HomeMy WebLinkAbout09-11-78
"
I. /... 7%'-CJ 3 Z '-I
R C C-33 (4-7'3)
.
COMMONWEALTH OF PENNSYL V ANIAS E P 11
DEP AR TMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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'lenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE EST A TE OF
Carrie May Anderman
(STATE FULL NAME OF DECEDENT)
Late of Cumberland
State of Pennsylvania
} AFFIDAVIT OF
EXECUTOR
County ADMINISTRATOR
County of
} ",
Administrator
Robert D. O'Hara
Executor
of th.. estate of the above-named decedent being duly sworn, depose
and say
Decedent died June
(MONTH)
Name and address of attorn,.y or }
other authorized representative to whom
all correspondence should be mailed.
12
, 19---1!L{:estate leaving a last will, copy of which is hereto attached. }
(YEAR) Intestate
(DAY)
Maurice E. Shaffer
223 N. Front St. P. O. Box 1188, Harrisburg, PA
17108
,-
That as such Executor deponent is familiar with the affairs or'~aid estate and the property constituting
( EXECUTOR-ADMINISTRATOR)
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 B6x RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT ~~ENTED.A SAFj': DEPO~IT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
cumoerlana I . J.'la. Dd.'un. N. A. Carrie M. Anderman None
p.u. l:SOX 55, Lemoyne, ---p]t-17043
7
That the contents of said safe deposit box or boxes are itemized under Schedules
with the exception of the following, for the reasons hereinafter set forth:
B 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 companic~s, or other institutions, whether individually, or in trust for any other person or persons
gi ving also separately the accrued interes t thereon, if any, down to the las t interes t 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 lo the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United State3,
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, carria;ses,
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 notds 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 secur;"j~s 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 reported are as far as
possible substant.iated by financial 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 a" the time of
death in any co-partnership or business, and in support of the value of such interest tl-Jerp is annexed to
said schedule, f'1nancial statements showing the assets lind liabilities of said co-partnership or lJusiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of tne agreement)
toget.her 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 decedent's interest
therein must be submi tted. It. should also SGt forth in itemized form, together with 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 Lake effect 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 Ii 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 COllY
of the deed, trust agreement or other instrument creating the trust. There is also set forth in said
schedule a list of all property, real and personal, with its value, which passes at decedellt.'s death by
virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested ill decedent, either individually or jointly, by the will, deed, or other instrUJT\ent of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof sets forth the names and addresses of all
persons benefic till ly 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 al 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 d,"cedent, 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 ann others, plus the date and place of record of instrUJT\ents 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 f of this decedent's estate, including funeral 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 plerlged. 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 WHIs, 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 direeted therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this
G, -it.
..............................~.. . day of Septemher..n
':f'r, 9 /) "
.......6L~~. >C.n.7Qg'L"
I !~.:i-';J\' .1, ,",;':U.. ',1:,")1::(\' piJbliC
(~ t ~tJ ~//j
\~"h~~+...~~..~~~...................
(Executor-A BIIl,ini_lItor )
130 Hummel Avenue
.........................................................................n........... ................................
(Street Number)
. II: ,f. : .'.:. :., "." c ...~~.~.c:>.Y?~.~......1.C~.......~?.?~.~...........
t/iy ::c;r'~mi~"i~.J =";Jir~~ March 9,1981 (City or Town and State)
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 and stlltements requi red under the paragraph above relating to Schedule "B" are attached. Also make
certain that colUJT\n #1 in the "Summary" has been properly completed as above-directed.
..........19..1.8....
~
RC C-34,(4-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLI_ECTlONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
*
Real property in Pe'nnsylvania, 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 in1~erest 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 I'he Commonwealth of Pennsylvania should be (1 ) (2) (3)
described by lot and block number, street and Itreet number, together with DEPARTMENT
a general descrIption of the property, wIth a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decl.dent took title; If a form state number of a. FOR YEAR OF ESTIMATED CAUTION
cres; also statement of mortgl~ge encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not wrIte
of decedent. Taxes, aSSeSSITlents, accrued Interest on mortgages, etc., are DEATH In this space)
to be listed on Schedule "F" and must not be deducted from this schedule.
NONE
,/"7-/1
! ./~
...
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.
RCC -35
IlESHJf;:;;'J. DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSfi'ER INHERITANCE TAX
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 wi th 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 ~lrnishings, 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
es tate 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)
PERSOW\L PROPLR~'Y
Clothes Drver Hack, $.50; clothes }}as}:et
$.50; \1hite enaMel chaMber pail, $.50;
1 box plastic curtains, $.25; 2 snack
trays, $1; foldin9 alur,linun lav.7l1 chair,
$1; ~Jra:' 1,.'001 blanket, $2; 1 lot cur-
tains, $2; green Chenille hedspread, $2;
table lann, $2.50; uhite chenille 1"1ed-
spread, $2; snaIl rug, $2; 2 suitcases
(old), at 0.50 ea., $1; 2 baskets, $1 ea.
$2; 2 netal laun chairs at $2.50 ea.,
$5; roll-a-uay l,ed & nattress, $5; bed
trav, $.50; '100den kitchen chair, $3;
vanltv stool, $2; chiffarobe, $5;
sciss(;rs, $.50; 1 lot bath tm.rels, $2;
ruCJ, $5; nink hedspread, $1; 2 blankets
at $2.50 ea., ~5; electric ChristMas
tree, ~?l; desk lanp, $1; bedspreac., ~;3;
cedar closet, $25; 2 scrub buckets,
$.50; G.L. electric fan, $1; closet rod,
$.50; snaIl rug, $.50; 1 lot hrick-a-
brae $2; 1 carton odd glasses, $1; 1
carton odd dishes, $2; tier tahle, $5;
netal porch chair, $2.50, glass-top
coffee table, $10; overstuffed arrchair,
~';3; B&'1 portable r.;V, r~aqnavox, G5;
boudoir chair, $2; sno]{ing stand, $2;
pie crust tClble, $10; table lanp, ~,~5;
glass vase, $5; pottery vase, $1; ruS,
$5; 3 throw rugs, $1; desk lanp, Marble
bil~;e, ~; 5; end table, :,;2.50; snaIl ~lOod-
em cupboard, $2; netal utilit:, calJinet,
~5; 2 plastic buckets, ;;.50; bath
scales, $2; snaIl wooden b~nch, $1;
dresser vith 11irror, $10; mill: Glass
lanp, $2.50 lIollyuood hed ujmattress,
~~:5; \lOoden chair, $ 3; vanity bench,
$2.50; snaIl stand, $2.50; step stool,
$1; Kelvinator refrigerator (sMall),
$30; Eel\. table radio, s2; chrome dinettE
set, $20; 1 lot pots & pans, $5;
Dor:unlon broiler oven, $2; 1 lot dishes,
$2; qlass berrv dish, $2.50; chrome
hupi~lor, $1; vlne~Jar crui t, $1, ruby [,
cr"stal dish & candlesticJ:s, $ 5; Hall
niJ:..ror, $5; table'linens & doilies, $2;
towels & Hash cloths, $2.
r.::'0tal $281. 25
281.25Vjf/';t )"
Ins er t this to tal opposi te "Personal Proper ty", Schedul e "B" in
the "As Reported" column on the last page of this return.
x X
RCC"-3S'
RESIDENT DECEDENT
SCHEDULE liB"
PERSONAL PROPERTY
COMMONWEALTH OF JPENNSYLVANIA
TRANSFER 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 ~rnishings, books, paintings, automobiles, boats, etc.)
Intangibll~ personal property, such as bonds, treasury certi~icates, 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 any undistributed
estate o~ or income ~rom any property held in trust under the will or agreement o~ another, even though
located outside o~ the State, at the time o~ death, should be listed in this schedule.
Item
No.
ITEM
List and describe ~lly
. UNIT
VALUE
ESTIMATED
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
Bl';W: CER~IrICl\T~;
4'
;Tunber 34~)6q, Cllnberland
County LJa1:ional Bank,
Certifica1:e of Deposit
dated l\.pril 4, 1972,
principal anount of
$2,000.00, plus accrued
interest to June 12, 1978,
date of death, of 819.16
':.:'otal value
I~/
IJUI.lber 13~)38, Cunberland
Coun ty IJa t:ional nanJ~,
Incone Certificate, dated
July 9, 1976, Principal
anount of $20,aOO.OO,plus
accrued interest to June
12, 1978, date of death,
of ~16.66 /Total value
.".""
IJurJ)er 1;1495, Dauphin
Deposi t Ban]~ and ':::'rust
Conpany, Certificate of
Deposit, dated June 13,
1977, in the principal
anount of 10,000.00, Dlus
accrued interest to June
12, 1978, date of death,
$180.83
2,019.16./
20,016.66\/
Total value
/'
,10,180.83~
32,216.65
'3:L.lJ./t,6.F
SAVIlJGS l\lm LOAlI ACCOUNTS
~~ional l\ccount Ilo.
V"~92, IIarris Savings and
Loan Association, plus
balance of $14,750.00
with accrued interest to
June 12, 1978, date of
death, of $347.70 Total value 15,097.70
l;ccount IJo. 001-00-06545,~
State Capital Savings, with
balance of ~14,600.00, plus
accrued interest to June 12,
1978, date of death, of
$346.83 Total value
~/
w/
14,9;16.83
30,044.53
30; {)tlf/"rJ
Insert this total opposite "Personal Property", Schedule "B" in X X
the "As Reported" column on the last page o~ this return.
::;.- - _'7.::
...- .....
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
~
f '-~~
I~\
('O\[\IO~WEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
I KSTHUCTIONS: This Schedule must disclose all tangible find intangible personal property oWlled individually
by the decedent, at the time of his death. Property owned by the decedent jointly wi th allotber or otbers
must be listed ullder Schedule "E". Intangible personal property, titled in tbe mune of the decedent, but
paYhble at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
tive trust ac('ounts, must be listed, despite the fact that they are not of the arlministered estate.
Tangible rersonal property should be listed first (e.g. jewelry, weltring al'parel, household
goods, lind fundsllings, hooks, paintings, aut.omobiles, hoats, etc.)
Illtang)ble personal property, such as bunds, treasury certificates, cash on hand Imd in bank,
stocks, mortgages, not.es, together with accrued interest or dividends, salltries or wages, insurance pay-
able to the estllte or fiduciary in sairl capacity, partnership interests, interest in Iinyundistributed
es tate of or i Tlcome from fiTlY property held in trust under the will or agreement of IHloU,er, eVe')} though
located outside of the St.ate, at the time of death, should be listed in this schedule.
I tern
l\ o.
ITEM
List and describe fully
UNIT
V ALliE
ESTIMATED
MAH.KET VALVE
DEPARTME1'."T \'AlXATI
(Do not write ir
this space)
u . S. Sl\,VII1GS BOlIDS
Series E DO~ 110. L
215077946E, Issued
Octoner, 1951, in
principal an.ount of
$50.00, plus accrued
interest to June 12,
1978, date of death,
of $60.18 ~btal value
110.18
110.18
110,/ t
REFUIJD
131 ue Rid~Je Haven
~fust, Inc. Total value
TOTAL Vl~LU:C
~~
.f/
/1" ,
lol,)~
'/~J,oO
127.00
loCo
..,.
"'.,
") .'
c 0
~ .{
Insert this total opposi te "Personal Property", Schedule "8" in
the "As Reported" column on the lust page of this return.
x X
=, ::----...
66,660.15 '.
lob )31 g ,q \)
-~_._--.~
610,) J;
RCC-V)
('UMMI1\N!::'AI:m IW l'E\'\TSYLL\.\TI A
TH.A\ ~FFi{ I \11":1\. LU'\CF TAX
SCHEDULE "e"
T H\\: <..: I'KI lS
~'})~"
....... ~
~ :~~~y t\
rJ- 'f:, ,\'-:~j>:".,_ I
t."~~,!'<.",)!
~""Y-{;.ii;ro;.<l'C"
ilESI1W\T IWCJ-:IW\T
( 1)
Did ~p~edpnt, within two years of'de.lth, make any transf'pl' of dny material part of' his estelte, without
reCPlV ~ng a valuable and adequl'l t.e l'onsirler<1tion therefor? (Answer yes or no) _No_
Did decedent., within two years of (leath, t.ransfer proper'Lv from himself' to tlimself' and another or
"thers (including a spouse) in joint ownership? (Answer ye~ or no)-.ND-___
If the answer to (1) or (2) above is in the affirmat.i.ve state:
(a) Age of decedent at time of transfer
(b) State of decedent's heal th at time of milking the transfer. (Note 1).
(C) Cause of decedent's deltth. (Note 1).
Did necedent, in hL; lifetime, make auy transfer of property without receiving a valuable or anequate
consideration therefor which was to take effect in possession or enjovment at or af'ter his death?
(Answer yes or no) No .
(a) lIas there any }lossibiU ty 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 transf'eree's age at time of' decenent' s death?
Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impltedly reserves f'or his lif'e or any period which does
not tn f'ltet end hef'ore his death:
(a) The possesston or er'joyment of' or the right to income f'rom the property transferren?
(Answer yes or no) No
(11) The right to designate the persons who shall possess cr enjoy the property transferred or
income theref'rom? (Answer yes or no) No
If' the answer to (5) (b) above is in the af'f'irmati.ve, state whether the right was reserven in decedent
(2)
UI)
(4)
(5)
(0)
alone ()r 0 tilers
(7) Dtd decerlent in I.is Itfetime make a transfer, the consideratton for which was transferee's promise to
pay income to or for the benen t of care of tl'aEsf'eror? (Answer yes or no) No
(8) Did necedent, at any ti.me, transf'er property, the benefi.cial enjoyment of which was subject to change,
because of ct reserved power to al ter, amend, or revoke, or whtch conld revert to decedent under terms
of' transf'er or by operati.on of law? (Answer yes or no) No
(9) If' the answ~,r to (fl) alJove i3 tn the af'firmati.ve, was the power to alter, amend, or revoke the inter-
est of the bepeficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)
r-;OTE1: The answers to these questtons shoul d be SUllPorted by aff'idavi I. by the attending phystcian as
well as a copy of' the death certif'i.cate.
I\OTE 2: If answer to any of the above questions is yes, set f'orth below a descrtption of the property
transferred, tt's f'air market value at nate of' death, dates of transfers and to ~'hom trrmsferred, with
relattonshtp of' transf'erees to decenent, tf' any. Submit copy of' any trust deen or instrument, if trans-
f'ers are claimed to be non-taxable, also submit detailen statement of' facts on whteh satn claim is bas en.
NOTE 3: List lipjlltcable property below in manner in whtch provir'led in Schedules A, B, or E.
ITE~l
DESCRIPTIOI\
MARKET VALUE
(Es tima ted)
DEPT. VALUAT~ON
(Dept. Only)
Insert thts total opposite "Transf'ers", Schedule "e" in the
"As Reported" colunm on the last page of' this return.
"RCc-Ji (12-6J)
CO:\I~IO~"'EALTl! OF I'E;"~:'\'SYYL\~L\
THANSFER INIIEHlTA1\TE TAX
RESIDENT DECEDENT
SCHEDULE "D"
~f~
~. ...
~."",'" i:Y
\!"~~,~.>) .~
lit'" ~'11"('~\
~..~~;~i::1.\ ,.tf':';;~(:;-,~,,!.JJ
BE:~EFICIAHIES
RELATIONSHIP i
(If step"children 0: i
i1Il'gitimate chlrlren I
arC' .nvolved, set
forth this fact.) !
I
None i
I
I
-.-.-.------,-----
I
DAT'R I
OF
BIRTH i
---t-
-------- I Spe~Jfic Bequest
of Clothing
INTEREST OF
EENEFICJAHY
IN EST\TE
BENEFICIARIES AND ADDRESSES
\State full names and addresses of all who
have an i!lter('~t, vested, contingent or ot!lpr-,
wise, in estate) I
"--'--- I
I
~;unVIVED
DECEDENT
STATE YES
OR NO
The S~lvation Army
1122 Green Street
Yes
I
I
Harrisburg, PA 17'105 I
I -------
Cerebral Palsey Cente.r None Yes I ________ Specific Bequest
,
15 South 30th Street I f-q.L!h 000.00
-- M___
Camp Hill, PA 17011
I-
i None
I
t I
-f- ----- --~ecifiC Bequest
I 1~$500.00
=i=
~
I
I Yes
~
_ Citizen's Fire Co~~
1 West Herman Avenue
Lemoyne, PA 1111i~ ----t-
- +--- -
Mrs. Louise Gorshin None Yes 11/13/08 i SDecific Bequest
102 48th Street ---+- I~ $3, 000. 00
Harrisburg, PA 17111 I
I !
Charles Raymond Shiner. Sr. None Yes 1/13/11 rpecific Bequest of
1430 fw?tara Stre~~ J- I $5 000 00' 1/2 share
,-
Harrisburg, PA 17104 L I Residuary Estate
I
I I
Betty E. Shiner None Yes 6/22/20 Specific Bequest
1430 Swatara Str_e~~ I I of $5, 000. 00
Harrisburg, PA 17104 I ---t---
Robert D. O'Hara None Yes 9/28/20 Specific Bequest of
I $5 1/2 share
130 Hummel Avenue 000 00:
Lemoyne, PA 1704:3 Residuarv Estate
I ! I
I I
I---~_+-
_J _~_____ I
Deponent further says that all the above-named beneficiaries are llving at this time except below:
--, ,
NAME DATE OF DEATH RESIDENCE
2
:~ ~ ~
~ - ~
.5"3.8
~ ; ~
~ t; ~
~ ;1..'
-;~t
'-' ::< 0
~ E ~
~ 0::
;;
SU~fMAHY
(Sch. "A")
(Sch. "B")
(Sch. "e")
( 1 )
(As H('port('d)
(2 )
(,\s J kkrrllilll.d \
$
$
$
$
$
$,
$
$
$
$
$
$
Heal Property
Personal Property
Transfers
Gross Taxable Estate
b "0
Z ,.,
.... W ell
o::l <':l ...l
Q) - ,.,
>-< """ '" <
~ <:.>
0 rI'J
(fJ -
..... <
~ o::l :&:
i:t:; ~ 'c =-
p.. 0 "" =-
p.. ;..
w --r: w <
:t :I: W ;...
'"" W i-< E-< Vl Q
~
~ ..... '" --r: ~ 'Z
C ..... c E-< c;
Z E-< (fJ i:-. ~
~ W ..... ~
~ 0 0 :&:
~. i:t:; ..... 0
i:o.
'Z W i: ~
o::l E-< ..... ;.. ~
.t: E-< c ,...
.::.: --r: ..... !::
~ c .c' E
~ ,/. Q) i: ~
,.. ~
..... ..... c
- 0
;;.. --r: ~ u
"
.RG:C"'J? (12-6J)
l'o:\ll\i()~\\'EAI:Tll OF f'E:'~:'\~YYL\;\JIA
TRANSFER INHEHITANl'E TAX
RESIDENT DECEDENT
SCHEDULE "I)"
~1~
~'~ JIA
r'..~.'hli'J I~Y
',;I~.."~';',; 0\:'
~ :','11,.(,1 ,-t
, J c'r ,: \;~'._,J}.Y., I ~ ~
1,,,,)1<;..~
".~ <~:.,"j\);:,,:~;_ ,~;,>) ~_cJ
BENEFICIAHIES
~12R n::!le Street
RELA TIONSH!P I~:T~~--~~ _,
(If step-children or I .:c~L"yI\E~ I DALE
ilIf'gitimate erijciren DEl;L~)~;~! I OF
are Involved, set STA f!<. r E;j I
forth this fact.) OR NO I HI RTH
Yes I 4/30/03
i
i
----.---....-------
BENEFICIARIES AND ADDRESSES
\State full names and addresses of all who
have an interest, vested, contingent or other~
-') I
WIse. In 2statp. j
Ida P Stetler I
I
INTEREST OF'
BENEFlCIAHY
rx EST \.TE
Niece-I!} _....Law I
S ecific Bequest
I $1, 000 00
=-1
~ Yes 6/25/12 I Specific Bequest
I j ~0.00__
I - -L
I Yes ==:J 4/24/09 J- Specific Bequest
San Diego, Calif.
B2104
Denton B. Burd
37 South 27th Street
Camp Hill. PA 17011
None
M
L'U'
L
d
I
I
1-
iN
rs. I Ie en erman I one
-
241.[\ H UrrlnH:~l A;v e:qu e I j $500 00
I
I
Lemoyne. PA 1704:3 i
-- t--------
ChurchviUe Cemetery Assoc. None Yes I Specific Beauest
-
(Oberlin Cemeter.J':-\ -1 I $1, 000 00
51 South Harrisbul:'Q: Street I I-
I -------
Oberlin, PA 17113
I --
~ ---..--.
i J
...~..__._.-
I
-- !
I I-
I I-
I I
L
I I
I -- --
~- -!- I
I
Deponent further says that all the above-named beneficiaries are living at this time except below:
-- ,
NAME DA TE OF DEATH RESIDENCE
...
]~]
.50.2
<;: @,
~~"C
'-- :l.'
-..... .....
;j :f; ~
c...; => 0
~ E 0.
~ ~
,- ~,
SUM~L\RY
(Sch. "A")
( Sch. "B")
(Sch. "C")
(1)
(As Heported)
( 2)
(As Df'lI'rmilll'd)
$
$
$
$
$
$
$
$
$
$
$
$
Heal Property
Personal Property
Transfers
Gross Taxable Estate
~ 'C
Z Q)
.... W ell
oj ell ..l
Il.i .... Q)
;>-< ,.,.. "" ~
W Q)
Ci rIl
(/) -
,..... ~
-< '" ell:
~ ~ "=
0... =-
0 - =-
0... .2:
~ ..-r: u.l ~
:x: ::c W ~.
,... ,... E- '" Q
W ~
~ ..,... 1.4 -< ~ Z
C ~ 0 E- ii
%; (/) 0... ~
\..I.. W .... ~
~ 0
0 ~ i:r:
~ r:::: ..... 0
c ::..
',c W ~ ;...;
co:: E- .... "' 0::
./:; E- o "'
.;': ..-r: .... ;.0. I
c .....
E ...., z 3
'-' - ,...
~ ..-r: .....l 0 U
"
R C ~-38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: Tllis schedule 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 tmder 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 "B", 11lus 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
Address and Relationship of Co-Owners, and Place
~",rnent, .he,. Real E,tnte.
unit
Value
percentage
Share
Estate
Valuation
DEPART~ffiNT VALUATION
CAUTION-Do not Write
In This Space.
Value of' Value of'
Entire Decedent's
Property Interest
NONE
~~
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
. .
-R C CoSO (!l-77f
County, Humber and Home
File Humber
Date of Death
File Date
Estate Home _l~,:n (k'rmM n
(L.AST NAME)
110. 21-78-324 Curl)erland
SUMMARY
.June .L2, .L~ l!j
rM rr; p
(FIRST NAME)
; t~"
(INITIAL)
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of
Pennsylvania, do respec1tfully 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:
ld_
I, f..J
I( ""I -(I --;-/ -.../
'.J i- ,- 0
r"J YVj',
t,... ',[.(( - J\, .,A/;, LI t. . L '-'-
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigne,d 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
-- -----
----.--
INVENTORY VALUE AS REPORTED VALUE AS APPRAISED CODE VALUE AS REAPPRAISED COD
Real Property (Schedule A) $ $ 004+- 00+
Personal Property (Schedule B) 66.660 15 10+ 10+
Jolnt.Held Property (Schedule E) 20+
Transfers (ScheduleC) 30+
TOTAL GROSS ASSETS 66.660 15
Less Debts and Deductions 9,387 69 40.
(SCHEDULE F)
AR VAL E OF ESTATE 57.272 46
E
CLE U
Valuation of life estates or
.:L-
PRINCIPLE
FACTOR
VALUE
CODE
!
annultles....................._ $
t=
ESTATE TAX ASSESSMENTS _ $
t=
FOR USE OF REGISTER O'NLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
CODE
COMPUTATION OF TAX
$
$
$
$
$
2%
6%
5%
10%
15%
*
TOTAL TAX
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretory of Revenue.
l=
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 month s after death
$
$
$
BALANCE OF INHERITANCE TAX DUE
Add interest at rote of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED
Estate tax paid
$
$
t:::
$
$
BALA~ICE DUE
$
$
TOT AL TAX BALANCE $
PAID $
Add interest at rote of 6% from
to
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. '
Eo-< ....l
Z '0 ~
UJ lU tZl
.... '" -
o;! :::E t':l ~
a) lU
~ UJ tJ Q:::
lU
tZl Q 0..
-
~ 0..
Q::: I':l ~
0.. ~ oa 0
0.. I':l
0 > Z
Ul ~ Ul - ~
::I:: ::I:: UJ >->
Eo< UJ Eo< E- 00 E-
o :c =
0 ~ ~ ~ = Q:::
Z E- O E- a) 0
~ tZl 0.. 0..
0 UJ '- UJ
~ 0 Q:::
Q::: ..c:
.8 UJ -'
-
-' E- o;!
o;! E- a)
.... '- ~
-' ~ 0
00 :::E '- =
"8 0 >-> ~
-'
::::"E~ a) =
-' :::s S
..... "0 o;! 0 0
~~ ....l U U
RCC-81 (6-73)
COMMONWEALTH OF PENNSYLVANIA
DEP ARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Robert D. O'Hara
130 Hummel Avenue
T.emoyne, Penn;:!
(Executor or Adm ini strator)
In Re: Estate of
r.;:trr;~ M. Anne~man
Cumberland
County - Fi Ie No.
21-78-0124
Dear
You are hereby noti fied that the Original
appraisl~ment in the estate of Carrie M. Anderman
has been filed in the office of the Register of Wills of Cumberland
County on 30 October ,19BL, Said appraisement reflects the following
valuatiolns:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
66.378.90
None
None
66,378.90
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. 3r~.
Date 30 October 78 Signed (--l\ ~_/ /( /~t:7-t. ~ .~~
Title
t /~---------------
Chief Appraiser
Note: This is not a bill.
R C C-2 (2-64)
DEPARTMENT OF REVENUE
BURfAU OF"COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
DATE \ 0 .-?, ()-"1 '8
COUNTY~~~
FILE NO. L- \ - I \3" ~ 03 'L~
Whereas, ~~ f'v'\ . ~...--..... late of '--~
in the County of -.C~~~ Commonwealth of Pennsylvania, having died on
the \ 'L.-{;:.1L. daYOf:::J ~ 1919 , seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, \ /). ~- GQ~ . 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 ~mnuities and life estates growing out of said estate, hereby file the following appraisement:
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
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 la,wful collateral rate on any such future interest.
Unit Appraisement
Description of A..et Value. Made for Inheritance
Tax 'Purposes
~-e.~.~ -J ...... $ N~[
\:~, '" ~ _JL.......
\=J /\....\\-..~ n--+-:- r
?~~ (p lo 3-1 b q 0
- \- -- 1-- .-
\~C> '--" --.J N <s>--lL
.) ,,~~ \ -k.Q-& \:~ I~O .J... N~>--t.
-....
" -~~
'T~ ~-b l.o io,31 '3 C(O
Having been duly sworn accortt to law, I do hereby cert'
formity with law on this \ L day of
that the above appraisement is made in con-
19~.
Appraiser
-\-ajV~, and Street)
! .~
" (Peat
, Penna.
~
?-, Eo< :::::::>
z Z
.- ~ ~
a :;;-
i....) ""
rJ1 00 ~
.... ..... c.:::
-< J -: ....
~ N ;: s::
~ '" '"
~ .-4 ~
,- J <0 ~ s:: "'::l'
... c:i '"
.g < "" ""
"::k 1 \0 < .. .., .., ...
~ ~ .... E- o -~ -;:j "'"
0:' ---. "0 Z ... ... l.. ~
..-4 I, < 0 '-' ~ <::>... <;>..
t II Eo< <:> ::::.. ~ ~ :::... ~ <;>.. ~
:'\" "" '-'
-, il "" 0 ~' == "<:: "<: "<::
8 " "" ~ ..... 1
I u -2 --1 '" .., ~ E- "'::l ~
~ ....
Z .., '-' ~ ~ s:: <::,
~ -< ~ Cl ~ t::l C5 a..
Eo< Q ..c ...... "'::l
....-. -~ "'l::I t::l ...
..... .... ..:::: c.... '" ts l..
r ~ "0 "'" ~ ~ "'l::I :::: ...
... ~- '" ';: '" ~ ;::
~ '" '" ~ Q '" c;
:= Q .. ... <;>.. ~
[">;( Z t;; ... "'.:t .~ ~ l.. "<::
.... .... ;; '-' ~
---. .., ~ '" I.tJ
Eo< 0 '0 ",' ~ C:::
Z "" ~ <::l> ~ "<::
"" ""- ~ i.i:
0 t:J "<:: c...
.... Q
Tn
...
~