ BALANCE DUE Add interest at rate of 6% from to $ $ TOT AL T AX BALANCE $ PAID $ Supplemental Codes: (FOR USE IN HARRISBURG ONL Y) 48-Adj ustment 49+Adjustment 56-Annuity 6O-Life Estate 92+Remainder Appraisal 93-Remainder Deduction 93C-Charity 94-Remainder Residue 96-Success i ve Life Estate FOR USE 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. RC C-2 ('2-64) DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG, PENNA, 17127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE December 1 L" 1 C-''' ~..;/O COUI'Ii"TY Cumberlond FILE NO. 21-73-246 Whereas, in the County of late of Hcchanicsburg Cumberland Commonvrealth of Pennsylvania, having died on 21st \ '1 78 the day of l pn. 19_. seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, Ira K. Gleim . 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: Clara E. He't'lett 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. - Unit Appraisement Description of Anat Values Made for Inheritance Tax Purposes Real Estate None $ -c - - Pcr50n.:11 Pronertv $24,141.<',9 24,141 49 . Trc,nsf ers None -c- Joint Property $ 7,138.67 7,138 67 Total Estate $31,280.16 $31,:280 16 --- Having been duly sworn according to law, I do hereby c~rtify that the above appraisement is made in_Ron- formity with law on this 14th day of Decemoer ~ ~ V .."'~ 19~. (', </ '.) 1<.-1.. Appraiser (lfbmber and Street) Harrisburg (Pod Otfteel , Penna.